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Fowler's syndrome—a cause of unexplained urinary retention in young women?

Nature Reviews Urology volume 11, pages 87–98 (2014)Cite this article

Subjects

Key Points

  • Fowler's syndrome, first described in 1988, is urinary retention in young women caused by a poorly relaxing external urethral sphincter and thought to be associated with polycystic ovaries

  • Women with Fowler's syndrome have an abnormal form of electrical activity on concentric needle electromyography of the external urethral sphincter

  • A poorly relaxing sphincter is thought to cause increased urethral afferent activity, which inhibits bladder afferent signalling leading to poor bladder sensation and detrusor underactivity

  • Most studies of Fowler's syndrome are limited due to small cohorts with no control group and a lack of videourodynamic data

  • Whether Fowler's syndrome represents a distinct cause of urinary retention or results from a maladaptive behaviour and is similar to dysfunctional voiding is unclear

  • Sacral neuromodulation can effectively restore normal voiding in patients with Fowler's syndrome, and appears to work by restoring afferent transmission to the brain

Abstract

Urinary retention in women is an uncommon and poorly understood condition. In 1986, Fowler and colleagues described a syndrome in young women with unexplained urinary retention associated with polycystic ovary syndrome. The underlying abnormality was a poorly relaxing external urethral sphincter that when studied using concentric needle electromyography showed a distinct abnormal pattern suggesting direct spread of impulses between muscle fibres. These findings were subsequently reproduced by other researchers and in larger patient cohorts, but remain the subject of much debate. A poorly relaxing sphincter is thought to cause increased urethral afferent activity, which inhibits bladder afferent signalling leading to poor bladder sensation and detrusor underactivity. Most studies of Fowler's syndrome are limited due to small cohorts with no control group and a lack of videourodynamic data. Whether Fowler's syndrome represents a distinct cause of urinary retention or results from a maladaptive behaviour and is similar to dysfunctional voiding is unclear. Application of sacral neuromodulation in patients diagnosed with Fowler's syndrome can restore normal voiding, in the absence of any effective pharmacotherapy or surgical treatment.

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Figure 1: Concentric needle electomyography recording.
Figure 2: Possible mechanism of voiding dysfunction and urinary retention in Fowler's syndrome.

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  1. Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, South Yorkshire, UK

    Nadir I. Osman & Christopher R. Chapple

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C. R. Chapple is a consultant and researcher for Allergan, Astellas, Pfizer and Recordati. N. I. Osman declares no competing interests.

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Osman, N., Chapple, C. Fowler's syndrome—a cause of unexplained urinary retention in young women?. Nat Rev Urol 11, 87–98 (2014). https://doi.org/10.1038/nrurol.2013.277

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