Teramoto Sakiko, Kurosawa Nagayuki, Ito Hiroki, Nagai Shingo, Kubota Yasuyuki
Division of Urology, Toyota Memorial Hospital.
Nihon Hinyokika Gakkai Zasshi. 2024;115(3):124-127. doi: 10.5980/jpnjurol.115.124.
Dysuria is caused by bladder outlet obstruction (BOO) and detrusor underactivity. Female BOO is often overlooked because it is difficult to diagnose a condition from history and symptoms alone. Fowler's syndrome is seen in young women and causes urinary retention due to a primary disorder of urethral sphincter relaxation. Although the level of evidence is still low, sacral neuromodulation or intra-sphincteric Botulinum toxin injection has been applied to Fowler's syndrome. A 44-year-old woman with a chief complaint of dysuria started clean intermittent catheterization because of urinary retention. Videourodynamics showed BOO, open bladder neck, and narrowing of the middle urethra during voiding, and MRI showed thickening of the urethral sphincter. A neurological examination was performed with no neurologic features, so the diagnosis of Fowler's syndrome was suggested. The possibility of a diagnosis of female BOO should always be kept in mind when a woman has dysuria, and urodynamic study or Videourodynamics should be considered.
排尿困难由膀胱出口梗阻（BOO）和逼尿肌活动低下引起。女性膀胱出口梗阻常被忽视，因为仅根据病史和症状很难诊断病情。福勒氏综合征见于年轻女性，由于尿道括约肌松弛的原发性疾病导致尿潴留。尽管证据水平仍然较低，但骶神经调节或括约肌内注射肉毒杆菌毒素已应用于福勒氏综合征。一名44岁以排尿困难为主诉的女性因尿潴留开始进行清洁间歇性导尿。影像尿动力学检查显示膀胱出口梗阻、膀胱颈开放以及排尿时尿道中段狭窄，磁共振成像显示尿道括约肌增厚。进行了神经学检查，未发现神经学特征，因此提示诊断为福勒氏综合征。当女性出现排尿困难时，应始终考虑女性膀胱出口梗阻的诊断可能性，并应考虑进行尿动力学研究或影像尿动力学检查。
