title: Pregnancy in women with Fowler's syndrome treated with sacral neuromodulation.
abstract: OBJECTIVE
  Our aim was to determine the impact of pregnancy on sacral neuromodulation (SNM) and vice versa in patients with Fowler's syndrome (FS), which is typified by chronic urinary retention (CUR).
  
  
  METHODS
  We performed a retrospective study of pregnancy in patients with FS who underwent a two-stage SNM implantation. Data were obtained using a standard questionnaire and clinical interview.
  
  
  RESULTS
  There were a total of ten patients with 13 pregnancies. The SNM was switched off in ten of the 13 pregnancies, with CUR recurring in nine of the ten pregnancies and recurrent urinary tract infections (UTI) occurring in four of these pregnancies (more than three UTI in the pregnancy). Those in whom the device was left on continued to void normally. One woman had a first trimester miscarriage, eight pregnancies went to term, and four deliveries were premature. Caesarean section was performed in eight pregnancies for obstetric reasons. Four pregnancies resulted in a vaginal delivery. There were no congenital anomalies reported. Following delivery, four of nine women experienced dysfunction of their SNM device when it was switched back on.
  
  
  CONCLUSIONS
  Turing off the SNM during pregnancy results in recurrence of CUR, with an increased risk of recurrent UTI associated with preterm delivery. This did not impact foetal well-being. The option of keeping the SNM on during pregnancy should therefore be considered, and as caesarean section affects the SNM device, we advise that caesarean section should only be performed for obstetric reasons.
authors: Department of Uro-neurology, National Hospital of Neurology and Neurosurgery, London WC1B 3BG, UK.
authors: Azar
authors: A
authors: Khunda
authors: Roopali
authors: R
authors: Karmarkar
authors: Bahareh
authors: B
authors: Abtahi
authors: Gwen
authors: G
authors: Gonzales
authors: Sohier
authors: S
authors: Elneil
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D012189:Retrospective Studies; D013577:Syndrome; D016055:Urinary Retention / Q000150:complications* / Q000628:therapy; D014552:Urinary Tract Infections / Q000209:etiology; D055815:Young Adult
references: Int Urogynecol J. 2010 Dec;21 Suppl 2:S475-83
references: 20972545
references: Urology. 2008 Jan;71(1):71-4
references: 18242368
references: Geburtshilfe Frauenheilkd. 1987 Sep;47(9):594-6
references: 2960587
references: J Urol. 2003 Nov;170(5):1905-7
references: 14532804
references: J Urol. 2005 Dec;174(6):2268-72
references: 16280802
references: BJU Int. 2004 Aug;94(3):335-7
references: 15291863
references: J Urol. 2007 Nov;178(5):2029-34
references: 17869298
references: Obstet Gynecol. 2003 Jul;102(1):129-35
references: 12850618
references: Clin Auton Res. 2001 Oct;11(5):309-11
references: 11758797
references: J Urol. 1988 Jan;139(1):121-2
references: 3257272
references: J Urol. 2002 Jan;167(1):165-8
references: 11743297