first described in 1988 as a syndrome which occurs in teenage girls and young women (1)
is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity (2)
is described only in hormonally active women between menarche and menopause, never in males, with a peak incidence between 20 and 30 years of age
epidemiological studies estimate that its incidence in young women ranges from 3 cases per 100,000 per year to 0.3% after the exclusion of other causes, such as postoperative, postpartum, gynecological, urological, rectal, and psychiatric causes (2)
characterized by chronic urinary retention with the history of general anesthesia for varying reasons, prolonged use of opiates, or delivery
most of the patients reveal a trigger medical event in their history, such as gynecological surgery or other surgical procedures, childbirth, and acute medical conditions (2)
pathognomonic clinical signs are (1):
unexplained urinary retention of more than 1 litre of sterile urine on catheterization,
an asensitive bladder with loss of urge to void, and
no help of straining, poor tolerance of clean intermittent self-catheterization
difficulties of self-catheterization are typically described as a sense of "something gripping" the catheter inside the bladder as it is being pulled out of the bladder
etiology of Fowler's syndrome remains unclear (2)
in around 50% of the patients, there is an association with polycystic ovaries or endometriosis
functional retention is caused by external urethral sphincter (EUS) spasm due to vicious circle of autonomous excitation of sphincter muscle cells and failure to relax
EUS hyperactivity is followed by an asensitive and hypotonic bladder with permanent loss of the ability to void
Reference:
Trachta J, Wachter J, Kriz J. Chronic Urinary Retention due to Fowler's Syndrome. European J Pediatr Surg Rep. 2018 Jan;6(1):e77-e80. doi: 10.1055/s-0038-1672147. Epub 2018 Oct 18. PMID: 30473987; PMCID: PMC6193800.
Szymanski JK et al. Fowler's Syndrome-The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat. Int J Environ Res Public Health. 2021 Mar 23;18(6):3310. doi: 10.3390/ijerph18063310. PMID: 33806865; PMCID: PMC8005021.
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