Bladder dysfunction in patients with cauda equina lesions

• Published in: Neurourology and urodynamics 2006-01, Vol.25 (1), p.23-31
• Main Authors: Podnar, Simon, Tršinar, Bojan, Vodušek, David B.
• Format: Article
• Language: English
• Subjects: Adult; cauda equina; clinical neurophysiology; conventional urodynamics; Electrodiagnosis; Electromyography; Female; Gastrointestinal Diseases - etiology; Gastrointestinal Diseases - physiopathology; Humans; Male; Neurologic Examination; neurourology; Polyradiculopathy - complications; Polyradiculopathy - diagnosis; Polyradiculopathy - physiopathology; Sexual Dysfunction, Physiological - etiology; Sexual Dysfunction, Physiological - physiopathology; Spinal Cord Compression - etiology; Spinal Cord Compression - physiopathology; Surveys and Questionnaires; Urinary Bladder Diseases - diagnosis; Urinary Bladder Diseases - etiology; Urinary Bladder Diseases - physiopathology; Urinary Bladder, Neurogenic - etiology; Urinary Bladder, Neurogenic - physiopathology; urinary dysfunction; Urodynamics - physiology
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.20188

Aims Data on lower urinary tract (LUT) function obtained in larger, systematically studied populations of patients with cauda equina lesions are limited. We report urinary function in 65 patients with chronic lesions. Methods A urinary function questionnaire was used, and neurological examination, quantitative electromyography (EMG) of the external anal sphincter (EAS) muscles, EMG assessment of the sacral reflex, and conventional urodynamic measurements were performed. Results Severe LUT dysfunction was found in 14%/15%, moderate in 27%/46%, and mild in 46%/39% men/women. Urinary symptoms interfered with daily life in 88%/92% and sexual life in 72%/67% of sexually active men/women. Symptoms of disturbed bladder emptying were the most common (95%/92% men/women), followed by urinary incontinence (56%/71%) and symptoms of overactive bladder (40%/56%). Perianal sensation was abnormal in 96%, EMG of the EAS muscle in 88%, and sacral reflex in 84% of patients. In 40%/17% men/women, a postvoid residual ( >100 ml) was found. On filling cystometry overactive bladder was found in 21%/0%, reduced detrusor capacity in 9%/15%, and during voiding phase an acontractile detrusor or detrusor underactivity were found in 59%/85% men/women. Using multiple linear regression analysis, perianal sensory loss (P = 0.0001) and female gender (P