There is a high prevalence of long-term bladder, bowel, sexual, and physical dysfunction in patients who have undergone surgery for CES, and patients should be monitored for ongoing problems at follow-up.[32]Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: diagnosis and evaluation. J Urol. 2021 Nov;206(5):1097-105.
https://www.auajournals.org/doi/10.1097/JU.0000000000002235
http://www.ncbi.nlm.nih.gov/pubmed/34495687?tool=bestpractice.com
[52]Emmanuel A. Neurogenic bowel dysfunction. F1000Res. 2019 Oct 28;8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820819
http://www.ncbi.nlm.nih.gov/pubmed/31700610?tool=bestpractice.com
Referral to physiotherapy, continence, urology, and/or pain management services may be required.[46]Hazelwood JE, Hoeritzauer I, Pronin S, et al. An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. Acta Neurochir (Wien). 2019 Sep;161(9):1887-94.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704093
http://www.ncbi.nlm.nih.gov/pubmed/31263950?tool=bestpractice.com
There is evidence that monitoring and therapy for ongoing sexual dysfunction and pain is inadequate in these patients.[36]Pronin S, Hoeritzauer I, Statham PF, et al. Are we neglecting sexual function assessment in suspected cauda equina syndrome? Surgeon. 2020 Feb;18(1):8-11.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117366
http://www.ncbi.nlm.nih.gov/pubmed/31036485?tool=bestpractice.com
[46]Hazelwood JE, Hoeritzauer I, Pronin S, et al. An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. Acta Neurochir (Wien). 2019 Sep;161(9):1887-94.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704093
http://www.ncbi.nlm.nih.gov/pubmed/31263950?tool=bestpractice.com
For all patients who have had disc herniation, a lifelong programme of muscle activity to maintain healthy core lumbar and pelvic girdle muscles is important to avoid continued degeneration and recurrence.