Urinary retention

doi:10.1136/bmj.b1727

Published 29 April 2009, doi:10.1136/bmj.b1727
Cite this as: BMJ 2009;338:b1727

Letters

Cauda equina syndrome

Urinary retention

The first 150 words of the full text of this article appear below.

Lavy and colleagues do not mention that urinary retention incauda equina syndrome is painless because the bladder is totallydenervated.¹ Once the bladder reaches maximum capacity, urinewill dribble out as overflow incontinence, which patients willalso not feel. Painless urinary retention is the cardinal signof the syndrome² ³: without it there is only a 1 in 1000 chanceof its presence.⁴

Any patient in whom cauda equina syndrome is suspected shouldhave at least post-micturition bladder scanning or urinary catheterisation.A painless residual volume of 750-1000 ml has a 90% specificityfor the syndrome.⁴ Since many of these patients have chronicback pain, they will usually be taking regular codeine (at least)and will be constipated. Constipation (along with pain) canalso result in urinary retention, but the residual volume willbe less since the bladder is not atonic. The S2/3/4 sensorysupply can be tested by . . . [Full text of this article]

Chris E Uff, SpR in neurosurgery¹

¹ Royal Free Hospital, London NW3 2QG

chrisuff@hotmail.com

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