RESULTS OF THE MANAGEMENT OF VESICOURETHR AL AND ANORECTAL DYSFUNCTIONS IN 20 PATIENTS WITH CAUDA-EQUINA LESION

Twenty patients (7 females and 13 males) with cauda equina lesions (12 herniated lumbar disks, 4 tumours, and 4 compression fractures of the lumbar spine), were treated according to a standardized management of their urinary and digestive symptoms, after surgery. The bladder empt ying inability was managed by Crede manoeuver facilitated by appropria te drugs completed by self intermittent catheterization. The constipat ion was treated by non irritant osmotic laxatives, and defecation obta ined by abdominal straining, was facilitated by a suppository. All the patients recovered a sphincteric autonomy, without invalidating incon tinence. Within 3 to 6 months, eleven patients improved enough bladder emptying to stop drugs and self-catheterization. None presented urina ry incontinence. Within the same time, 14 had a stool daily, but medic al treatment of the constipation had to be carried on in all of the 20 patients. None of the patients had incontinence for the solid stools, but only the patients who improved (spontaneously or after biofeedbac k therapy) the voluntary anal sphincter contraction were continent for the gaz, and liquid stools. The intermittent self-catheterization rel ease (a complete emptying of the bladder being achieved) was more freq uent after tumor treatment than after herniated disk, or compressive f racture treatment; the same release happened in case of immediate mana gement if compared with delayed management of the urinary symptoms. Ad versely, the digestive recovering was not influenced by either the eti ology of the cauda equina lesions or the therapeutic management delay. Defecography demonstrated anatomical disturbances of the rectoanal ap paratus such as perineal descent and/or mucosal prolapse, which could be secondary to the abdominal straining necessary to complete bladder and rectum emptying.