Introduction: Cauda equina syndrome (CES) is a neurosurgical emergency with a high risk of persistent bladder, bowel, and sexual dysfunction despite timely surgery. Most studies emphasise neurological or continence outcomes, with limited integration of urodynamic studies (UDS) and patient-reported measures (PROMs). This study evaluates functional recovery and the impact of surgical timing. Materials and

Methods: Forty-five CES patients (36 retrospective, 9 prospective) undergoing decompression were analysed. Prospective patients underwent pre- and postoperative UDS; retrospective patients had long-term postoperative UDS. Functional outcomes included NBDS (Neurogenic Bowel Dysfunction Score), USP (Urinary Symptom Profile), ASEX (sexual function), and SF-12 (quality of life). Surgical timing was analysed as a continuous variable and stratified into <24 h, 24–36 h, and >36 h. Statistical tests included Fisher’s exact, Kruskal–Wallis, Spearman’s correlation, and logistic regression.

Results: Median age was 39 years; 71% were male. Lumbar disc herniation accounted for 87% of cases. At 3 months, 78% showed UDS improvement, and 22% regained normal voiding. Long-term, 61% achieved contractile bladder function. NBDS correlated with UDS (ρ = 0.41, p = 0.02). Patients operated within 24–36 h had the highest recovery (68%) compared to 50% in <24 h and 46% in >36 h, though not statistically significant (p = 0.16).

Conclusions: Decompression results in meaningful but often incomplete bladder recovery in CES. Early intervention favours better outcomes. Combining UDS with PROMs offers a comprehensive assessment and should guide follow-up and rehabilitation.