Fowler's syndrome

Fowler's syndrome, or Isolated urinar retention in young women has been discussed since 2528, named after the names of those reported for the first time. The patients in this group that have not urinate. The catheter. But did not detect any abnormalities that would explain the piss out of it. It was found that 50 percent are associated with polycystic ovary because in this disease is still a very small number of patients have been treated not as pathological. The urethra has been extended due to the constricted urethra. Urinary catheter or a car, etc. In order to understand the importance of the issues outlined above at Fowler's syndrome.


The lower urinary tract.
The first class will have a basic knowledge of the urinary tract in the urine and urinary retention. Which is a function of the lower urinary tract is the main This includes the bladder. Mechanism of the sphincter. And neural control. The bladder is a muscular bag has the ability to stretch and shrink it. The capacity of approximately 300 to 400 ml with 150 ml of urine, it is known that the urine but no pain. It was only a delay. And the sphincter is closed. Urinary incontinence was not topping out. Sphincter in women, it means that this muscle from the urethra and bladder neck down to the end. It works automatically. The urethra is a muscle of the pelvic area is covered. Which operates under the control of the nervous system. If we want to hold your urine, it will instruct the muscle to work harder to squeeze the urethra.

When the urine is full, it sends out nerve impulses. From tight to the wall of the bladder through the S2-4 spinal cord to the brain. After that they were not urinate. For example, in the bathroom already. Nerve, it will come down to the sphincter relaxes, and followed by the compression of the bladder. Urine to flow out until the end. But if it is not in a condition such as a bathroom to urinate, or are busy during the trip. The order comes down to the sphincter tightly closed by the compression of the muscle that surrounds the urethra, as mentioned above. In the case of the brain were not regular The accident. Or stroke. Which are not normally recognized. The patient can not urinate at the pons or brain stem is also served. Cause an inconsistency between the bladder and sphincter when the pons can not control the nerves, the S2-4 as the accident at the spine and the brain stem and spinal cord levels S2-4, it can cause. Working together is called. detrusor-sphincter dyssynergia neurological control of lower urinary tract is primarily through the autonomic nervous system. This work is coordinated, balanced by sympathetic nerves control the bladder neck and urethra when the stimulus is compression. Hold urine in the bladder parasympathetic. To control the bladder when the urge is the compression of the urinary bladder Chiapas.


Pathophysiology.
Although it remains unclear what the exact cause of Fowler's syndrome is caused by any failure, but we can find some of them. This can be summarized as follows.

A. Than normal sphincter function. This can be verified that the sphincter has a lot of work while urination. Urine can not drain out of it. When we examine the electrical signal from electromyography (EMG) in the dynamics between the urinary system. (Urodynamics) and can recognize the disorder. Moreover, if the symptoms for a long long time, it was found that the thickness of the urethra and sphincter hypertrophy of the vaginal ultrasound. It can detect abnormalities such as this.

Two. A deficiency of the hormone. Because we find that about 50 percent are believed to be associated with polycystic ovary relative progesterone deficiency condition, and because progesterone acts to destabilize the cell wall. When the hormones that cause the activation of the cell wall than usual. The sphincter of the more commonly mentioned in the beginning.

Three. The failure of the autonomic nervous system. (Dysautonomia) is due to the operation of the system. Lower urinary tract is under the control of the autonomic nervous system, both sympathetic and parasympathetic. The sympathetic nervous system to lubricate the urethra and bladder neck. When the stimulus will cause a compression of the urinary retention. The nervous system. parasympathetic. The bladder is the main supply. If the stimulus will cause a compression of the bladder. In normal conditions, the autonomic nervous system and are coordinated. When the compression of the bladder, it will be to relax the sphincter. If there is a malfunction of the autonomic nervous system that stimulates the sympathetic or decrease the stimulation. parasympathetic, the urine is not removed. I do not have or disorders of the autonomic nervous static, this is only a guide only. Because we do not have the autonomic nervous system to other systems of the body.


Signs and symptoms.
These patients are patients who are not so much. Most are aged between 20-35 years of age but can also be found in the higher as well. But it is not menopause. Patients usually do not urinate. I have pain in urination. There may be pain. With thigh pain. And tend to be rushed to the emergency room to the catheter. Patients may be induced before the fifth day of treatment out. Such as surgery, childbirth, but the surgery was not related to an area to the urethra or bladder. Patients may have difficulty urinating. Urine gradually The first, some may have a urinary infection is the urinary bladder at the time and it may be that the diagnosis of urinary infection. However, the symptoms do not improve after antibiotic treatment. In the history I have to try to get the details for the disease to others before. Such as illness, medical history, especially of the effect of stimulating a receptor, such as pseudoephedrine, often found to have urinary symptoms after eating it. The effect of anti cholinergic drugs such as depression or even cure the symptoms of overactive bladder (overactive bladder), it will piss you off, too.

Physical examination is normal. Both general and neurological examination. But we need a detailed physical examination to exclude other diseases. Beginning of the general body. Check for signs of spinal deformities after surgery or a meningocele in the nervous system. In particular, nourished by the S2-4 in both the sense and motor and reflex examination anal sphincter is also important as well.

The laboratory to include a urine test to determine if there is inflammation. Or mixed blood or not. If there is a need to search further. Search rays. Made to exclude other diseases, especially those with kidney stones or stones falling down on the bladder. To do an ultrasound to determine if there is one area of ​​the uterus. Kidney or bladder at the bottom. (Ureterocele), or it may be pressed until the piss out of the urethra.

The dynamics of the urinary system. The disease was confirmed. As can be sure that there is a greater than normal sphincter. By measuring the pressure in the urethra (urethral pressure profile) or the EMG of the sphincter of the bladder capacity is normal.


Treatment
The first step in the catheter to the patient more comfortable before. If the urine is more than a liter of urine as a car park because it was just one. One will likely be another catheter. The bladder is stretched too much. After that, it is advisable. Catheter, patients learn to self-clean. The catheter is designed specifically as an image by a catheter to urinate 4 times per day, although it does not. As long as the park has more than 50 ml of urine, they still need the catheter.

The alfa blocker drugs, especially those that have specific effects on the bladder neck and urethra, such as alfuzosin or tamsulosin, it might be helpful because it reduces the compression of the urethra. We may be administered in conjunction with a muscle relaxant.

Injection of botulinum toxin into the sphincter, it will help reduce pressure on the urethra. The effect is only temporary. Drugs have no effect on the patients might have already lost.

Treatment can be considered effective. Is to balance the nervous system. (neuromodulation) is inserted into the device to adjust the balance of the S3 foramen, as Figure 2 and 3 showed significant reduction. Can cause the patient to urinate more quickly.

However, the treatment of patients with urinary catheterization is a clean, along with the drug can also cause the patient to urinate on their own over 50 percent.