Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

General Orthopaedics

URODYNAMIC POST-VOID RESIDUAL (PVR) URINE VOLUME VALUE IN CAUDA EQUINA SYNDROME ASSESSMENT: WHAT IS THE PVR TO BE CONSIDERED A RED FLAG? A META-ANALYSIS

The British Indian Orthopaedic Society (BIOS) Annual Scientific Meeting, Cardiff, Wales, 2–3 July 2021.



Abstract

Abstract

Background

Cauda equina syndrome (CES) is a rare serious condition that, if missed at initial presentation, can lead to serious disability. Early diagnosis is crucial for a favourable outcome. Few studies included urodynamic test and measurement of post-void residual urine (PVR) as an adjunct screening tool for acute CES before proceeding to MRI scan, yet there are differences in the cut-off point as a threshold volume to be considered as a red flag for doing MRI amongst these studies.

Aim

Meta-analysis and systematic review of literature that included PVR as a predictive tool in CES to identify the reliability of PVR and the optimal numerical value to be considered as red flag.

Material & Methods

A comprehensive literature search was undertaken in PubMed, Medline, and Embase databases using our search strategy. Meta-analysis of collated data.

Results

A total of seven studies were included with a total of 938 patients. The number of cases suitable for meta-analysis was 714. CES was confirmed in 73. urodynamic testing and PVR diagnosed 86 and excluded 426. The sensitivity of PVR>100ml was 64% (CI 97.5%: 0.44–0.80), specificity 59.2% (CI 97.5%: 0.46 – 0.711), while PVR >200 showed more predictive figures, with sensitivity improved to 83.1% (CI 97.5%: 0.62–0.94) and specificity to 93.5% (CI 97.5%: 0.50–0.99).

Conclusions

Urodynamics test is an essential tool in CES assessment. Authors recommend PVR > 200 ml as the numerical cut-off point to be considered as a red flag that if present with other clinical red flags, urgent MRI is recommended in suspected CES.