Neurological Abnormalities

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All the abnormalities mentioned above have similar presentation and management in women, in fact some conditions such as MS are far more prevalent in the female population.

Generally, women with voiding dysfunction in the absence of structural abnormalities of the lower urinary tract are very difficult to manage. A small group of female patients with obstructed voiding, and in some cases AUR, have been shown to have a specific electro-myographic abnormality of the striated urethral sphincter, explaining their symptoms. When associated with features of polycystic ovary syndrome (PCOS), these patients are said to have Fowler's syndrome (Ka-via et al. 2006; Fowler and Kirby 1984,1985). They characteristically present at age 20-30, with episodes of AUR, and are often intolerant of urethral catheteriza-tion. Acutely, they can be managed with urethral cathe-terization, if tolerated, or CISC, although this is often tolerated even less well. Some patients will require su-prapubic bladder drainage for this reason.

On initial presentation, any other neurological cause of AUR must be excluded, as well as any other structural abnormalities, before a diagnosis of Fowler's syndrome is made.

Long-term management is also a problem, with the only effective treatment that can restore normal voiding function (to date) being sacral nerve stimulation (Kavia et al. 2006).

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