Psychogenic urinary retention in a boy

Voiding and storage symptoms in depression/anxiety

We here described the frequency and nature of voiding and storage bladder symptoms in depression/anxiety, for which we propose the name "bladder somatic symptom disorder (SSD)" because such symptoms most probably have brain mechanisms. SSD was formerly called as various terms including "somatoform disorder", "medically unexplained physical symptoms", "functional somatic syndrome" and "hysterical neurosis/hysteria". Bladder SSD has the following specific features that are distinguishable from "true" neurologic/organic bladder dysfunction: 1) situation-dependence (close association with life event in some), 2) urodynamically increased bladder sensation/hypersensitivity and 3) absence of neurologic/organic diseases, in addition to 4) other stress symptoms (insomnia, etc.), are key clues to the possibility of bladder SSD. Urodynamics in these patients showed, to a lesser extent, underactive bladder without post-void residual. These findings might reflect the biological changes of the depressive brain; e.g., decreases in serotonin and GABA, and possible increases in CRH. Treatment of bladder SSD can follow that of general depression/anxiety, with the potential addition of anticholinergic or selective beta3 bladder drugs.

Psychogenic urinary dysfunction: a uro-neurological assessment

AIMS

The diagnosis of psychogenic urinary dysfunction (PUD) is one of exclusion, particularly from urologic and neurologic causes, and is usually accompanied by more obvious psychologic/ psychiatric features. We here describe patients with PUD who were diagnosed in our uro- neurological laboratory.

MATERIALS AND METHODS

We reviewed the digitized records of 2,300 urodynamic cases treated in the past 6 years to identify patients who fulfilled the diagnostic criteria of PUD. All 2,300 patients had completed a urinary questionnaire and undergone both electromyography (EMG)-cystometry and a detailed neurological examination. In addition, pressure-flow analysis, neurophysiology tests including sphincter EMG analysis, and MRI of the brain and spinal cord were performed as applicable.

RESULTS

PUD was seen in 16 cases (0.7%): 6 men, 10 women, mean age 37 years. Lower urinary tract symptoms (LUTS) included overactive bladder (OAB) alone in 5, difficult urination alone in one, and both in 10. LUTS commonly occurred in particular situations, for example, OAB only while riding the train. Some patients showed extremely infrequent toileting. The urodynamic findings were normal except for increased bladder sensation (50%) for OAB and acontractile detrusor (31%) for difficulty. The final diagnosis was conversion reaction in six followed by anxiety in four.

CONCLUSIONS

PUD patients experienced the situational occurrence of OAB and/or difficult urination and, in some patients, extremely infrequent toileting. The main urodynamic abnormalities were increased bladder sensation and acontractile detrusor. However, even in cases suggestive of PUD, a non-PUD pathology behind the symptoms should be explored.

Is "shy bladder syndrome" (paruresis) correctly classified as social phobia?

Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N = 226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia.

Psychogenic urinary retention ('paruresis'): diagnosis and epidemiology in a representative male sample

BACKGROUND

Although research interest in social phobias has expanded during the last decade, a special subtype of social phobia known as paruresis, which manifests in the inability to urinate in public rest rooms, is rarely mentioned. The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105).

METHOD

Due to the lack of well-established screening instruments for paruresis, the Paruresis Checklist (PCL) must be tested for reliability and validity. An empirically based cutoff score must be determined by using the subjective interference with everyday life as an external criterion.

RESULTS

Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis. In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.

Urinary retention, erectile dysfunction and penile anaesthesia after circumcision: a mixed dissociative (conversion) disorder

We report on the long-term followup of a mixed dissociative (conversion) disorder after circumcision in childhood.

The wet child

Urinary incontinence is one of the most frequent problems seen in pediatric urology. Although there can be serious structural problems that produce wetting, most of the children seen will have nonstructural causes for their incontinence. A systematic approach and persistence with therapy should result in resolution of the problem in most instances.

Diagnostic study of urinary frequency in children

A urologic study of 28 patients (11 males and 17 females, 4 to 14 years old) revealed that 23 patients (83%) had organic disease, 20 of whom had lower urinary tract abnormalities. Of 22 patients who were assessed psychologically, 14 had difficulty in adaptation, 20 had special birth order problems, and in 14 onset of symptoms occurred before school age. After five years of follow-up, 18 of 20 patients who were re-evaluated had no recurrent urinary frequency symptoms.

Paruresis: overview and implications for treatment

Paruresis or psychogenic urinary retention is a functional disorder of micturition characterized by psychosomatic symptomatology that includes an inability to void urine in public facilities. Through largely non-experimental studies and case reports, clinical investigators have identified characteristics, behaviors, and etiological factors associated with the disorder. Although few reports about paruresis appear in the literature, a review is presented to describe the disorder and compare treatments used. As adjuncts to a multifaceted approach to treatment, the 1948 Kegel exercises and the use of beta-adrenergic blocking drugs are specific methods for alleviating the maladaptive symptomatology.

Urinary retention without organic cause in children

Acute urinary retention without organic explanation is well known in adults but has only rarely been described in children. Six cases (four boys and two girls) of non-organic acute urinary retention are reported. The diagnosis was based on negative findings on extensive urological examination. So-called psychogenic urinary retention in children is associated with constipation and infrequent voiding.

Functional voiding disorders in men

A total of 47 men who complained of recurrent voiding symptoms and/or peri-genital pain syndrome of obscure etiology underwent neuro-urologic evaluation. Results of urodynamic assessment were divided into 3 groups: bladder areflexia with nonrelaxing perineal floor (50 per cent), bladder hyperreflexia (36 per cent) and normal studies (14 per cent). Pain symptoms were reproduced during bladder filling or contraction in 45 per cent of the patients. Treatment was according to the type of urodynamic abnormality demonstrated, resulting in a 77 per cent improvement rate. The concept of functional voiding disturbance and its relation to chronic prostatitis are discussed.

Psychogenic urinary retention

Six cases (5 females and 1 male) of unexplained urinary retention are reported. The diagnosis of psychogenic urinary retention was considered after negative medical, urologic, urodynamic, and neurologic evaluations. This diagnosis was then confirmed by psychiatric consultation. Urinary retention was managed by combining biofeedback-monitored relaxation and specific imagery techniques with intermittent self-catheterization on a fixed schedule. Psychotherapy, pharmacotherapy, and behavior therapy were also utilized with good to excellent short-term results.