Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review

Abstract

This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

“…Limited data on sexual function are ubiquitous in CES patients in literature [2], most likely due to barriers on both the patients' side as well as on the doctor's side, which could unfortunately not be minimized in this retrospective study design. The nature of Fig.…”

“…Criteria to diagnose a patient with CES were, according to consensus of literature, one or more of the following: (1) dysfunction of micturition, defecation, and/or sexual function (not being attributable to use of opiates or previous disease), (2) altered sensation of the saddle area, with possible neurologic deficit in the lower limb (motor or sensory loss or reflex changes) [1,2]. Patients filed with a diagnosis of CES but not meeting those criteria were excluded.…”

“…Cauda equina syndrome (CES) is a neurological condition caused by compression of the cauda equina, most commonly described as a combination of sensory loss of the saddle area, motor deficit and/or loss of reflexes of the lower limbs, micturition dysfunction, defecation complaints, and/or sexual dysfunction [1,2]. The first article about CES appeared in 1934, in which a combination of neurological and urological complaints in patients with a ruptured intervertebral disc was described [3].…”

“…In literature, there is a little focus on the prognosis of micturition, defecation, and sexual function [2]. This is remarkable considering the definition of CES.…”

“…This is remarkable considering the definition of CES. Recently, clinicians in spinal care were found to barely discuss sexual health and/or defecation at presentation and at follow-up, suggested to be due to, e.g., lack of knowledge or time [2,15,16]. Clinicians who do want to inform their patients about the prognosis of these functions are confronted with scarce data.…”