Gynaecological pathology in women with Fowler's syndrome

Karmarkar, Roopali; Abtahi, Bahareh; Saber-Khalaf, Mohammed; Gonzales, Gwen; Elneil, Sohier

doi:10.1016/j.ejogrb.2015.08.009

Cited by 12 publications

(6 citation statements)

References 20 publications

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“… 3 A possible, however, not proven, hormonally dependent etiology is supported by the high association with polycystic ovaries or endometriosis in up to 50% of the patients compared with 20 to 30% in healthy female population. 4 …”

Section: Discussionmentioning

confidence: 99%

Chronic Urinary Retention due to Fowler's Syndrome

Trachta

Wachter

Kříž

2018

European J Pediatr Surg Rep

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Fowler's syndrome (FS) is a rare cause of chronic urinary retention in teenage girls and young women. We present a case of a 14-year-old girl who presented at our hospital 2 weeks after uncomplicated laparoscopic appendectomy. The girl complained of reduced urinary frequency and prolonged micturition time. Following an acute cystitis 2 months later, she completely lost her ability to void. A comprehensive set of investigations to assess the cause of her urinary retention including a cerebral and spinal magnetic resonance imaging (MRI), and videourodynamics were performed. The diagnostic workup revealed polycystic ovaries and an asensitive and hypotonic bladder with capacity up to 1200 mL and high maximum urethral pressure of 120 cm of water. She did not tolerate clean intermittent catheterization; therefore, a suprapubic catheter was placed. Under this treatment, she suffered recurrent urinary tract infections. Two years later, she was diagnosed with FS on the basis of the medical history, clinical symptoms, and urodynamic findings. Finally, the implantation of a S3 neurostimulator restored her ability to void.

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Section: Discussionmentioning

confidence: 99%

Chronic Urinary Retention due to Fowler's Syndrome

Trachta

Wachter

Kříž

2018

European J Pediatr Surg Rep

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“…The most prevalent were endometriosis, polycystic ovarian syndrome (PCOS), and subfertility. Although the incidence of these pathologies reached statistical significance, their occurrence in the FS group and the controls stayed within the population range, making the theory of the increased concomitance of FS with other gynecological pathologies tenuous [13,14]. Another theory assumes that the primary failure of relaxation of the striated muscle of the urethral sphincter leads to a raised urethral pressure profile.…”

Section: Pathophysiology Of Fowler's Syndromementioning

confidence: 99%

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

Szymański

Słabuszewska-Jóźwiak

Jakiel

2021

IJERPH

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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.

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“…External urethral sphincter electromyography patterns show complex repetitive discharges with bursts of deceleration [14] (although it should be noted that these findings can also be present in asymptomatic women [15]), and a high maximal urethral closure pressure on urethral pressure profilometry. This condition was originally described in women of reproductive age, but has been reported in women of all ages and can be associated with concurrent diagnoses of polycystic ovarian syndrome and endometriosis [16]. It is imperative that women with urinary retention are not inappropriately labelled with a diagnosis of HTNRS without considerable observation and assessment for alternative causes.…”

Section: Functional Disordersmentioning

confidence: 99%

British Association of Urological Surgeons (BAUS) consensus document: Management of female voiding dysfunction

et al. 2021

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To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction. MethodsA contemporary literature search was conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used. ResultsFemale patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided. ConclusionWa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients.

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Gynaecological pathology in women with Fowler's syndrome

Cited by 12 publications

References 20 publications

Chronic Urinary Retention due to Fowler's Syndrome

Chronic Urinary Retention due to Fowler's Syndrome

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

British Association of Urological Surgeons (BAUS) consensus document: Management of female voiding dysfunction

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