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Commentary on “Erectile Dysfunction as a Sentinel Presenting Feature of Cauda Equina Syndrome”


Eric Chung, Dr. Alice Thompson


Department of Neurology, University Medical Center


Eric Chung, Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane QLD 4000 Australia; Tel: 07 33242468; Fax: 07 33242546.


The case report by Chengde Pham and Jin W. Tee entitled “Erectile Dysfunction as a Sentinel Presenting Feature of Cauda Equina Syndrome” offers an intriguing perspective on the presentation of cauda equina syndrome (CES) with a solitary symptom of erectile dysfunction (ED). This case underscores the complexity of diagnosing CES, a condition traditionally associated with a variety of neurological deficits but not commonly presented with ED alone. While the report is enlightening, it raises questions about the broader implications for clinical practice, particularly in the initial assessment and differential diagnosis of similar cases.

Firstly, the authors’ emphasis on the absence of traditional CES symptoms such as lower limb weakness, sensory deficits, or bowel and bladder dysfunction in the presence of ED is notable. However, the discussion could benefit from a deeper exploration of the neuroanatomical connections between the cauda equina and erectile function. Detailing these pathways could enhance understanding of how isolated ED might occur as a result of cauda equina compression without other neurological symptoms.

Secondly, while the case effectively highlights the importance of considering a broad differential diagnosis when a patient presents with ED, further discussion on the specific diagnostic strategies that should be employed in similar cases would be beneficial. For example, the utility of routine pelvic and lumbar spine imaging in patients presenting with new-onset ED without clear etiology could be debated. This could help establish clearer guidelines for clinicians who might encounter similar presentations.

Furthermore, the report briefly mentions the resolution of ED following surgical intervention but does not discuss the long-term follow-up for such patients. It would be advantageous to know the duration of ED prior to intervention and any long-term neurologic or sexual function outcomes. This information could provide insight into the critical time window for surgical intervention to prevent permanent dysfunction.

Moreover, this case presents an opportunity to discuss the broader implications for sexual history taking in clinical practice. The authors rightly point out that sexual histories are often inadequately explored. Expanding this discussion to include practical advice on how to sensitively and thoroughly take sexual histories could be an invaluable addition for practitioners reading this case report.


The case presented by Pham and Tee is a valuable contribution to the literature on cauda equina syndrome and its varied presentations. However, by expanding the discussion on neuroanatomical considerations, diagnostic strategies, long-term outcomes, and sexual history taking, the report could further enhance its impact. Providing these additional details would not only clarify the clinical approach to similar cases but also underscore the need for comprehensive assessments in patients presenting with erectile dysfunction.


  1. Pham C, Tee JW (2018) Erectile Dysfunction as a Sentinel Presenting Feature of Cauda Equina Syndrome. JSM Spine 3(1): 1014. Article DOI :