[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-134011-en":3,"doc-seo-134011-105":31,"detail-sidebar-cat-0-en-105":93},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":28,"seo_description":14,"update_tm":29,"read_time":30},134011,16904993612988,"Olivia Brown","https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd",7,"Healthcare","Post-void bladder ultrasound in suspected cauda equina syndrome - data from medicolegal cases and relevance to magnetic resonance imaging scanning","Post-void residual (PVR) bladder ultrasound scans under 200 ml are increasingly used to reduce concern for cauda equina syndrome (CES) and to delay emergency MRI in suspected cases. A retrospective audit reviewed 50 medicolegal CES cases with MRI confirmation to test whether PVR ≤ 200 ml reliably rules out CES. Among those with PVR measured, half with ≤ 200 ml still had clinically and radiologically confirmed CES requiring emergency decompression.","International Orthopaedics (2022) 46:1375–1380 [https://doi.org/10.1007/s00264-022-05341-0](https://doi.org/10.1007/s00264-022-05341-0)  \nPost‑void bladder ultrasound in suspected cauda equina syndrome—data from medicolegal cases and relevance to magnetic resonance imaging scanning  \nNicholas Todd1 · Katerina Dangas2 · Chris Lavy2  \nReceived: 2 February 2022 / Accepted: 5 February 2022 / Published online: 19 February 2022 © The Author(s) 2022  \nAbstract  \nObjective Post-void residual (PVR) scans of less than 200 ml are increasingly being used to rule out the likelihood of caudaequina syndrome (CES) and to delay emergency MRI scanning in suspected cases. This study was done to review a series of 50 MRI confirmed cases of CES and to test the hypothesis that a PVR of less than 200 ml was unlikely to be present. Methods Fifty consecutive medicolegal cases involving CES were audited. Records were reviewed to see ifPVR scans were done. MRI scans were reviewed, clinical and radiological diagnosis reviewed, and treatment recorded.  \nResults Out of 50 CES cases, 26 had had PVR scans. In 14/26 (54%) the PVR scan was ≤ 200 ml. In one case, the CES diagnosis was in question leaving 13/26 (50%) cases where there was a clear clinical and MRI diagnosis of CES despite the PVR being ≤ 200 ml. All 13 were classified as incomplete cauda equina syndrome (CESI) and all proceeded to emergency decompression.  \nConclusions This study is the first in the literature to demonstrate that there is a significant group of CES patients who require emergency decompression but have PVRs ≤ 200 ml.  \nThe results demonstrate the existence of a significant group of CESI patients whose bladder function may be deteriorating, but they have not yet reached the point where the PVR is over 200 ml. Given the accepted understanding that CESI is best treated with emergency decompression, such patients are likely to have worse outcomes if MRI scanning and therefore surgery is delayed. We recommend the following:  \n• PVR is recommended as an assessment tool in suspected CES.  \n• A PVR of ≤ 200 reduces the likelihood of having CES but does not exclude it; clinical suspicion of CES should always lead to an MRI scan.  \n• Further investigation of PVR as a prognostic tool is recommended.  \n* Chris Lavy [chris.lavy@ndorms.ox.ac.uk](chris.lavy@ndorms.ox.ac.uk)  \n1 Newcastle Nuffield Hospital, Newcastle upon Tyne, UK  \n2 Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK  \nIntroduction  \nThe CES is a condition that can lead to severe disabling symptoms causing long-term social and medical morbidity. Early diagnosis and treatment ofCES can prevent harm. The failure to diagnose and treat CES before there is permanent and/or severe neurological injury is important for all patients and is also important medicolegally. There is no universally agreed definition of CES. Many symptoms and signs are quoted as “red flags” for CES but none reliably predict caudaequina (CE) compression on MR imaging [1–5] . This leads to high rates of negative MRIs in patients who have suspected CES [6] . Bladder ultrasound is a cheap, noninvasive assessment of bladder function, which is widely available in emergency departments. The residual volume of urine present in the bladder post-void (PVR) has been proposed asan accurate assessment of the probability of a patient having CES [6] [7] . Katzouraki et al. have stated that if the PVRis ≤ 200 ml, and there are no clinical signs of CES, the probability of a negative MRI is 98.7%, and such patients do not require emergency MR imaging [7] . Deyo et al. [8] in 1992  \nwent even further and stated that “the predictive value of a negative test (no urinary retention) would be almost 0.9999”.  \nWhilst we value the assessment of objective measures to diagnose cauda equina syndrome and support the widespread use of bladder scanning, we wish to document our experience that cauda equina syndrome requiri","cbCaim12QKvZnxtO","https://ap.wps.com/l/cbCaim12QKvZnxtO","pdf",553262,5,1,6,"English","en",105,"# Abstract\n## Objective\n## Methods\n## Results\n## Conclusions\n# Introduction\n## Background and clinical rationale\n## Limitations of red flags\n## Role of bladder scanning and prior evidence\n# Methods\n## Case selection and data collected\n# Results\n## Distribution of PVR measurements\n## MRI timing and CESI classification","[{\"question\":\"What hypothesis does the study test about PVR scans in suspected CES?\",\"answer\":\"The study tests the hypothesis that a post-void residual (PVR) of less than 200 ml is unlikely to be present in CES, and therefore would reduce the likelihood of true CES requiring urgent intervention.\"},{\"question\":\"How many CES cases had PVR scans and how many showed PVR ≤ 200 ml?\",\"answer\":\"Out of 50 MRI-confirmed CES cases, 26 had PVR scans recorded, and 14 of those had PVR ≤ 200 ml.\"},{\"question\":\"Does a PVR ≤ 200 ml exclude cauda equina syndrome?\",\"answer\":\"No. The study identifies a significant group of CES patients, classified as incomplete CES, who have PVR ≤ 200 ml yet still require emergency decompression; clinical suspicion should still lead to MRI.\"}]","Post-void bladder ultrasound in suspected cauda equina syndrome - data from medicolegal cases and relevance to magnetic resonance imaging scanning | PDF",1787231341,15,{"code":4,"msg":32,"data":33},"ok",{"site_id":25,"language":24,"slug":34,"title":13,"keywords":35,"description":14,"schema_data":36,"social_meta":88,"head_meta":90,"extra_data":92,"updated_unix":29},"post-void-bladder-ultrasound-in-suspected-cauda-equina-syndrome-data-from-medicolegal-cases-and-relevance-to-magnetic-resonance-imaging-scanning","",{"@graph":37,"@context":87},[38,55,70],{"@type":39,"itemListElement":40},"BreadcrumbList",[41,45,49,52],{"item":42,"name":43,"@type":44,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":46,"name":47,"@type":44,"position":48},"https://docshare.wps.com/document/","Document",2,{"item":50,"name":12,"@type":44,"position":51},"https://docshare.wps.com/document/healthcare/",3,{"item":53,"name":13,"@type":44,"position":54},"https://docshare.wps.com/document/post-void-bladder-ultrasound-in-suspected-cauda-equina-syndrome-data-from-medicolegal-cases-and-relevance-to-magnetic-resonance-imaging-scanning/134011/",4,{"url":53,"name":13,"@type":56,"author":57,"headline":13,"publisher":59,"fileFormat":62,"inLanguage":24,"description":14,"dateModified":63,"datePublished":64,"encodingFormat":62,"isAccessibleForFree":65,"interactionStatistic":66},"DigitalDocument",{"name":9,"@type":58},"Person",{"url":42,"name":60,"@type":61},"DocShare","Organization","application/pdf","2026-09-03","2026-08-20",true,{"@type":67,"interactionType":68,"userInteractionCount":20},"InteractionCounter",{"@type":69},"ViewAction",{"@type":71,"mainEntity":72},"FAQPage",[73,79,83],{"name":74,"@type":75,"acceptedAnswer":76},"What hypothesis does the study test about PVR scans in suspected CES?","Question",{"text":77,"@type":78},"The study tests the hypothesis that a post-void residual (PVR) of less than 200 ml is unlikely to be present in CES, and therefore would reduce the likelihood of true CES requiring urgent intervention.","Answer",{"name":80,"@type":75,"acceptedAnswer":81},"How many CES cases had PVR scans and how many showed PVR ≤ 200 ml?",{"text":82,"@type":78},"Out of 50 MRI-confirmed CES cases, 26 had PVR scans recorded, and 14 of those had PVR ≤ 200 ml.",{"name":84,"@type":75,"acceptedAnswer":85},"Does a PVR ≤ 200 ml exclude cauda equina syndrome?",{"text":86,"@type":78},"No. The study identifies a significant group of CES patients, classified as incomplete CES, who have PVR ≤ 200 ml yet still require emergency decompression; 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