Case Report of Management of Fowler’s Syndrome During Pregnancy: Challenges and Outcomes

Fowler's syndrome (FS) is a rare cause of urinary retention affecting young women, characterized by dysfunctional urethral sphincter relaxation. Its management during pregnancy presents challenges, particularly regarding sacral neuromodulation (SNM), which is the preferred treatment but remains controversial due to concerns about uterine contractions and limited safety data. Intermittent catheterization is an alternative but increases the risk of urinary tract infections and pregnancy complications. This case report aims to describe the obstetric management and clinical outcomes of a pregnant patient with Fowler's syndrome undergoing SNM. A 25-year-old woman with FS conceived unexpectedly and, concerned about potential pregnancy risks, deactivated the device and initiated intermittent catheterization. However, she experienced persistent urinary retention, nocturia, and sciatic pain, prompting her to reactivate the device without medical supervision. Despite these challenges, her pregnancy progressed without urinary tract infections or preterm labor. At 37 weeks and four days, she underwent a planned cesarean section, delivering a healthy newborn. Managing FS during pregnancy is complex due to the risks and benefits of SNM versus intermittent catheterization. This case highlights the need for individualized, multidisciplinary care. Further research is essential to develop standardized guidelines to optimize maternal and fetal outcomes.