Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review
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Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little seems to be known about long-term outcome. Aim of this study is to review current literature on outcome of micturition, defecation and sexual function in CES due to lumbar disk herniation.
A literature search was done in Pubmed, Embase and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a Cochrane checklist adjusted for this purpose.
Fifteen studies were included. Risk of bias varied with six studies showing low risk. Mean minimal follow-up time was 17.0 months (range 3–24 months). All studies evaluated micturition and reported dysfunction at follow-up in 42.5 % (range 13.3–90.0 %). Defecation and sexual function were evaluated in eight and nine studies, respectively, and reported to be 49.6 (range 10.5–90.0 %) and 44.3 % (range 10.0–76.6 %), respectively. Only two studies assessed sexual function in all patients at follow-up.
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.
KeywordsCauda equina syndrome Lumbar disk herniation Micturition Defecation Sexual dysfunction Pelvic floor
Conflict of interest
- 10.Platform-Evidence-Based-Richtlijn-Ontwikkeling (2006) Formulier III voor het beoordelen van een Cohortonderzoek. Dutch Cochrane Center. http://dcc.cochrane.org/sites/dcc.cochrane.org/files/uploads/cohort.pdf. Accessed 29 March 2012
- 11.Harbord RM, Higgins JPT (2009) Meta Regression in Stata. In: Sterne JAC (ed) Meta-analysis in Stata: an updated collection from the Stata journal, 1st edn. Stata Press, College Station, pp 70–96Google Scholar
- 19.Buchner M, Schiltenwolf M (2000) Cauda equina syndrome caused by intervertebral lumbar disk prolapse—mid-term results of 22 patients and review of the literature. Neuro Orthop 27(1–2):55–64Google Scholar
- 30.von Wild K (1990) Lumbar intervertebral disk operation in the aged. Zentralbl Neurochir 51(1):34–41Google Scholar
- 63.Nascone JW, Lauerman WC, Wiesel SW (1999) Cauda equina syndrome: is it a surgical emergency? University Pennsylvania Orthop J 12:73–76Google Scholar
- 65.Tandon PN, Sankaran B (1967) Cauda equina syndrome due to lumbar disk prolapse. Indian J Orthop 1:112–119Google Scholar