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What causes difficulty in passing urine post back surgery?

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Spine Surgeon
Practicing since : 1998
Answered : 116 Questions
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Good day

I am a 40 year old male who is desperately seeking answers to a few questions following recent back surgery. I would appreciate if an experienced neurosurgeon can answer these questions. I would also appreciate if my questions are not published and kept confidential.

The background to my questions is as follows:

After playing contact sports in my younger years, combined with water skiing and jet skiing in my twenties and early thirties, I started experiencing some lower back pains from my mid-thirties onwards. These were infrequent and normally went away after a day or two. After attempting to lift a heavy object in November 2010, I immediately felt that something was wrong in my back, and my left leg started to go numb and sore shortly thereafter. This got progressively worst until it became unbearable.

A MRI scan in early XXXXXXX 2011, revealed a herniated disc between the L4/L5 vertebra. A neurosurgeon recommended surgery, and a 2nd opinion also concurred with the recommendation. In January 2011 a laminectomy and discectomy and was performed by the neurosurgeon on the L4/L5 disc. The numbness and pain in my left leg went away immediately and after a 10 week recovery period, I resumed my work.

I had then had no further back issues for the next 3 years. About 5 weeks ago, when I woke up one morning and felt that my right leg was slightly numb and sore. I don't recall picking up anything heavy or doing anything that could have re-injured my back. The next 3 or 4 days it felt more or less the same. But then on the morning of the 7th July 2014, I felt an excruciating pain in my right leg that was debilitating. I once again had a MRI scan shortly thereafter, which revealed another herniated disc. This time the herniation was between the L3/L4 vertebra.

The diagnostic radiologist report stated the following: "There appears to be extrusion of disc material at the postero-lateral aspect of disc L3/4 with disc material extending posterior to vertebral body L4. There is prominent encroachment and impingement of the cauda equina at this level and especially impingement of the anterior and posterior roots of right exiting nerve root L3. Prominent impingement of the thecal sac and cauda equina is also clearly visible on MRI myelogram with almost complete loss of signal at this level."

After my neurosurgeon received the MRI and the report, he informed me that he would recommend immediate surgery to release the nerve compression, as the herniated disc was close to the nerves that also feeds the bladder. I decided that this time I would not get an 2nd opinion as it would be a waste of time.

I underwent surgery on the 10th July, during which a laminectomy and discectomy was done to remove the herniated disc in the L3/L4. A large portion of the disc was removed (approx 1/3 of the disc) and the dural was repaired with stitches and a patch.

When I woke up after the surgery, the pain in my right leg was gone. However, my left leg and buttock were numb (the "pins and needles" feeling). I had a catheter in for 2 days, and once it was removed, I also felt a partial numbness of my penis. However I assumed that the numbness was caused by the catheter. I was able to pass urine (with some effort) and did not feel too bad overall. I was discharged from hospital on the 14th July.

When I returned home, I realised that my perineum area was very numb and that I was also unable to get a normal full erection. At the same time, I had some constipation and battled to have a bowel movement for 3 days. After using some laxatives, I was able to have a bowel movement again. However, this proved to be quite difficult and the straining to have bowel movements eventually caused hemorrhoids to form. The hemorrhoids started bleeding and my GP cut these out on Saturday, 19th July. After I described my symptoms to my GP, he advised that I must return to the neurosurgeon as soon as possible.

I saw my neurosurgeon again on the 22nd July, and I explained my symptoms to him. After he examined me, he said that he was concerned that there could be a dural tear which could cause cerebrospinal fluid (CSF) leaking. He suggested that I undergo another surgery to check if there was a dural tear.

I underwent the 2nd operation on the 24th July. After the operation, the neurosurgeon reported that there was no dural tear and no leaking of CSF. He stated that the dural stated healing nicely. After the operation I was given cortisone and steroids to assist in the nerve regeneration. He then also arranged for an urologist to also examine me.

