05 History of the

Discovery of a syndrome

In 1985 together with Roger S. Kirby, we wrote a paper in which we reported 5 women with urinary retention in whom we had recorded an usual type of electromyographic (EMG) activity from their striated urethral sphincters and suggested that this abnormal activity was causing a failure of relaxation of the sphincter, resulting in chronic retention (Fowler and Kirby 1985). Coming from a background of clinical neurophysiology I was particularly interested in the exact details of the EMG activity and in that first paper suggested it was a form of “pseudomyotonia”, a theory that I subsequently revised in a longer paper, reporting more patients and analysing the EMG abnormality in greater detail, later that same year (Fowler, Kirby et al. 1985). Excited by this finding which suggested a cause for  urinary retention in women, which had previously been said to be an hysterical condition, we managed to publish a paper in The Lancet which concluded “the finding of a significant abnormality in 72% of cases calls into question the validity of the commonly applied diagnosis of psychogenic urinary retention” (Fowler and Kirby 1986). Following that was the paper in the BMJ which proposed a relationship between the abnormal sphincter EMG activity and the observation that many of the women had clinical features of polycystic ovaries (Fowler, Christmas et al. 1988). Eventually, as often happens, the syndrome became known after the first author – “Fowler’s syndrome”.

As with any new idea that challenges entrenched thinking, there was initially considerable antagonism and hostility to the concept, and for several years I chose not to be involved in urological patients. However young women kept on going into urinary retention and apparently no one could find a better explanation for their problem. They were referred to me in ever increasing numbers and by the time I retired from full time work in July 2010 I was seeing approximately one new patient a week with urinary retention, referred from all over the UK, although only about one third turned out to have Fowler’s syndrome.