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.
