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''''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.<ref>{{Citation|last=Wein|first=Alan J.|title=Pathophysiology and Classification of Lower Urinary Tract Dysfunction|date=2012|url=http://dx.doi.org/10.1016/b978-1-4160-6911-9.00061-x|work=Campbell-Walsh Urology|pages=1834–1846.e1|publisher=Elsevier|isbn=978-1-4160-6911-9|access-date=2020-05-26}}</ref> == 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|Polycystic ovary Syndrome]] and [[Endometriosis]].<ref name=":0">{{Cite journal|last=Panicker|first=Jalesh N|last2=Pakzad|first2=Mahreen|last3=Fowler|first3=Clare J|date=April 2018|title=Fowler's syndrome: a primary disorder of urethral sphincter relaxation|url=http://doi.wiley.com/10.1111/tog.12448|journal=The Obstetrician & Gynaecologist|language=en|volume=20|issue=2|pages=95–100|doi=10.1111/tog.12448}}</ref> It is seen in about one third of women having complaints of urinary retention.<ref>{{Cite web|title=The Possible Role of Opiates in Women With Chronic Urinary Retention: Observations From a Prospective Clinical Study|url=https://pubmed.ncbi.nlm.nih.gov/22704100/|last=Jn|first=Panicker|last2=X|first2=Game|date=August 2012 |website=The Journal of urology|language=en|pmid=22704100|access-date=2020-05-26|last3=S|first3=Khan|last4=Tm|first4=Kessler|last5=G|first5=Gonzales|last6=S|first6=Elneil|last7=Cj|first7=Fowler}}</ref> They will have no neurological or other urological complaints. Alternatively, women with FS can also present with impairment in urination, like obstructed urination or increased frequency of urination but rarely becoming incontinent.<ref name=":0" /> Clinical features seen commonly in Fowler’s syndrome: <ref name="undefined" /> '''•''' Female. '''•''' Age between the onset of menarche and menopause, however, usually present in the third decade. '''•''' No evidence of urological, gynecological or neurological disease. '''•''' Urinary retention with volumes often >1000 ml. '''•''' No sense of urinary urge despite high bladder volumes. '''•''' Abdominal straining does not help with bladder emptying. '''•''' Sensation of ‘something gripping’ or difficulty in removing the catheter used for urinary drainage. '''•''' No history of urological abnormalities in childhood or associated abnormalities of the urinary tract. '''•''' Association with polycystic ovarian syndrome and endometriosis. == 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]].<ref name=":1" /> This may cause an excessive excitability of the external urethral sphincter which prevents the adequate relaxation of the muscle necessary for voiding .<ref>{{Cite web|title=Teaching Course: Ion Channelopathies in Neurology|url=https://pubmed.ncbi.nlm.nih.gov/10525971/|last=K|first=Jurkat-Rott|last2=H|first2=Lerche|date=September 1999 |website=Journal of neurology|language=en|pmid=10525971|access-date=2020-05-26|last3=N|first3=Mitrovic|last4=F|first4=Lehmann-Horn}}</ref> == Diagnosis == [[Cystometry|Cystometrogram]] shows large bladder capacity and absence of sensations during the filling phase. The maximum urethral closure pressure (MUCP) is raised.<ref>{{Cite journal|last=Wiseman|first=Oliver J.|last2=Swinn|first2=Michael J.|last3=Brady|first3=Ciaran M.|last4=Fowler|first4=Clare J.|date=March 2002|title=MAXIMUM URETHRAL CLOSURE PRESSURE AND SPHINCTER VOLUME IN WOMEN WITH URINARY RETENTION|url=http://www.jurology.com/doi/10.1016/S0022-5347%2805%2965297-4|journal=Journal of Urology|language=en|volume=167|issue=3|pages=1348–1352|doi=10.1016/S0022-5347(05)65297-4|issn=0022-5347}}</ref> The diagnosis is done by testing the [[Electromyography|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.<ref>{{Cite web|title=Abnormal Electromyographic Activity (Decelerating Burst and Complex Repetitive Discharges) in the Striated Muscle of the Urethral Sphincter in 5 Women With Persisting Urinary Retention|url=https://pubmed.ncbi.nlm.nih.gov/4038618/|last=Cj|first=Fowler|last2=Rs|first2=Kirby|date=February 1985 |website=British journal of urology|language=en|pmid=4038618|access-date=2020-05-26}}</ref><ref name=":1">{{Cite journal|last=Tawadros|first=Cecile|last2=Burnett|first2=Katherine|last3=Derbyshire|first3=Laura F.|last4=Tawadros|first4=Thomas|last5=Clarke|first5=Noel W.|last6=Betts|first6=Christopher D.|date=September 2015|title=External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle|url=http://doi.wiley.com/10.1111/bju.13042|journal=BJU International|language=en|volume=116|issue=3|pages=423–431|doi=10.1111/bju.13042}}</ref> == Treatment == [[Sacral neuromodulation|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.<ref>{{Cite web|title=Sacral Neuromodulation for Women With Fowler's Syndrome|url=https://pubmed.ncbi.nlm.nih.gov/11025383/|last=Mj|first=Swinn|last2=Nd|first2=Kitchen|date=October 2000 |website=European urology|language=en|pmid=11025383|access-date=2020-05-26|last3=Rj|first3=Goodwin|last4=Cj|first4=Fowler}}</ref><ref>{{Cite web|title=Neuromodulation - A Therapeutic Option for Refractory Overactive Bladder. A Recent Literature Review|url=https://pubmed.ncbi.nlm.nih.gov/31908692/|last=Jk|first=Szymański|last2=A|first2=Słabuszewska-Jóźwiak|date=December 2019 |website=Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques|language=en|doi=10.5114/wiitm.2019.85352|pmc=6939208|pmid=31908692|access-date=2020-05-26|last3=K|first3=Zaręba|last4=G|first4=Jakiel}}</ref> == History == This disease was described first by Fowler et al in 1985.<ref>{{Cite web|title=Abnormal Electromyographic Activity of the Urethral Sphincter, Voiding Dysfunction, and Polycystic Ovaries: A New Syndrome?|url=https://pubmed.ncbi.nlm.nih.gov/3147005/|last=Cj|first=Fowler|last2=Tj|first2=Christmas|date=1988-12-03|website=BMJ (Clinical research ed.)|language=en|doi=10.1136/bmj.297.6661.1436|pmc=1835186|pmid=3147005|access-date=2020-05-26|last3=Cr|first3=Chapple|last4=Hf|first4=Parkhouse|last5=Rs|first5=Kirby|last6=Hs|first6=Jacobs}}</ref> 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 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. Panicker JN, Pakzad M, Fowler CJ. Fowler’s syndrome: a primary disorder of urethral sphincter relaxation. The Obstetrician & Gynaecologist 2018;20:95–100. https://doi.org/10.1111/tog.12448 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.'