scholarly journals Fowler's syndrome: a primary disorder of urethral sphincter relaxation

2018 ◽  
Vol 20 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Jalesh N Panicker ◽  
Mahreen Pakzad ◽  
Clare J Fowler
Keyword(s):  
Urethral Sphincter ◽  
Primary Disorder ◽  
Fowler’S Syndrome

Urinary retention in women

2017 ◽  
Author(s):  
Clare J. Fowler ◽  
Jalesh N. Panicker
Keyword(s):  
Urinary Retention ◽  
Young Woman ◽  
Young Women ◽  
Emg Activity ◽  
Urethral Sphincter ◽  
Polycystic Ovaries ◽  
Medical Opinion ◽  
Positive Identification ◽  
Striated Urethral Sphincter ◽  
Fowler’S Syndrome

If a young woman in complete urinary retention is investigated and all urological and neurological investigations are found to be normal, the commonest diagnosis then made is Fowler’s syndrome (FS). Described by Fowler et al. in 1987, the original syndrome comprised of complete urinary retention with the finding of a particular pattern of electromyographic (EMG) activity recorded with a concentric needle electrode from the striated urethral sphincter, in a young woman with clinical features of polycystic ovaries. Prior to that, description medical opinion was that urinary retention in young women was due to ‘hysteria’; more had been written about ‘psychogenic urinary retention in women’ than any other possible causes. Twenty-five years on, the situation now seems to be that if neither the urologist or urologist can discover an underlying abnormality, the woman may be told she has FS without any positive identification of that condition.

scholarly journals Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Felix Preisser ◽  
Matthias Mueller ◽  
Lena H. Theissen ◽  
Maria N. Welte ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Radical Prostatectomy ◽  
Regression Models ◽  
Urethral Sphincter ◽  
Anatomical Characteristics ◽  
Logistic Regression Models ◽  
Pad Test ◽  
Type D ◽  
Multivariable Logistic Regression ◽  
Type C

Abstract Purpose To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.

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