Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients

Two Cases of Acute Urinary Retention Associated With Acute Sarcopenia in Older Women

Acute urinary retention during hospitalization is a poor prognostic predictor. Therefore, prevention of the same is important. Herein, we describe two cases of acute urinary retention in older women admitted to the hospital for acute illness, with severe sarcopenia being the only predisposing cause. Both women developed urinary problems shortly after admission. In both, acute urinary retention was preceded by an in-hospital period of poor nutritional intake and a lack of progress in rehabilitation. There was no evidence of genitourinary disorder, neurological disease, drug-induced dysuria, bone fracture, or pain. Both patients presented with severe sarcopenia and severe frailty.Although the loss of mass in the voiding muscles is difficult to detect, the possibility of dysuria as one of the complications of acute and severe sarcopenia was indicated in our patients. Of note, however, is that many patients with severe sarcopenia do not develop dysuria. Therefore, accumulating evidence on the possible association between severe sarcopenia and dysuria is needed to inform prevention.

An impacted urethral stone: a rare cause of acute urinary retention in women—case report

Background

Urethral calculi are rare, representing 1–2% of all calculi affecting the urinary tract. Impacted urethra calculi are commoner in males due to anatomical differences between the male and female urethra. The treatment approach is determined by the size and location of the stone, associated anomalies and available facilities.

Case presentation

We present the case of 35-year-old woman who presented with acute urinary retention secondary to an impacted urethral stone. The calculus could not be removed through the external urethral meatus due to the size of the stone. She had cystolithotomy after retrograde manipulation to the bladder. She did well postoperatively. This line of management was based on the size of the stone, and the available facilities which are typical of many hospitals in developing countries.

Conclusions

Urethral calculi are extremely rare in women. The treatment should be individualized.

Fowler's Syndrome-The Cause of Urinary Retention in Young Women, Often Forgotten, but Significant and Challenging to Treat

Urinary retention in young women is a relatively rare clinical problem and is often underdiagnosed. In particular, functional causes of urinary retention pose a diagnostic challenge. One of them is Fowler’s syndrome, which is associated with impaired urethral relaxation. Fowler’s syndrome is characterized by a large bladder capacity, reduced sensation, increased maximal urethral closure pressure, and detrusor underactivity. Several hypotheses have arisen to explain the cause of urethral relaxation disorders: hormonal changes characteristic of Polycystic Ovary Syndrome (PCOS), causing abnormal stabilization of the muscle membrane, primary failure of relaxation of the striated muscle of the urethra sphincter, and increased urethral afferent activity, inhibiting the bladder afferent signals from reaching the brain by potentiating a spinal mechanism of urinary continence. Currently, sacral neuromodulation is the only intervention that can restore an atypical voiding pattern in women with Fowler’s syndrome. The therapeutic effectiveness exceeds 70%, although the revision rate is relatively high, exceeding 50%. Well-designed, long-term prospective studies comparing sacral neuromodulation (SNM) with other therapies such as pelvic floor muscle physiotherapy are warranted to offer the best patient-tailored treatment.