Mariusz Majewski 1, Agnieszka Bossowska 1, Joanna Wojtkiewicz 1, Włodzimierz Baranowski 2, Andrzej Witek 2, Andrzej Borkowski 4, Piotr Radziszewski 4
- 1 Katedra Fizjologii Klinicznej, Uniwersytet Warmińsko-Mazurski w Olsztynie
2 Klinika Chorób Kobiecych, Wojskowy Instytut Medyczny MON w Warszawie
3 Klinika Ginekologii i Położnictwa ¦AM w Katowicach
4 Katedra i Klinika Urologii AM w Warszawie
- Introduction. Fowler syndrome (FS) is characterized by the presence of polycystic ovaries and urinary retention. The etiology of FS is not well known yet. External urethral sphincter enlargement was suggested to be the most important factor. Changes observed both in the hormonal milieu and in the function of the gonad could be of crucial importance, too. Therefore we decided to study the ovary innervation in women with the clinically diagnosed FS.
- Objectives. To study the ovarian innervation in women with the clinically diagnosed FS.
- Materials and methods. Patients with polycystic ovary syndrome (PCOS) were screened for voiding difficulties. After identification of such patients, a complete urodynamic study was performed. The diagnosis of FS was established after confirmation of external urethral sphincter enlargement by transrectal ultrasound examination. During laparosopic cautherization of the ovarian cysts ovary samples were obtained and processed for immunohistochemistry. Ovary innervation was studied with the single immunolabeling technique using the primary antisera against neuropeptide Y (NPY),vasoactive intestinal polypeptide (VIP), peptide histidine-isoleucine (PHI), galanin (GAL) and substance P (SP). Double labeling using the anti-GAL, anti-NPY and anti-SP antibodies was also performed. Control ovaries were obtained from age-matched patients undergoing different gynecological procedures, requiring ovary resection.
- Results. After screening of 200 females with PCOS we identified 10 patients with FS in a mean age of 20.4 years (from 18-33). The mean volume of the external urethral sphincter was 2.8 cm3. The majority of the changes in the ovary innervation were observed within the cortical stroma. An increase in the numbers of VIP-, PHI- and GAL-positive nerve fibers in patients with FS was observed, when compared to control specimens. Double-immunostaining revealed a distinct increase in the density of GAL-positive, but NPY-negative nerve fibers. A less pronounced increase in the number of GAL- and NPY-positive, as well as SP-positive, but GAL-negative terminals was also observed. Within the tunica albuginea we did not observed any nerve fibers positive to the examined substances except for NPY positive nerve fibers, whose density was decreased in patients with FS.
- Conclusions. In our study we described a group of females with enlargement of the external urethral sphincter and PCOS, without urinary retention, having however voiding difficulties. The origin of these problems could be probably attributed to the changes in ovarian functions, that, in turn may be caused by altered pattern of both the sympathetic and parasympathetic innervation of the ovary.