Early surgery predicts a better prognosis of urinary function in cauda equina syndrome with retention: a systematic review and meta-analysis

Background: The timing of surgical intervention for cauda equina syndrome with retention remains debated. This systematic review and meta-analysis aimed to investigate the relationship between the timing of surgical intervention and the prognosis of micturition function in cauda equina syndrome with retention.Material and methods: Literatures in PubMed and ELSEVIER between Jan 1, 1990 and Dec 31, 2014 were reviewed. 10 studies were included in our meta-analysis by Generic Inverse Variance method at the 24-, 48-hour time point with Review Manager 5.0 to identify the evidence of urgent surgical decompression in cauda equina syndrome with retention. Events were defined as either the abnormal recovery of urinary function, or the catheterization. Results: There was a significant difference in the abnormal urinary function at 24hour breakpoint. Operation beyond 24 hours increased the risk of the abnormal urinary function by 54%. Additionally, a significant difference in the catheterization requiring was observed at 48-hour breakpoint. A delayed operation after 48-hours increased the risk of catheterization by 47%. Conclusions: Bladder dysfunction caused by cauda equina syndrome with retention can be effectively attenuated by an early surgery. An operation within 24 hours may prevent the occurrence of abnormal urinary function. Meanwhile, an operation within 48 hours may help to reduce the usage of catheter.