Fowlers syndrome 2018 TOG

Question 1

What is fowlers syndrome?

Answer 1

elevated urethral pressure profile, increased urethral sphincter volume and characteristically abnormal electromyography of the urethral sphincter.

Question 2

When to consider fowlers syndrome

Answer 2

Urinary retention and normal urological and neurological Ix

Question 3

Clinical features of fowlers syndrome

Answer 3

Reproductive ages female
No urological, gynae or Neuro disease
Rentention >1L
No urgency
Abdo straining not helping
Sensation ‘something gripping’ difficulty remove the catheter
Ass PCOS and endometriosis

Question 4

Structural causes of urinary retention (rare in women)

Answer 4

Urethral diverticula
Uterine/cervical fibroid
Vaginal wall cyst
Urethral stricture disease
Urethral tumours

Question 5

Neurological causes of urinnary retention

Answer 5

Spinal cord disease
Multiple system atrophy
Lesion of conus medullaris or conus medullaris
Radical pelvic surgery
Small fibre neuropathy – diabetes, amyloidosis
Meningitis retention syndrome

Question 6

Non-neurological causes of urinary retention

Answer 6

Fowler’s syndrome
Medications – opiates, drugs with anticholinergic activity
Chronic intestinal pseudo-obstruction

Question 7

Treatment of fowlers syndrome

Answer 7

Sacral neuromodulation (via S3 nerve route)
Success around 75%

New alternative treatment - botox injection into urethras, remains inconclusive