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Urinary retention in women: its causes and management
Author(s) -
KAVIA RAJESH B.C.,
DATTA SOUMENDRA N.,
DASGUPTA RANAN,
ELNEIL SOHIER,
FOWLER CLARE J.
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06009.x
Subject(s) - medicine , urinary retention , psychogenic disease , urethral sphincter , urinary incontinence , gynecology , surgery , radiology
Urinary retention in women is a diagnostic and therapeutic challenge to urologists and to all involved in the treatment of the condition. The patients referred to a single institution with this condition over a 4‐year period were audited and the data are presented. The importance of Fowler's syndrome is described, as is the value of sacral nerve stimulation in this condition. In another paper, authors from France present evidence of occult dysautonomia in Fowler's syndrome. OBJECTIVE To report the experience of the last 4 years from a centre to which women with voiding difficulties and urinary retention were referred nationally, describing what investigations were helpful in making a diagnosis and the management strategies used PATIENTS AND METHODS Women with voiding difficulties and urinary retention remain a diagnostic and management challenge, and those with no anatomical or neurological basis for their symptoms may be dismissed, assuming that their retention has a psychogenic basis. The finding of an electromyographic (EMG) abnormality of the striated urethral sphincter explaining their disorder (Fowler's syndrome) has led to the referral of women for consideration of that diagnosis. Thus we audited the referrals to the centre over a 4‐year period of such women. RESULTS In all, 247 women (mean age 35 years) with complete (42%) or partial retention (58%) were referred; 175 (71%) had urethral pressure profilometry, 141 (57%) had a transvaginal ultrasonographic measurement of the sphincter volume, and 95 (39%) had sphincter EMG. The mean maximum urethral closure pressure difference between patients with an EMG abnormality (101.5 cmH 2 O) and the patients with known other causes of voiding dysfunction (66.2 cmH 2 O) was 35.3 cmH 2 O ( P < 0.05). In patients with complete retention there was a significant difference in sphincter volume between those who were EMG‐positive (2.14 mL) or EMG‐negative (1.64 mL) ( P < 0.05). CONCLUSION These investigations helped to classify the cause of retention in two‐thirds of cases. The commonest diagnosis was Fowler's syndrome, in which sacral nerve stimulation is the only intervention that restores voiding.