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Background. The Cauda Equina Syndrome is a condition of severe compression or inflammation of the nerves that make up the cauda, that is the anatomical structure consisting of the last spinal roots. Case presentation. On the second day after a caesarean section, a 34-year-old woman at her third pregnancy referred urinary retention, dysesthesia in the buttock and posterior region of the left thigh; constipation on the fifth day. After several clinical examinations, and having excluded the more statistically likely aetiologies, an incomplete Cauda Equina Syndrome was diagnosed, caused by chemical arachnoiditis from a spinal anaesthesia based on hyperbaric bupivacaine. The pathology resolved spontaneously and was not necessary to adopt any therapy other than the minimally invasive one. The urological symptoms were the first to completely disappear, while constipation resolved a few weeks later. Today, only a slight dysesthesia remains in the aforementioned areas. Conclusions. Spinal anaesthesia still proves to be a safe and absolutely practicable method, even if not totally free of serious risks.

Background: The anal symptoms occurring pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with a wide range of incidence in the Literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to give a bad quality of life. Methods: Our study has been conducted by means of a questionnaire administered via of a social media with the aim of obtaining an epidemiologic data on incidence of symptoms of HD in an unselected population of pregnant women. In addition, we investigated for the presence of those factors notoriously predisposing or associated to haemorrhoidal disease (constipation, straining on the toilet, low dietary fibers and fluid intake). Results: Out of 133 patients 51% reported Symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fiber and fluid intake were not significantly related to incidence of haemorrhoids. Only a previous history of haemorrhoidal disease correlated to onset of hemorrhoids in pregnancy and reached a statistical significance (odds ratio = 5.2, p<0.001). Conclusion: Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measuresare lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment, taking in mind however, that surgery can be an option in selected cases.

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Objective. To demonstrate the long-term efficacy and safety of intravesical botulinum toxin in the treatment of patients having neurological problems with a spontaneous voiding phase. Patients and Methods. It is a prospective pilot study. We analysed 20 women came to the Hospital from March 2019 to March 2020 and underwent trigone-sparing Botulinum toxin bladder infiltration. The primary outcome was the improvement of the voiding diary score at two, four, twelve and twenty-four weeks and 12 months after treatment. Complications and quality of life improvement after treatment were considered as secondary outcomes. Results. No signs of autonomic dysreflexia were observed during the procedure. Procedure associated pain has an average of 5 on Visual Analogic Scale. First benefits were evident within 2 days; full improvements were evident after 7-10 days. The duration of treatment (voiding diary score improvement) was of 5.5 months on avarage. Among the early complications: mild hematuria (no need of catheter placement) was described in 50% of patients and urinary infection in 20% of patients. None of the patients experienced fever, muscle weakness or worsened constipation. No late complications such as inability to empty bladder was described. Conclusions. Botulinum toxin detrusor's infiltration remains an effective and safe long term therapy in patients with neurogenic bladder with preserved voiding phase, characterized by improvement in quality of life and reduction of side effects.