![]() We used the same criteria as Katzouraki et al. In cases where the PVR was ≤ 200 ml, we recorded the following: age, sex, bladder symptoms, urinary and/or bowel incontinence at any time, subjective and clinician-tested impairment of perineal sensation, reduced anal tone, level of compression on MRI, confirmation of diagnosis by a radiologist and surgeon, the clinical decision to perform emergency decompression, and the timing of surgery. We identified those cases where the PVR was recorded. The reports were prepared for both claimants and defendants. ![]() We retrospectively reviewed the two senior authors’ 50 most recent medicolegal reports that concerned patients who were litigating in relation to CES. Whilst we value the assessment of objective measures to diagnose cauda equina syndrome and support the widespread use of bladder scanning, we wish to document our experience that cauda equina syndrome requiring emergency decompression can still be present when a PVR is less than 200 ml. in 1992 went even further and stated that “the predictive value of a negative test (no urinary retention) would be almost 0.9999”. have stated that if the PVR is ≤ 200 ml, and there are no clinical signs of CES, the probability of a negative MRI is 98.7%, and such patients do not require emergency MR imaging. The residual volume of urine present in the bladder post-void (PVR) has been proposed as an accurate assessment of the probability of a patient having CES. Bladder ultrasound is a cheap, noninvasive assessment of bladder function, which is widely available in emergency departments. This leads to high rates of negative MRIs in patients who have suspected CES. Many symptoms and signs are quoted as “red flags” for CES but none reliably predict cauda equina (CE) compression on MR imaging. There is no universally agreed definition of CES. The failure to diagnose and treat CES before there is permanent and/or severe neurological injury is important for all patients and is also important medicolegally. Early diagnosis and treatment of CES can prevent harm. The CES is a condition that can lead to severe disabling symptoms causing long-term social and medical morbidity. PVR is recommended as an assessment tool in suspected CES.Ī PVR of ≤ 200 reduces the likelihood of having CES but does not exclude it clinical suspicion of CES should always lead to an MRI scan.įurther investigation of PVR as a prognostic tool is recommended. Given the accepted understanding that CESI is best treated with emergency decompression, such patients are likely to have worse outcomes if MRI scanning and therefore surgery is delayed. The results demonstrate the existence of a significant group of CESI patients whose bladder function may be deteriorating, but they have not yet reached the point where the PVR is over 200 ml. This study is the first in the literature to demonstrate that there is a significant group of CES patients who require emergency decompression but have PVRs ≤ 200 ml. All 13 were classified as incomplete cauda equina syndrome (CESI) and all proceeded to emergency decompression. In one case, the CES diagnosis was in question leaving 13/26 (50%) cases where there was a clear clinical and MRI diagnosis of CES despite the PVR being ≤ 200 ml. Out of 50 CES cases, 26 had had PVR scans. MRI scans were reviewed, clinical and radiological diagnosis reviewed, and treatment recorded. Records were reviewed to see if PVR scans were done. ![]() Methodsįifty consecutive medicolegal cases involving CES were audited. This study was done to review a series of 50 MRI confirmed cases of CES and to test the hypothesis that a PVR of less than 200 ml was unlikely to be present. Post-void residual (PVR) scans of less than 200 ml are increasingly being used to rule out the likelihood of cauda equina syndrome (CES) and to delay emergency MRI scanning in suspected cases. ![]()
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