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  1. Meher Lad1,
  2. Jai Seth2,
  3. Jalesh Panicker2,
  4. Gwen Gonzales2,
  5. Juliana Ochulor2,
  6. Collette Haslam2,
  7. Thomas Kessler2,
  8. Clare Fowler2
  1. 1University College Hospital, London
  2. 2National Hospital of Neurology and Neurosurgery, London


Background Urinary retention in young women due to a disorder of external urethral sphincter relaxation, known as Fowler's syndrome, is characterised by elevated urethral pressure profile (UPP) and abnormal urethral sphincter EMG. Sacral neuromodulation is the only effective treatment currently. The aim of this study was to assess the efficacy of botulinum toxin in Fowler's Syndrome.

Methods Ten women with Fowler's Syndrome (obstructed voiding (n=5), complete urinary retention (n=5) were recruited at a tertiary referral centre. Baseline and post-treatment symptoms were assessed using the International Prostate Symptom Score (IPSS) questionnaire, and urinary flow and post-void residual volumes were measured. Patients were reviewed at weeks 1, 4 and 10 post-treatment.

Results There was a significant improvement in symptom scores on the IPSS questionnaire at week 10. In women with obstructed voiding, mean flow rate improved from 8.12mls/sec (3–10) to 12.6mls/sec (6–27), whereas four women in complete retention voided spontaneously. Mean post-void residual volume decreased from 315mls (40–700) to 112 mls (0–230). No serious side effects were reported.

Conclusion In this pilot study, urethral sphincter injections of Botulinum toxin was shown to be safe and effective in the management of urinary retention in women due to Fowler's syndrome.


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