Urinary retention in women: its causes and management.
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.


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).


CONCLUSIONS
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.
Kavia
Rajesh B C
RB
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Datta
Soumendra N
SN
Dasgupta
Ranan
R
Elneil
Sohier
S
Fowler
Clare J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008485:Medical Audit; D008875:Middle Aged; D017060:Patient Satisfaction; D010502:Perineum / Q000294:innervation*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*