The urologist examine me and a sonar verified that I was able to empty my bladder (although this takes some effort to do). It was explained that if I was unable to do this, intermediate self catheterisation would have been required until the nerves have recovered. As I could not feel if my bladder is full, the urolgist stressed the importance of emptying my bladder every 4 hours. The urologist also prescribed Cialis to assist with the erectile disfunction during this period when the nerves to my penis are not yet fully functional. I was then discharged from the hospital on the 29th July to recover further at home.

My current status today (7th August) is as follows:
The incision wound has healed very well and my staples was removed earlier today. My legs are still weak and I have lost significant muscle mass in my carves, quads and buttocks. I have physiotherapy twice a week and doing some light exercises daily. I can feel that there has been some improvement in my leg strength during the past few days. However, daily pain management is still required and is done by taking medication (Lyrica and Tramal.

However, I still have the same numb feeling in my left lower leg and in particular a "pins and needles" feeling in my left foot. I also still have the same numb feeling in my saddle area, including my penis, perineum area and my left buttock. It is not that there is no feeling there, it just has a slight dull / numb feeling there. I can now feel when my bladder is full, but it still takes some effort to urinate. I however cannot get a full erection, although I can feeling the prescribed medication has started to work the past two days. I also have control over my bowel movement, but I using stool softeners and laxatives (suppositories) to assist in me in my bowel movements and prevent further hemorrhoids from forming.

The next appointment with my neurosurgeon is on the 22nd August. However, as I am very concerned about my own health and future, and I have the following burning questions that I would like to have answered:

1.) Before my first operation, I had no symptoms (numbness or pain) in my saddle area, difficulty in passing urine or having bowel movements. Why after the operation did these symptoms appear? Was it because the nerves were damaged by the herniated disc and after the decompression the nerve needs time to recover? Or is it possible that the nerves to my saddle area and left leg was damaged by the surgeon during the laminectomy and discectomy operation?

2.) What is the likely cause of the damage to the dural? As per the above question, was it caused by the herniated disc or could the surgeon have damaged the dural during the first operation? Is damage to the dural not an indication that the neurosurgeon caused the nerve damage? How does this correspond with the comments from the radiologist on the MRI?

3.) It has now been 4 weeks since my first operation, and I still have the same numbness in my saddle area, and the other symptoms are still there. What are the chances of a full recovery for me? I understand the nerve can regenerates at a rate of +/- 1cm per month. Is it possible to put an estimated time on the recovery period for the numbness in my left leg, buttock and saddle area goes away?

4.) My biggest concern is that the symptoms does not go away and that it worsens and I develop Cauda Equina Syndrome (CES). Is CES not usually caused by nerve damage lower down the spine at the L5/S1 level?

5.) Is there anything else that I can do now to increase the chances of a full recovery? Will more cortisone or steroids assist the nerve regeneration now? Anything other medicine that could assist?

6.) Will another MRI scan assist now? Is it possible that there was something else that happened after the MRI in July, that another MRI will show?

7.) I am I being too impatient and should I give myself more time to recover? Should I seek another neurosurgeon for an examination and another opinion?

8.) Any other advise for me?


Thank you very much.

Kind regards
XXXX
Posted Sat, 23 Aug 2014 in Back Pain
 
 
Answered by Dr. S K Mishra 3 hours later
Brief Answer:
This happens sometimes after such surgery

Detailed Answer:
Hi,

Your description is detailed, good.This happens sometimes after such surgery and not very very rare.

1.Retraction of thecal sac(containing nerve roots as there is no spinal cord in this area) which is essential to remove large central disc prolapse(as there was complete loss of signal on MR myelogram) sometimes may cause retraction edema in nerves leading to saddle anesthesia and bladder involvement which is usually temporary.
2. First thing dural damage does not mean damage to nerves , and secondly you were re operated for that and surgeon denied.

3,7.Already 4 weeks have passed after surgey and you have started recovering. Usually bladder is last to recover. I expect a further recovery over next few months.

4. Cauda equina syndrome is symptom is not a disease itself rather it is due to damage to cauda equina due to various causes or diseases.

5.Drugs are unlikely to help .you may take methycobalamin.

6,8.Continue physiotherapy. You may ask for MRI and there is no harm in consulting another neurosurgeon.

Hope I was able answer your query.
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