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Sexual dysfunction rapidly recovers following surgery
2%
16/850
There are no difference in outcomes with decompression >48 hours compared <48 hours
Post void residual volume >200 mL excludes the diagnosis
1%
9/850
Urinary function can have a prolonged recovery
94%
797/850
Elderly patients have better neurologic recovery than younger patients
5/850
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Urinary function after cauda equina syndrome can have a prolonged recovery and has a less reliable degree of recovery than other neurologic functions. Cauda equina syndrome results from acute compression of the nerve roots in the lumbar spine leading to an ischemic event. Significant neurologic deficits can develop including bowel, bladder, and sexual dysfunction. Early decompression is essential to mitigate long-term dysfunction. The optimal timing is controversial but generally speaking, as soon as safely possible is recommended. Improved recovery had been reported with decompression <48 hours of onset. Urologic function is the least likely neurologic function to recover, has the least predictable recovery, and can recover over a 16 month period after decompression. Ahn et al. performed a meta-analysis evaluating the effect of time to decompression on neurologic outcomes of cauda equina syndrome. They reported significant benefits regarding motor, sensory, urinary, and rectal function in patients treated within 48 hours of onset. They concluded that surgical decompression of cauda equina syndrome within 48 hours was associated with improved neurologic outcomes. Kohles et al. commented on the results reported by Ahn et al. regarding the effect of time to decompression on neurologic outcomes of cauda equina syndrome. The authors criticized the methodology of Ahn et al. which undermined the importance of early decompression (<24 hours) on neurologic outcomes of cauda equina syndrome. They concluded that early surgery for cauda equina syndrome may have been under-emphasized in the Ahn et al. meta-analysis. Incorrect answers Answer 1: Sexual dysfunction can have a prolonged recovery after surgical decompression which may last over 1 year. Answer 2: Surgical decompression <48 hours of onset has been reported to have improved neurologic recovery than patients decompressed >48 hours. Answer 3: A post-void residual volume >200 mL is highly suggestive of cauda equina syndrome. Answer 5: Older patients tend to have less neurologic recovery than their younger counterparts.
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