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Cauda Equina Syndrome: Urinary Retention on Presentation

Cauda Equina Syndrome: Urinary Retention on Presentation

Urinary retention is what differentiates incomplete cauda equina syndrome from complete cauda equina syndrome. It is a very important symptom because once urinary retention develops, the outcome will be less favourable.

Incomplete cauda equina syndrome

Cauda equina syndrome (CES) has two stages: incomplete and complete. Incomplete CES is characterised by lower back pain that extends to the legs, numbness around the perineum, buttocks and urethra, and urinary dysfunction. This urinary dysfunction will not prevent the individual from passing urine. However, the sensation will be reduced and it will be difficult to empty the bladder.

When the condition is treated in the incomplete stage, the patient's symptoms may improve, or even resolve altogether.

Complete cauda equina syndrome

Complete cauda equina syndrome is the second and final stage. It differs to incomplete cauda equina syndrome because there will be urinary retention. This means that the patient is unable to pass urine and is retaining it in their bladder. If a catheter is not inserted, the bladder will become so full that it overflows, causing the individual to be incontinent.

When the condition is treated in the complete stage, the outcome will be less favourable. That is why it is important to treat cauda equina syndrome while it is still incomplete.

Complete on presentation

Unfortunately some patients will already have complete cauda equina syndrome by the time they present to a medical setting. According to Patient.info, around 50% to 70% of patients have urinary retention on presentation. For these patients it may be too late to effectively treat the condition and any symptoms will be permanent. Even so, surgical decompression should still be carried out because it will prevent the symptoms from becoming any worse.

Incomplete on presentation

Patient.info states that 30% to 50% of patients present to a medical environment with incomplete cauda equina syndrome. For these patients, it is vital that medical practitioners recognise and treat the condition without delay. A neurological examination should be followed by an emergency MRI scan. If this confirms nerve compression, the patient should be sent to the operating theatre the same day.

Failing to treat incomplete cauda equina syndrome

If a patient presents to their GP or hospital with incomplete cauda equina syndrome but treatment is delayed, causing him/her to progress to complete cauda equina syndrome, there could be a case of medical negligence. This is because the delay in treatment will have caused the patient to suffer a less favourable outcome.

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