(Page 376) PRE-OPERATIVE MANAGEMENT Avoid unacceptable delay A more frequent claim for potential medical negligence is an unacceptable delay in a patient who has a bladder problem. Spinal pathology which compromises the sacral nerves supplying the bladder generally requires emergency treatment. Every surgeon knows that a patient who has a spine problem and is unable to pass urine or alternatively is incontinent of urine has a potentially serious condition. Involvement of the L5 nerve may leave a patient with a foot drop and some numbness of the foot. It is a disability, but not serious even if it does not recover. However, involvement of the sacral nerves which supply the bladder is a major problem. When the symptoms have been there for more than a few hours the problem tends to be permanent, with loss of normal bladder function for a lifetime. The same nerves supply the bowel and sexual function, which are also permanently affected1.

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