There is limited data as to how the objective signs of cauda equina syndrome (CES) change as CES becomes progressively more severe. I previously reviewed a database of 40 patients with CES who were assessed for medicolegal purposes.1 I revisited that database to identify patients who had had examination of the perineum and/or rectal examination as part of their clinical assessment. Patients were classified as having an incomplete cauda equina syndrome (CESI) or a cauda equina syndrome with neurogenic retention of urine (CESR). CESI was defined as objective evidence of CES, for example impaired perianal sensation, with preserved control of the bladder. The point of CESR was taken as either the complete inability to pass urine with absent bladder sensation; absent bladder sensation, catheterised, with a large residual bladder volume or an insensate paralysed bladder with incontinence.
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