Psychogenic urinary dysfunction: a uro-neurological assessment

Area of Science:

• Urology
• Neuroscience
• Psychiatry

Background:

• Psychogenic urinary dysfunction (PUD) is a diagnosis of exclusion, often associated with overt psychological symptoms.
• Identifying PUD requires differentiating it from urologic and neurologic conditions.

Purpose of the Study:

• To describe patients diagnosed with PUD in a uro-neurological laboratory setting.
• To characterize the clinical presentation and urodynamic findings in PUD patients.

Main Methods:

• Reviewed 2,300 urodynamic case records over six years.
• Included patients who completed questionnaires, underwent EMG-cystometry, neurological exams, and applicable neurophysiology tests and imaging (MRI).

Main Results:

• PUD was diagnosed in 16 cases (0.7%), with lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and/or difficult urination.
• Symptoms were situational (e.g., OAB on a train) or involved infrequent toileting.
• Urodynamic findings showed normal results except for increased bladder sensation (50%) and acontractile detrusor (31%).

Conclusions:

• PUD patients exhibit situational LUTS and potentially infrequent toileting.
• Key urodynamic findings include increased bladder sensation and acontractile detrusor.
• It is essential to investigate non-PUD pathologies even when PUD is suspected.