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• W2083991616 abstract "No AccessJournal of UrologyAdult Urology1 Aug 2012The Possible Role of Opiates in Women with Chronic Urinary Retention: Observations from a Prospective Clinical Study Jalesh N. Panicker, Xavier Game, Shahid Khan, Thomas M. Kessler, Gwen Gonzales, Sohier Elneil, and Clare J. Fowler Jalesh N. PanickerJalesh N. Panicker Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author , Xavier GameXavier Game Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Department of Urology, Kidney Transplantation and Andrology, CHU Rangueil, Toulouse, France More articles by this author , Shahid KhanShahid Khan Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author , Thomas M. KesslerThomas M. Kessler Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Department of Neuro-Urology, Spinal Cord Injury Centre, Balgrist University Hospital, University of Zürich, Zürich, Switzerland More articles by this author , Gwen GonzalesGwen Gonzales Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author , Sohier ElneilSohier Elneil Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author , and Clare J. FowlerClare J. Fowler Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Financial interest and/or other relationship with Allergan, AstraTech and Astellas. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.04.011AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Urinary retention in women often presents a diagnostic difficulty, and the etiology may remain unidentified even after excluding structural and neurological causes. We evaluated a group of women referred to a specialist center with unexplained urinary retention. Materials and Methods: A total of 61 consecutive women with complete urinary retention were evaluated. Urological and neurological investigations locally had failed to identify a cause. Urethral pressure profile, sphincter volume measurement and in some cases urethral sphincter electromyography were performed to diagnose a primary disorder of sphincter relaxation (Fowler's syndrome). Results: Mean patient age was 39 years (range 18 to 88). Following investigations, a probable etiology was identified in 25 (41%) women, the most common being Fowler's syndrome. Of the women 24 (39%) were being treated with opiates for various pain syndromes and in 13 no other cause of retention was identified. Opiates could be discontinued in only 2 patients, and both demonstrated improved sensations and voiding. Conclusions: The cause of urinary retention may remain unknown in spite of extensive investigations. Young women regularly using prescription opiates for various undiagnosed pain syndromes present a challenging clinical problem and this study suggests that iatrogenic causes should be considered if voiding difficulties emerge. An association between opiate use and constipation is well-known and, although urinary retention is a listed adverse event, it appears to be often overlooked in clinical practice. It is hypothesized that Fowler's syndrome is due to an up-regulation of spinal cord enkephalins and that exogenous opiates may compound any functional abnormalities predisposing young women to urinary retention. References 1 : Abnormal electromyographic activity (decelerating bursts and complex repetitive discharges) in the striated muscle of the urethral sphincter in 5 women with persisting urinary retention. Br J Urol1985; 57: 67. Google Scholar 2 : Abnormal electromyographic activity of the urethral sphincter, voiding dysfunction, and polycystic ovaries: a new syndrome?. BMJ1988; 297: 1436. Google Scholar 3 : Electromyography in urinary retention and obstructed voiding in women. Scand J Urol Nephrol Suppl2002; 210: 55. Google Scholar 4 : Maximum urethral closure pressure and sphincter volume in women with urinary retention. J Urol2002; 167: 1348. Link, Google Scholar 5 : The urethral pressure profile: theoretical considerations and clinical application. Br J Urol1974; 46: 325. 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Pharmacoepidemiol Drug Saf1999; 8: S63. Google Scholar 14 : Safety and efficacy of tramadol in the treatment of idiopathic detrusor overactivity: a double-blind, placebo-controlled, randomized study. Br J Clin Pharmacol2006; 61: 456. Google Scholar 15 : Leucine enkephalin: localization in and axoplasmic transport by sacral parasympathetic preganglionic neurons. Science1980; 208: 1479. Google Scholar 16 : The presence of leucine-enkephalin in the sacral preganglionic pathway to the urinary bladder of the cat. Neurosci Lett1983; 39: 143. Google Scholar 17 : The neural control of micturition. Nat Rev Neurosci2008; 9: 453. Google Scholar 18 : Influence of naloxone on inhibitory pudendal-to-bladder reflex in cats. Exp Neurol2010; 224: 282. Google Scholar 19 : Urethral sensitivity–an integral component of the storage phase of the micturition cycle. Neurourol Urodyn1982; 1: 193. Google Scholar 20 : Endorphins–a role in lower urinary tract function?: The effect of opioid blockade on the detrusor and urethral sphincter mechanisms. Br J Urol1982; 54: 638. Google Scholar 21 : Neural control of the urethra. Scand J Urol Nephrol Suppl2001; 207: 35. Google Scholar 22 : Intrathecal opioids and lower urinary tract function: a urodynamic evaluation. Anesthesiology2004; 100: 1497. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 188Issue 2August 2012Page: 480-484 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordselectromyographyurinary retentionenkephalinsopioid-related disordersMetricsAuthor Information Jalesh N. Panicker Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author Xavier Game Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Department of Urology, Kidney Transplantation and Andrology, CHU Rangueil, Toulouse, France More articles by this author Shahid Khan Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author Thomas M. Kessler Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Department of Neuro-Urology, Spinal Cord Injury Centre, Balgrist University Hospital, University of Zürich, Zürich, Switzerland More articles by this author Gwen Gonzales Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author Sohier Elneil Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom More articles by this author Clare J. Fowler Department of Uro-Neurology, the National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom Financial interest and/or other relationship with Allergan, AstraTech and Astellas. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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