Retention of urine in women is alleviated by uterosacral ligament repair: implications for Fowler's syndrome

Abstract

IntroductionThe aim of this study was to independently evaluate idiopathic urinary retention and other known Fowler's syndrome (FS) descriptions in 24 women treated for posterior fornix syndrome (PFS) by reinforcement of the uterosacral ligaments (USL) using the tissue fixation system (TFS).Material and methodsThe main inclusion criterion was: idiopathic urinary retention with post-void residual urines (PVR) >100 ml.ResultsThe mean patient age was 63 years (range 32–87). Except for peak urine flow, features typical of FS were statistically improved (p 0.015 to <0.0001), pre-op mean with post-op mean in brackets: PVR 272 ml (34 ml); abnormal emptying symptoms n = 24 (18/24 cured or 80% improved); natural bladder volume 598 ml (301 ml); emptying time 50 seconds (20 seconds): peak flow 42 ml/sec (37 ml/sec); chronic pelvic pain n = 18 (14/18 >80% improved); maximal urethral closure pressure >90 cm (n = 4) 93 cm H2O (75 cm); frequency (14/14 improved); nocturia 110 episodes (33 episodes).ConclusionsFunctional disorders typical of FS, also present in posterior fornix syndrome, principally idiopathic urinary retention, were cured/improved by USL sling repair. Suggested anatomical pathway: lax USLs weaken the backward muscular forces, unbalancing bladder neck and urethral closure. Compensatory forward-acting closure muscles narrow the distal urethra, causing urinary flow difficulties, and retention. This functional imbalance can be relieved by posterior sling repair. We suggest that, rather than spasm from the (weak) rhabdosphincter (Fowler's syndrome), USL weakness is the most likely cause of idiopathic urinary retention in women.

Underactive bladder, Fowler’s syndrome are potentially curable by uterosacral ligament repair

“…Strengthening the USL, if possible, non-surgically ( 7 ), or surgically ( 15 , 17 - 20 ), can cure or improve UAB symptoms, presumably by restoring the contractile power of LP/LMA which contract against the USLs. The LP/LMA now more easily opens out the posterior urethral wall to reduce resistance to urine flow by bladder contraction.…”

“…Using squatting-based pelvic floor exercises, Skilling reported that 23 women with pre-treatment mean residual urines of 202 mL (range, 50–550 mL), were reduced post-treatment to 71 mL (range, 15–450 mL) (P≤0.005) ( 7 ). Following surgical repair of the USL with a TFS minisling tape, Petros et al ( 14 , 15 ) reported reduction of pre-treatment residual urine from mean 271 mL preoperatively to 53 mL post-operatively (P<0.005) ( 15 ). Mean emptying time for this group (n=29) decreased from 41 s (12–130 s) to 31 s (7–130 s) (P<0.005) ( 13 ).…”

“…In urodynamically validated surgical studies, Goeschen et al ( 18 ), Petros ( 15 , 17 ), and Himmler et al ( 20 ) followed PFS protocols for diagnosis and surgery to repair USL laxity, using posterior slings. All reported high surgical cure rates for the PFS conditions ( Figure 1 , red rectangle).…”

Simulated operations (SOs) apply mechanical support to structures to confirm symptom causation

“…If surgery is intended, a positive SO indicates a higher probability of cure with surgical repair. Such SOs are standard predictive interventions for surgeons who follow the IT Paradigm (ITP) for surgical repair of the symptoms in the three zones of the vagina ( 4 - 12 ) ( Figure 2B ). The SOs which follow will be categorized according to the structural level of damage (yellow circles), numbered 1–4, in Figure 2A,2B .…”

Squatting-based exercises cure bedwetting in children and improve pain and bladder symptoms in premenopausal women

“…Fundamental to any pelvic muscle exercise treatment for dysfunction is a clear understanding of the actions of pelvic muscle forces. During coughing or straining, three directional muscle forces are seen, forwards, backwards, downward ( 1 , 2 ) ( Figure 1 , broken lines) (see Videos S1,S2 ). “Squeezing”, upward pulling of the pelvic diaphragm is known as the Kegel technique ( Figure 2 ).…”