First Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 Str., 01-004 Warsaw, Poland.
Int J Environ Res Public Health. 2021 Mar 23;18(6):3310. doi: 10.3390/ijerph18063310.
Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler's syndrome, which is associated with impaired urethral relaxation. Fowler's syndrome is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity. Several hypotheses have arisen to explain the cause of urethral relaxation disorders: hormonal changes characteristic of Polycystic Ovary Syndrome (PCOS), causing abnormal stabilization of the muscle membrane, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity, inhibiting the bladder afferent signals from reaching the brain by potentiating a spinal mechanism of urinary continence. Currently, sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with Fowler's syndrome. The therapeutic effectiveness exceeds 70%, although the revision rate is relatively high, exceeding 50%. Well-designed, long-term prospective studies comparing sacral neuromodulation (SNM) with other therapies such as pelvic floor muscle physiotherapy are warranted to offer the best patient-tailored treatment.
年轻女性的尿潴留是一种相对罕见的临床问题，往往被漏诊。特别是，尿潴留的功能性原因构成了诊断挑战。其中之一是福勒氏综合征，它与尿道松弛功能障碍有关。福勒氏综合征的特点是膀胱容量大、感觉减退、最大尿道闭合压升高和逼尿肌活动低下。已经出现了几种假说来解释尿道松弛障碍的原因：多囊卵巢综合征（PCOS）特有的激素变化导致肌肉细胞膜异常稳定、尿道横纹肌初始松弛失败、以及尿道传入活动增加，通过增强脊髓的尿控机制来抑制膀胱传入信号到达大脑。目前，骶神经调节是唯一可以恢复福勒氏综合征女性非典型排尿模式的干预措施。其治疗效果超过 70%，尽管修订率相对较高，超过 50%。需要进行设计良好、长期的前瞻性研究，比较骶神经调节（SNM）与其他治疗方法（如盆底肌肉物理治疗），为患者提供最佳的个体化治疗。
