Fowler's Syndrome-The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat.

Jacek K Szymański,Grzegorz Jakiel,Aneta Słabuszewska-Jóźwiak

doi:10.3390/ijerph18063310

Abstract

Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity. Several hypotheses have arisen to explain the cause of urethral relaxation disorders: hormonal changes characteristic of Polycystic Ovary Syndrome (PCOS), causing abnormal stabilization of the muscle membrane, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity, inhibiting the bladder afferent signals from reaching the brain by potentiating a spinal mechanism of urinary continence. Currently, sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with Fowler’s syndrome. The therapeutic effectiveness exceeds 70%, although the revision rate is relatively high, exceeding 50%. Well-designed, long-term prospective studies comparing sacral neuromodulation (SNM) with other therapies such as pelvic floor muscle physiotherapy are warranted to offer the best patient-tailored treatment.

Highlights

This study aimed to review the literature on the current knowledge of Fowler’s syndrome with consideration of sacral neuromodulation as a modern therapeutic method
Fowler and her colleagues described a syndrome in young women who demonstrated urinary retention as the primary symptom, accompanied by an abnormality in electromyography (EMG) of the striated muscle of the urethral sphincter, which was related to a pathological contraction of the muscle [13,29]
The medical community should be aware of this pathology disrupting the quality of life of young women

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Urinary retention in young women is a relatively rare clinical problem. Epidemiological studies estimate that its incidence in young women ranges from 3 cases per 100,000 per year to 0.3% after the exclusion of other causes, such as postoperative, postpartum, gynecological, urological, rectal, and psychiatric causes [1,2,3]. The incidence of Fowler’s syndrome is rated at 0.2 cases per 100,000 per year [4]

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