A Systematic Review of the Value of a Bladder Scan in Cauda Equina Syndrome Diagnosis.

Awf A Alshahwani,Amr Elbahi,Joseph Boktor,Purnajyoti Banerjee

doi:10.7759/cureus.14441

Abstract

Cauda equina syndrome (CES) is one of the emergency conditions that can lead to devastating permanent functional disabilities, if misdiagnosed. Multiple studies have questioned the reliability of clinical assessment in diagnosing CES, whether some of the features should be considered to be potential red flags. Bladder dysfunction can reflect CE compromise. The post-void residual (PVR) volume bladder scan is useful in CES diagnosis, but to date there has been no single systematic review supporting its use. Furthermore, there is no clear cut-off point to consider PVR statistically significant. The aim of the study is to perform a systematic review of the current evidence behind the use of the PVR bladder scan as a diagnostic tool for CES diagnosis. This was a comprehensive search using Medline, PubMed and Embase. All articles included post-void bladder scans with the mentioned clear cut-off volume as a diagnostic parameter. A total of five study articles from 1955 fit with our inclusion and exclusion criteria. The total number of patients who had a bladder scan was 531. CES was confirmed in 85 cases. Bladder scan diagnosed 70 cases and excluded 327. The best results for both sensitivity and specificity in correlation with the sample of the study were for PVR more than 200 ml. Measuring the post-void urine volume using a bladder scan is an essential tool in the diagnosis of CES. There is a significant correlation between the PVR volume more than 200 ml and higher sensitivity and specificity.

Highlights

BackgroundCauda equina syndrome (CES) is an emergency spinal pathology that can lead to devastating permanent functional disabilities
The British Association of Spine Surgeons (BASS) emphasized that an urgent Magnetic resonance imaging (MRI) scan should be performed for suspected CES, and decompressive surgery should be undertaken at the earliest opportunity in confirmed cases [6]
Post-void urine volume using a bladder scan is essential in the diagnosis of CES

Summary

Introduction

Cauda equina syndrome (CES) is an emergency spinal pathology that can lead to devastating permanent functional disabilities. The clinical features and outcome of scannegative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients [13]. The study involved 58 patients where all were inspected for red flags including PVR more than 500 ml; using this high value as a cut-off point carries the risk of missing impending CES that might progress with time and might lead to irreversible CES with retention with no expected recovery of the urinary function [12]. Four years later, used the same cut-off point when they included 57 patients with suspected CES; 13 of them (23%) were found to have CES on MRI scan They showed much less impressive conclusion with the sensitivity of PVR at 38% and the specificity 76% [5]. All studies are retrospective except for two, and there are no randomized controlled trials and meta-analysis studies

Conclusions

Disclosures

Findings

18. Todd NV