The neurophysiology of urinary retention in young women and its treatment by neuromodulation

Abstract

Urinary retention occurring in young women as an isolated phenomenon was often thought to be psychogenic in origin. However, in 1988, Fowler et al. described a syndrome in young women in which urinary retention was the predominant feature and in which electromyography (EMG) of the striated urethral sphincter revealed a striking abnormality. This abnormality, it was postulated, would result in an inability of the sphincter to relax and retention would therefore result. Until recently there was no effective treatment for this disorder except management by clean intermittent self-catheterisation. However, preliminary results of neuromodulation using a Medtronic sacral nerve stimulator have been particularly promising in this group of patients. The response is often spectacular; a woman who has not passed urine per urethram for many months or years will frequently find that within a few hours of insertion of the percutaneous nerve evaluation (PNE) lead, she can void quite normally with little or no residual urine. The precise mechanism of action is yet to be defined, but measurements of the latency of anal sphincter contraction on S3 stimulation during PNE are so prolonged that they can only be the result of an afferent-mediated reflex.

Acute urinary retention

“…AUR in women may develop after surgery, or secondary to cystitis, infravesical obstruction, insuf®cient detrusor function, obstetrical and gynaecological conditions, or hysterical reactions [44] (Table 3). Fowler et al [45] and Goodwin et al [46] described a syndrome in young women aged 15±30 years (usually in their 20s) who presented with painless AUR associated with residual volumes usually >1000 mL. These young women commonly had a long history of voiding dif®culty, the most commonly reported being infrequent voiding (<2± 3 times/24 h).…”

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

“…Urinary retention is the inability to empty the bladder completely, and can lead to significant complications. Non-obstructive retention occurs when bladder pressure is insufficient to overcome outlet resistance and may result from bladder muscle hypocontractility (Jonas et al 2001), increases in the outlet resistance (Goodwin et al 1998), or both. Chronic urinary retention can lead to several urological complications including reflux, upper urinary tract damage, urinary tract infection, and overflow incontinence.…”

Urinary Side Effects of Duloxetine in the Treatment of Depression and Stress Urinary Incontinence

“…Other obstructive voiding symptoms were reported in 1.0% (19/1877) of women. These other obstructive voiding symptoms included difficulty in micturition (number of events = 5), urinary hesitation (3), urine flow decreased (2), and dysuria (9). One woman reported both difficulty in micturition and urinary retention.…”

“…[2][3][4] Vesico-urethral sphincter dyssynergia is related to the lack of striated urethral sphincter relaxation when the bladder contracts during voiding. The condition is rare and its pathophysiology is poorly understood, but in some women with the condition, particularly younger women, it may be due to neuronal damage.…”