[Overactive bladder--which diagnosis investigations are necessary before initiating primary treatment?]

[Chronic pollakiuria: cystectomy or psychotherapy]

BACKGROUND

Persistent unexplained urological complaints and diseases are a common problem in clinical practice. Psychological components can play an important role in urological complaints. Neglect of these facts can lead to an insufficient or incorrect treatment. Therefore, apart from the specific medical diagnostics, a complete examination of mental and psychological functions before an invasive intervention is also required.

PSYCHOSOMATICS IN UROLOGY

Illustrated by the case of a young woman with a request for a cystectomy while suffering from a chronic pollakiuria, this paper explains the importance of good interdisciplinary collaboration for evidence-based, guideline-oriented medical treatment. The patient's suffering and urge for removing the bladder was contrasted by a lack of medical indication for surgery and the principle of proportionality. The essay gives insight into the discipline of psychosomatic medicine, somotoform disorders found in urology and, especially, the symptoms of pollakiuria and overactive bladder.

CONCLUSION

The case illustrates the importance of timely and simultaneous medical and psychosocial diagnostics for the treatment outcome in patients with unspecific physical complaints. Treatment recommendations for patients with somatoform complaints in clinical practice are provided.

[Neurogenic or idiopathic destrusor overactivity after failed antimuscarinic treatment : clinical value of external temporary electrostimulation]

Antimuscarinic drugs are regarded as the standard treatment of detrusor overactivity (DO). However, side effects and lack of efficacy cause patients to discontinue long-term therapy. We evaluated the clinical efficacy of functional external electrostimulation (FES) as "second-line" therapy in patients with symptomatic idiopathic or neurogenic DO.In a retrospective study, 52 patients (38 women and 14 men) were evaluated at least 1 year after FES. Eighteen patients (32.7%) regarded FES as successful. No change occurred in 34 patients (65.4%) and 1 patient reported worsening of symptoms. Treatment success lasted for 13.2 months. In successfully treated patients, voiding frequency was significantly reduced from 13.3/24 h to 6.1/24 h under FES and to 6.75/24 h at follow-up. FES is a clinically useful, well-tolerated, conservative second-line treatment option after failed antimuscarinic treatment in patients with idiopathic or neurogenic DO.