Functional and quality of life outcomes following surgical treatment for cauda equina syndrome: A retrospective tertiary centre study.

BACKGROUND

This study evaluated bladder, bowel, and sexual function outcomes following surgical decompression for cauda equina syndrome (CES) using urodynamic studies (UDS) and patient-reported outcome measures (PROMs), and explored the influence of surgical timing on recovery. Evidence integrating objective UDS findings with PROMs remains limited.

METHODS

Forty-five patients with clinically and radiologically confirmed CES who underwent decompression were analysed retrospectively. Functional outcomes were evaluated using the Neurogenic Bowel Dysfunction Score (NBDS), Urinary Symptom Profile (USP), Arizona Sexual Experience Scale (ASEX), and SF-12. Surgical timing was analysed as a continuous variable and stratified into <24 h, 24-36 h, and >36 h. Thirty-six patients had long-term postoperative urodynamic data, while a subset of nine patients had both pre- and postoperative assessments. Final urodynamic patterns were analysed as cross-sectional functional outcomes across the entire cohort, while longitudinal changes in the subset were analysed separately as exploratory findings.

RESULTS

Median age was 39 years; 71% were male. Lumbar disc herniation accounted for 87% of cases. In an exploratory subset (n = 9), 78% demonstrated improvement in urodynamic patterns at three months, with 22% achieving normal voiding. At final follow-up, 61% demonstrated contractile bladder activity. NBDS correlated significantly with UDS findings (ρ = 0.41, p = 0.02). Sexual dysfunction was observed in 67% of early postoperative and 22% of long-term patients. A higher proportion of contractile recovery was observed with earlier surgery, although this did not reach statistical significance (p = 0.16).

CONCLUSIONS

Surgical decompression for CES leads to meaningful but often incomplete bladder recovery. A non-significant trend toward improved outcomes with earlier intervention was observed; however, causal inference is limited by the study design. Integration of UDS with PROMs provides a comprehensive assessment of recovery and should be incorporated into routine follow-up.