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The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome.

Abstract Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, defecation and sexual function-which are by definition affected in CES-are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 28423044
OWN - NLM
STAT- MEDLINE
DA  - 20170419
DCOM- 20170428
LR  - 20170428
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - The long term outcome of micturition, defecation and sexual function after spinal
      surgery for cauda equina syndrome.
PG  - e0175987
LID - 10.1371/journal.pone.0175987 [doi]
AB  - BACKGROUND: Cauda equina syndrome (CES) is a rare neurologic complication of
      lumbar herniated disc for which emergency surgical decompression should be
      undertaken. Despite the common belief that the restoration of functions that are 
      affected by CES can take several years postoperatively, follow up seldom exceeds 
      the first year after surgery. Long term outcome of especially micturition,
      defecation and sexual function-which are by definition affected in CES-are
      unknown. The aim of this study is to evaluate 1) postoperative long term outcome 
      of micturition, defecation and sexual function in CES patients 2) attitude of
      patients towards received hospital care with regard to (recovery of) these
      functions. METHODS: CES patients were selected by screening the records of all
      patients operated on lumbar herniated disc in our university hospital between
      1995-2010. A questionnaire was sent to the selected CES patients evaluating
      current complaints of micturition, defecation and sexual function and attitude
      towards delivered care with focus on micturition, defecation and sexual function.
      RESULTS: Thirty-seven of 66 eligible CES patients were included (response rate
      71%, inclusion rate 56%). Median time after surgery was 13.8 years (range
      5.8-21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition
      dysfunction, 43% defecation dysfunction and 54% sexual dysfunction. Younger age
      at presentation was associated with sexual dysfunction at follow up: for every
      year younger at presentation, odds ratio for sexual dysfunction at follow up was 
      1.11 (p = 0.035). Other associations with outcome were not identified. Two-third 
      of the CES patients wished their neurosurgeon had given them more prognostic
      information about micturition, defecation and sexual function. CONCLUSION: The
      presented data demonstrate that dysfunction of micturition, defecation and sexual
      function are still highly prevalent in a large number of CES patients even years 
      postoperatively. These alarming follow up data probably have a devastating effect
      on personal perceived quality of life, which should be studied in more detail.
      CES patients communicate a clear demand for more prognostic information. The
      presented figures enable clinicians to inform their CES patients more
      realistically about long term postoperative outcome of micturition, defecation
      and sexual function after surgical intervention.
FAU - Korse, Nina S
AU  - Korse NS
AUID- ORCID: http://orcid.org/0000-0001-5315-6875
AD  - Department of Neurosurgery, Leiden University Medical Center, Leiden, the
      Netherlands.
FAU - Veldman, Anna B
AU  - Veldman AB
AD  - Department of Neurosurgery, Leiden University Medical Center, Leiden, the
      Netherlands.
FAU - Peul, Wilco C
AU  - Peul WC
AD  - Department of Neurosurgery, Leiden University Medical Center, Leiden, the
      Netherlands.
AD  - Department of Neurosurgery, Haaglanden Medical Center, the Hague, the
      Netherlands.
FAU - Vleggeert-Lankamp, Carmen L A
AU  - Vleggeert-Lankamp CLA
AD  - Department of Neurosurgery, Leiden University Medical Center, Leiden, the
      Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20170419
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Adult
MH  - Aged
MH  - Coitus/physiology
MH  - Decompression, Surgical/methods
MH  - Defecation/physiology
MH  - Female
MH  - Humans
MH  - Intervertebral Disc Displacement/pathology/physiopathology/psychology/*surgery
MH  - Lumbar Vertebrae/pathology/physiopathology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Polyradiculopathy/pathology/physiopathology/psychology/*surgery
MH  - Prospective Studies
MH  - Quality of Life/*psychology
MH  - Treatment Outcome
MH  - Urination/physiology
EDAT- 2017/04/20 06:00
MHDA- 2017/04/30 06:00
CRDT- 2017/04/20 06:00
PHST- 2017/02/27 [received]
PHST- 2017/04/03 [accepted]
AID - 10.1371/journal.pone.0175987 [doi]
AID - PONE-D-17-07899 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 19;12(4):e0175987. doi: 10.1371/journal.pone.0175987.
      eCollection 2017.

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