Fowler's syndrome: Difference between revisions
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Revision as of 13:37, 19 July 2020
| Fowler's syndrome | |
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| Specialty | Urologist |
Fowler's syndrome (Non neurogenic urinary retention) is a disease characterized by urinary retention with abnormal EMG activity in young women in the absence of overt neurological disease.[1]
Presentation
This condition affects women, often under the age of 30 years. The predominant complaint is the inability to urinate for a day or more with no urgency to urinate, in spite of a large bladder volume of more than 1 liters. Normally a person feels the need to urinate at a bladder volume of 400-500ml. The person usually has a progressively increasing lower abdominal pain. The condition is commonly seen in women with Polycystic ovary Syndrome and Endometriosis.[2] It is seen in about one third of women having complaints of urinary retention.[3] They will have no neurological or other urological complaints.[citation needed]
Alternatively, women with FS can also present with impairment in urination, like obstructed urination or increased frequency of urination but rarely becoming incontinent.[2]
Cause
The exact cause of Fowler's syndrome is not yet known.The probable cause is an abnormality in muscle membrane, possibly due to a hormonally dependent channelopathy.[4] This may cause an excessive excitability of the external urethral sphincter which prevents the adequate relaxation of the muscle necessary for voiding .[5]
Diagnosis
Cystometrogram shows large bladder capacity and absence of sensations during the filling phase. The maximum urethral closure pressure (MUCP) is raised.[6]The diagnosis is done by testing the electromyographic(EMG) activity of external striated urethral sphincter. The usual findings are complex repetitive discharges(CRDs) without deceleration and CRDs with deceleration (decelerating bursts,DBs)suggesting an impairment in sphincter muscle relaxation.[7][4]
Treatment
Sacral neuro modulation is the commonly practiced treatment for restoration of normal micturition.This technique involves modulation of micturition reflex by stimulating S3 nerve root.[8][9]
History
This disease was described first by Fowler et al in 1985.[10]
References
- ^ Wein, Alan J. (2012), "Pathophysiology and Classification of Lower Urinary Tract Dysfunction", Campbell-Walsh Urology, Elsevier, pp. 1834–1846.e1, ISBN 978-1-4160-6911-9, retrieved 2020-05-26
- ^ a b Panicker, Jalesh N; Pakzad, Mahreen; Fowler, Clare J (April 2018). "Fowler's syndrome: a primary disorder of urethral sphincter relaxation". The Obstetrician & Gynaecologist. 20 (2): 95–100. doi:10.1111/tog.12448.
- ^ Jn, Panicker; X, Game; S, Khan; Tm, Kessler; G, Gonzales; S, Elneil; Cj, Fowler (August 2012). "The Possible Role of Opiates in Women With Chronic Urinary Retention: Observations From a Prospective Clinical Study". The Journal of urology. PMID 22704100. Retrieved 2020-05-26.
- ^ a b Tawadros, Cecile; Burnett, Katherine; Derbyshire, Laura F.; Tawadros, Thomas; Clarke, Noel W.; Betts, Christopher D. (September 2015). "External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle". BJU International. 116 (3): 423–431. doi:10.1111/bju.13042.
- ^ K, Jurkat-Rott; H, Lerche; N, Mitrovic; F, Lehmann-Horn (September 1999). "Teaching Course: Ion Channelopathies in Neurology". Journal of neurology. PMID 10525971. Retrieved 2020-05-26.
- ^ Wiseman, Oliver J.; Swinn, Michael J.; Brady, Ciaran M.; Fowler, Clare J. (March 2002). "MAXIMUM URETHRAL CLOSURE PRESSURE AND SPHINCTER VOLUME IN WOMEN WITH URINARY RETENTION". Journal of Urology. 167 (3): 1348–1352. doi:10.1016/S0022-5347(05)65297-4. ISSN 0022-5347.
- ^ Cj, Fowler; Rs, Kirby (February 1985). "Abnormal Electromyographic Activity (Decelerating Burst and Complex Repetitive Discharges) in the Striated Muscle of the Urethral Sphincter in 5 Women With Persisting Urinary Retention". British journal of urology. PMID 4038618. Retrieved 2020-05-26.
- ^ Mj, Swinn; Nd, Kitchen; Rj, Goodwin; Cj, Fowler (October 2000). "Sacral Neuromodulation for Women With Fowler's Syndrome". European urology. PMID 11025383. Retrieved 2020-05-26.
- ^ Jk, Szymański; A, Słabuszewska-Jóźwiak; K, Zaręba; G, Jakiel (December 2019). "Neuromodulation - A Therapeutic Option for Refractory Overactive Bladder. A Recent Literature Review". Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. doi:10.5114/wiitm.2019.85352. PMC 6939208. PMID 31908692. Retrieved 2020-05-26.
- ^ Cj, Fowler; Tj, Christmas; Cr, Chapple; Hf, Parkhouse; Rs, Kirby; Hs, Jacobs (1988-12-03). "Abnormal Electromyographic Activity of the Urethral Sphincter, Voiding Dysfunction, and Polycystic Ovaries: A New Syndrome?". BMJ (Clinical research ed.). doi:10.1136/bmj.297.6661.1436. PMC 1835186. PMID 3147005. Retrieved 2020-05-26.