The management of female voiding dysfunction: Fowler's syndrome -- a contemporary update

Several aspects of voiding dysfunction in women remain under investigation, including standardization of the diagnosis and management of bladder outflow obstruction. This article describes a specific cause of urinary retention in young women, associated with a failure of urethral sphincter relaxation, and a treatment option that can restore voiding in this group of patients - sacral nerve electrical stimulation therapy. Recently there have been advances in the stimulator implantation technique, as well as in our appreciation of its mechanism of action.

Advances include the use of ancillary investigations such as urethral function tests as well as better understanding of the clinical profile of these patients. Improvements in the surgical technique include better methods of lead fixation and a less invasive surgical approach. Research suggests the action of neuromodulation is on the afferent pathway, though it remains to be shown whether this is at a spinal or supraspinal level. It is likely that sacral nerve stimulation has an indirect modulatory effect on detrusor contractility rather than a direct effect on the sphincter.

Experience of sacral nerve stimulation has increased over the past few years, and its application is expanding to other clinical domains. This knowledge has helped improve the therapy, which is particularly effective in the treatment of women with urinary retention. Although how it works is still not fully understood, this is something that is being addressed by ongoing research.