Twenty patients were enrolled to receive InterStim, and it was found that 18 of 20 (90%) had a decrease in their PVR and the number of catheterizations per day. The results did not reach statistical significance, but the author hypothesized this was because of the small size of the study. Chaabane et al5 further examined sacral neuromodulation for treating neurogenic bladder. Over a 10-year interval, 62 patients were evaluated for placement of a sacral device; of these, only 37 were implanted. Of the original 62 patients,

PI3K inhibitor 28 were noted to have urinary retention; however, it is not indicated how many of the 37 implants were placed in this population. The remaining population had detrusor overactivity click here (n = 34) or detrusor-sphincter dyssynergia (n = 9). In the implanted population, 75% had a 50% or greater improvement of their UDS testing. One possibility is that our patient had Fowler’s syndrome. This syndrome is characterized by painless urinary retention in young women and is thought to be because of failure of urethral sphincter relaxation.6 Typically, patients are approximately

between the ages of 20-35 years at first presentation and have a triggering event, such as an operation or childbirth. This leads to infrequent voiding and intermittent stream, which then progress to urinary retention. The definitive test for diagnosis is electromyography sampling of the urethral sphincter using a concentric needle electrode. Although it is not possible to retrospectively rule out this syndrome, our patient had characteristics that were different from patients with typical Fowler’s syndrome. She had complete bladder atony, whereas patients with Fowler’s syndrome usually have some measurable detrusor voiding pressure. As well, our patient had experienced these episodes since very early childhood and only had stress as a precipitating event. A smaller point is that she had no cysts in her ovaries which can be seen in >50%

of patients with Fowler’s syndrome. If the patient did have Fowler’s syndrome, she was treated appropriately, as sacral neuromodulation is the treatment of choice Tolmetin for this syndrome. In our case, the patient clearly benefited from her implant and further supports the use for sacral neuromodulation for the management of refractory urinary retention and bladder atony, not just urge incontinence and symptoms of urgency and frequency. The use of sacral neuromodulation for urinary retention is not new, but its efficacy and utility for complete bladder atony have yet to be fully established. To our knowledge, sacral neuromodulation has not been reliably shown to be efficacious in cases of severe bladder atony. This case reiterates that sacral neuromodulation might be a valuable tool in this setting, and in light of our findings, bears further investigation by the urologic community as to the continued expansion of its indications.