BACKGROUND The present consensus suggests urgent surgical decompression if clinical features of cauda equina syndrome (CES) are supported by MRI evidence of pressure on cauda equina. However, clinical diagnosis has a high false-positive rate and MRI is a poor indicator. Though urodynamic studies (UDS) provide objective information about the lower urinary tract symptoms experienced by patients including neurogenic bladder, its role in the diagnosis of CES is not established. OBJECTIVE To evaluate the ability of an objective urological assessment protocol using uroflowmetry + USG-PVR as screening test and invasive UDS as confirmatory test in patients with suspected CES to rule out neurological impairment of the bladder function. METHODS A retrospective study was conducted on all patients who were referred to our institution with equivocal findings of cauda equina syndrome from January 2014 to December 2018 with positive MRI findings. An algorithm using multichannel UDS was followed in all the included patients. RESULTS Out of 249 patients who fulfilled the inclusion criteria, 34 patients (13.65%) had normal uroflowmetry and USG-PVR findings; 211 patients underwent the invasive UDS. Only 141(57.6%) patients out of 245 patients had neurovesical involvement due to compression of cauda equina; 67 patients were treated conservatively using the objective protocol. Only one patient treated conservatively had to undergo emergency decompression for deterioration in symptoms. CONCLUSIONS Multichannel UDS provides an objective diagnostic tool to definitively establish the neurovesical involvement in CES. Utilising multichannel UDS as an adjunct to clinical findings avoids the probability of false-positive diagnosis of CES. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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马尾综合症：多通道尿动力学研究可减少神经源性膀胱假阳性诊断。

背景技术如果马尾神经综合征（CES）的临床特征得到马尾神经压迫的MRI证据的支持，则目前的共识建议进行紧急外科手术减压。但是，临床诊断的假阳性率很高，而MRI则是较差的指标。尽管尿流动力学研究（UDS）提供了有关患者（包括神经源性膀胱）所经历的下尿路症状的客观信息，但尚未确定其在CES诊断中的作用。目的对怀疑患有CES的患者，采用尿流计+ USG-PVR作为筛查试验，并采用侵入性UDS作为确证试验，评估客观泌尿科评估方案排除膀胱功能神经系统损害的能力。方法回顾性研究从2014年1月至2018年12月转诊到我们机构的马尾综合症模棱两可的所有患者，并且MRI呈阳性。所有纳入的患者均遵循使用多通道UDS的算法。结果符合入选标准的249例患者中，有34例（13.65％）的尿流率和USG-PVR结果正常。211例患者接受了侵入性UDS。245名患者中只有141名（57.6％）患者因马尾神经受压而出现神经膀胱受累。使用客观方案保守治疗了67例患者。只有一名接受过保守治疗的患者因症状恶化而不得不进行紧急减压。结论多通道UDS提供了一种客观的诊断工具，可以最终确定CES中的神经血管参与。利用多通道UDS作为临床发现的辅助手段可避免CES假阳性诊断的可能性。这些幻灯片可以在电子补充材料下找到。