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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Urinary urgency following second lamenectomy of L5S1Forum: Neurology Forum
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My 37 year old wife just underwent her second lamenectomy in 14 months at L5 S1. Her original symptoms were diagnosed as saddle anesthesia as a result of a herniated disk which reduced and almost eliminated her bladder and bowel function. Her glutal and genital area also lost all sensation. The fisrts surgery to correct this was generally a success. She immediately regained her bladder and bowel function but some of the numbness remained for up to a year. Six weeks ago she started experiencing some recurrent symptoms which lead to her first operation. The symptoms were creeping and she was starting to lose some of her bladder and bowel function again. The neurosurgeon who performed the first surgery said not to worry about it. After persistent calls to his office that the problem was getting worse, he finally agreed to see us only after we got an MRI. After we got the MRI, he noticed some slight herniation and some scarring, but said he still did not see anything that could be causing the present problems. He decided to take it to a radiologist who did point out to him that there was some disk pushing on the nerve. He did operate four weeks ago to take out more of the disk. Post-operatively, everything seemed to be going OK until my wife developed a constant urinary urgency sensation 10 days later. The neurosurgeon has been no help and referred us to a urologist, who in turn referred us to a neurologist, who in turn referred us back to the urologist. The urologist prescribed some bladder relaxing medicine which has helped ease the sensation mildly, but sporadically. All of the physicians we have met with think this sensation is temporary, but my wife is scared to death that it will be permanent and the longer the sensation persists the more depressed she is getting. The only true relief she gets is while she is resting in bed or sleeping. Could the surgeon have injured her some how that may have resulted in her current problem? If this is arachnoiditis, could the neurosurgeon have caused it and if not, what is the genesis of this problem? What can we do to get a diagnosis? How long should we wait for the symptoms to go away before we pursue arachnoiditis as a diagnosis? I would appreciate any insight you can provide. Sincerely, Josh As I understand it, your wife had incontinence that was improved after both the first and second surgeries and now has urgency, which is a little different that the original incontinence. It is conceivable that there was damage done at surgery, but this would be unusual in a relatively common procedure such as this. First of all, it is early after surgery and symptoms present before surgery do not necessarily go away overnight. The nerves need some time to heal. Second, there may be something very simple going on such as a urinary tract infection that may cause some urgency. Perhaps this has been investigated already. Urologists can also do studies to see whether a patient's sensation is intact and whether the sphincters function correctly. Often symptoms linger after surgery in spite of a successful procedure. Your surgeon, based on this, may choose conservative measures for the time being and see how your wife does clinically. If your wife continues to have problems or begins to get worse, your surgeon may consider another MRI. If you get to this point you may consider a second opinion to be sure you are on the right track. Good luck.
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