Fowler’s Syndrome of Recurrent Painless Retention in Women

Abstract

Fowler’s syndrome is a painless retention of urine occurring in young women with no obvious organic cause, commonly associated with polycystic ovarian disease. It is believed that increased afferent signaling from the urethra due to a poorly relaxing external urethral sphincter inhibits the afferent activity from the bladder leading to poor bladder sensation and detrusor underactivity. Diagnosis is based on clinical, video-urodynamic and characteristic electromyography findings of the external urethral sphincter. Most of the literature on Fowler’s syndrome has limitations due to the small patient population often with no control group, variable definitions for diagnosis and absence of video-urodynamic data. Sacral neuromodulation has so far been the most effective treatment for restoring voiding in women with Fowler’s syndrome. Intrasphincteric injections of botulinum toxin is recently being explored as a possible outpatient-based treatment.