Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom.
J Urol. 2012 Aug;188(2):480-4. doi: 10.1016/j.juro.2012.04.011. Epub 2012 Jun 15.
Urinary retention in women often presents a diagnostic difficulty, and the etiology may remain unidentified even after excluding structural and neurological causes. We evaluated a group of women referred to a specialist center with unexplained urinary retention.
A total of 61 consecutive women with complete urinary retention were evaluated. Urological and neurological investigations locally had failed to identify a cause. Urethral pressure profile, sphincter volume measurement and in some cases urethral sphincter electromyography were performed to diagnose a primary disorder of sphincter relaxation (Fowler's syndrome).
Mean patient age was 39 years (range 18 to 88). Following investigations, a probable etiology was identified in 25 (41%) women, the most common being Fowler's syndrome. Of the women 24 (39%) were being treated with opiates for various pain syndromes and in 13 no other cause of retention was identified. Opiates could be discontinued in only 2 patients, and both demonstrated improved sensations and voiding.
The cause of urinary retention may remain unknown in spite of extensive investigations. Young women regularly using prescription opiates for various undiagnosed pain syndromes present a challenging clinical problem and this study suggests that iatrogenic causes should be considered if voiding difficulties emerge. An association between opiate use and constipation is well-known and, although urinary retention is a listed adverse event, it appears to be often overlooked in clinical practice. It is hypothesized that Fowler's syndrome is due to an up-regulation of spinal cord enkephalins and that exogenous opiates may compound any functional abnormalities predisposing young women to urinary retention.
女性尿潴留常导致诊断困难，即使排除了结构和神经原因，病因仍可能无法确定。我们评估了一组因不明原因尿潴留而转至专科中心的女性患者。
共评估了 61 例完全性尿潴留的连续女性患者。局部的泌尿科和神经科检查未能确定病因。进行尿道压力描记、括约肌容量测量，某些情况下还进行尿道括约肌肌电图检查，以诊断括约肌松弛的原发性疾病（福勒综合征）。
患者平均年龄为 39 岁（18 至 88 岁）。经检查，25 例（41%）患者确定了可能的病因，最常见的病因是福勒综合征。24 例（39%）患者因各种疼痛综合征正在接受阿片类药物治疗，13 例患者未确定其他潴留原因。仅 2 例患者能够停用阿片类药物，且这 2 例患者的感觉和排尿均得到改善。
尽管进行了广泛的检查，但尿潴留的病因仍可能未知。经常因各种未确诊的疼痛综合征而定期使用处方阿片类药物的年轻女性会带来具有挑战性的临床问题，本研究表明，如果出现排尿困难，应考虑医源性原因。阿片类药物使用与便秘之间存在关联，尽管尿潴留是一种已列出的不良事件，但在临床实践中似乎经常被忽视。据推测，福勒综合征是由于脊髓内啡肽的上调，而外源性阿片类药物可能会加重任何使年轻女性易发生尿潴留的功能异常。
