In patients with cauda equina syndrome (CES) post decompression surgery, 17-92% have been described to have bladder dysfunction. Urodynamic findings are variable and there is little predictability in this from symptoms. All patients with urinary symptoms should have follow-up with their local spinal injuries centre or locally agreed urology service, as per the UK national CES pathway.

Using our electronic patient record system (EPIC SlicerDicer), we identified all patients (n = 171) who underwent laminectomy or lumbar decompression for cauda equina syndrome between January 2024 and June 2025 at the UK South East London and Kent Neurosurgery centre. We reviewed inpatient notes and Neurosurgical outpatient follow-up records to identify patients who experienced urinary symptoms. These included, but were not limited to: urinary retention; difficulty voiding; or incontinence following surgery for cauda equina syndrome.

Of the 171 patients, 30 (17.5%) experienced urinary symptoms on discharge but had no documented plan for referral to Urology; 17 (9.9%) had urinary symptoms with a plan documented in the neurosurgical follow-up clinic for their family doctor to refer them to local Urology services; and only 8 (4.7%) were referred directly to Urology. Only three patients had urodynamics booked. One showed detrusor overactivity with obstructed voiding; the other a large capacity bladder with detrusor failure; the third is awaited.

This study highlights the importance of timely investigation and management of the post-operative patient with cauda equina syndrome who has urinary symptoms, to minimise disruption to their quality of life and prevent the progression of bladder dysfunction.

We plan to streamline the referral pathway to Urology in line with national UK guidelines to improve care for the urological sequelae of cauda equina syndrome, as these patients appear an undeserved group. We recommend further analysis of urodynamic findings in CES also, which may not be as expected, in order to offer individualised treatment for urinary symptoms.