From the Guidelines
Fowler's syndrome should be managed with clean intermittent catheterization as the initial treatment to empty the bladder, as it is a effective way to manage urinary retention. This approach is supported by the American Heart Association/American Stroke Association guidelines, which recommend intermittent catheterization for initial management of urinary retention 1.
Diagnosis and Treatment
The diagnosis of Fowler's syndrome involves urodynamic testing, electromyography of the urethral sphincter, and ruling out other causes of urinary retention. The condition is often associated with polycystic ovary syndrome and can be triggered by surgery, childbirth, or pain.
- Urodynamic testing to assess bladder function
- Electromyography of the urethral sphincter to evaluate muscle activity
- Ruling out other causes of urinary retention, such as obstruction or neurological disorders
Long-term Management
For long-term management, sacral neuromodulation (SNM) is a effective treatment option, involving implantation of a device that stimulates the sacral nerves to improve bladder function 1. Some patients may also benefit from urethral botulinum toxin injections to relax the sphincter.
- Sacral neuromodulation (SNM) for long-term management
- Urethral botulinum toxin injections as an alternative treatment option
Quality of Life
Fowler's syndrome can significantly impact quality of life, causing pain, recurrent urinary tract infections, and psychological distress. Early diagnosis and appropriate management are essential, as the condition tends to be chronic but can be effectively controlled with proper treatment.
- Pain management to reduce discomfort and improve quality of life
- Prevention of recurrent urinary tract infections through proper catheterization and hygiene techniques
- Psychological support to address distress and improve overall well-being
From the Research
Definition and Characteristics of Fowler's Syndrome
- Fowler's syndrome (FS) is a rare cause of chronic urinary retention in teenage girls and young women 2
- It is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity 3
- The syndrome is associated with impaired urethral relaxation, which can be caused by various factors, including hormonal changes, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity 3
Diagnosis and Investigation
- The diagnosis of FS is based on medical history, clinical symptoms, and urodynamic findings 2, 3
- Investigations such as cerebral and spinal magnetic resonance imaging (MRI), videourodynamics, and electromyographic examination can be used to assess the cause of urinary retention and rule out other conditions 2, 4
- Cardiovascular autonomic function tests (CAFTs) can also be used to detect occult dysautonomia, which may be present in women with FS 4
Treatment and Management
- Sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with FS, with a therapeutic effectiveness exceeding 70% 3
- However, the revision rate is relatively high, exceeding 50%, and well-designed, long-term prospective studies are needed to compare sacral neuromodulation with other therapies such as pelvic floor muscle physiotherapy 3
- Other treatment options, such as clean intermittent catheterization and suprapubic catheterization, may be used in some cases, but can be associated with complications such as urinary tract infections 2