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Tests of Urethral Function
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Kristi L. Hebert, Barry G. Hallner, Ryan M. Krlin, J. Christian Winters
Fowler syndrome wAs first described in 1985 in young women with Urinary retention [69]. The sphincter eMG signAl in these women contAins repetitive dischArges And decelerAting bursts. This impAirs sphincter relAxAtion And leAds to obstructed voiding with either incomplete emptying or retention. The development of the sphincter AbnormAlity mAy
Electrophysiological evaluation: Basic principles and clinical applications
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Fowler’s syndrome, which is urinary retention, with the CNEMG findings as above, associated with polycystic ovaries,104 is reported as the commonest cause of urinary retention in a series of 297 women.105 Most commonly, the initial episode of urinary retention is precipitated by a gynecological surgical procedure using general anesthesia at a mean age of 28 years. It is not associated with a generalized neurological disorder.106 It was shown that this pathological spontaneous activity endures during micturition and may cause interrupted flow.22 The disorder of sphincter relaxation appears to lead to secondary changes in detrusor function – either instability or failure of contractility.
Primary care providers’ knowledge about the therapeutic management of refractory pelvic floor dysfunctions in Flanders, Belgium: a cross-sectional study
Published in Acta Chirurgica Belgica, 2021
Lynn Ghijselings, Kim Pauwaert, Wesley Verla, Dimitri Beeckman, Dirk Van de Putte, Piet Pattyn, Karel Everaert
The extent of knowledge of SNM was further categorized by a grading system based on the results of multiple-choice questions and one open answer question (Table A1). Having heard of SNM before, without having additional knowledge, was defined as having superficial or grade 1 knowledge. Having grade 2 knowledge was defined as giving at least one correct answer on the 2 additional MCQ questions regarding the type and course of the procedure. Regarding the type of the procedure, the answer was correct if the response ‘SNM being an invasive procedure with implantation of an electrode and a battery, stimulating the sacral nerves’ was given. The question concerning the course of the procedure was indicated as correct if they knew SNM is a two-stage surgical procedure with the implantation of the electrode as the first stage, i.e. the test phase, followed by the implantation of the definitive neuromodulator in a second stage. Grade 3 was defined as having grade 2 knowledge and additionally being able to enumerate at least one indication for SNM. American Food and Drug Association (FDA) approved indications are idiopathic OAB dry, OAB wet, chronic non-obstructive urinary retention, dysfunctional voiding, Fowler’s Syndrome, and FI [12].
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
Sacral neuromodulation (SNM) could be an effective option for non-obstructive urinary retention. Lombardi et al. determined the efficacy of SNM for neurogenic non-obstructive urinary retention in patients with incomplete spinal cord lesions and found that 42.4% (36 in 85) of patients improved by percutaneous first stage of SNM [122]. SNM was also applied for women with Fowler’s syndrome who had chronic urinary retention and resulted in return of voiding [123]. Generally, SNM is beneficial for patients with an intact spinal cord, micturition center, and spinal roots [57].
Sacral neuromodulation for female pelvic floor disorders
Published in Arab Journal of Urology, 2019
Ahmed S. El-Azab, Steven W. Siegel
We included in our review three studies assessing the effectiveness of SNM in women with urinary retention [14,15,25]. Dasgupta et al. [25] reviewed the results of SNM in a group of 26 women with Fowler’s syndrome (FS). After 72 months follow-up, they reported an impressive success rate, with 20/26 patients (77%) voiding spontaneously without need for CIC. Dasgupta and Fowler [26] analysed the urodynamic data of those women with refractory urinary retention due to FS who underwent SNM. They found that sphincter activity does not change after SNM, whilst detrusor contractility increases. They postulated that this increase in contractility led to improved voiding in those patients as a result of SNM. FS, which mostly affects young women, may represent the most common identifiable cause of urinary retention in women. Retention is due to primary abnormality of the striated urethral sphincter, with an abnormal increase in sphincter electromyographic activity associated with elevated maximum urethral closure pressure. Prolonged increase in the urethral closure pressure in those women leads to detrusor failure (the detrusor contraction is inhibited) and suppression of bladder sensation. That is why retention in those women is associated with large bladder volumes (>1 L) and is not associated with a severe desire to void as might be expected [26]. It has been postulated from several functional MRI and positron emission tomography (PET) studies that the brain response to bladder afferents is attenuated in patients with FS. A study using PET has documented the attenuation of the brain response to a full bladder in patients with FS. The study documented the deactivation of the regional brain matrix regions implicated in control of the bladder (the periaqueductal grey and thalamus), an action that was reversed by SNM. With SNM afferent activity reaches the periaqueductal grey, presumably because SNM blocks urethral inhibition of afferent information flow from the bladder, thus enabling voiding [27,28].