JU INSIGHT Psychological Comorbidities and Functional Neurological Symptoms in Women With Urinary Retention

By: Caroline Selai, MSc, PhD, DipPsych, CPsychol, AFBPSs, MBACP, UCL Queen Square Institute of Neurology, University College London, United Kingdom The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Cheng-hung Lee, BSc, MSc, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Sara Simeoni, MBBS, MD, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Mahreen Pakzad, BSc, MD, FRCS(Urol), The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Eileen Joyce, MA, PhD, MB BChir, MRCP, FRCPsych, UCL Queen Square Institute of Neurology, University College London, United Kingdom The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Pany Petrochilos, MMBS, BSc, MSc, MRCGP, MRCPsych, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom; Khadija Rehrou Rantell, MSc, PhD, UCL Queen Square Institute of Neurology, London, United Kingdom; Vasile Boico, BSc, MSc, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, United Kingdom; Jalesh N. Panicker, MD, DM, FRCP, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, United Kingdom UCL Queen Square Institute of Neurology, University College London, United Kingdom | Posted on: 17 Jul 2024

Selai C, Lee CH, Simeoni S, et al. High prevalence of psychological comorbidities and functional neurological symptoms in women with urinary retention. J Urol 2024;212(1):136-144. doi:10.1097/JU.0000000000003983

Study Need and Importance

Chronic idiopathic urinary retention in young women and Fowler’s syndrome remain poorly understood. A high prevalence of psychological and functional comorbidities is reported, however these have been poorly characterized. We invited patients presenting to our clinic with urinary retention to have an in-depth consultation with a psychologist.

What We Found

High prevalences of psychiatric and psychological comorbidities were reported (97%) including current depression, current anxiety, and post-traumatic stress disorder, functional neurological disorder, other functional symptoms, self-harm, personality disorder, and a history of childhood trauma (Table).

Table. Psychological Comorbidities in 91 Females Presenting With Chronic Idiopathic Urinary Retention

	No. (%)
Psychiatric comorbidities
Psychiatric history	71 (78)
Depression ever	79 (87)
Depression current	70 (77)
Anxiety ever	81 (89)
Anxiety current	71 (78)
Post-traumatic stress disorder	29 (32)
Functional symptoms
Functional neurological symptoms	51 (56)
Functional syndromes	59 (65)
Self-harm ever	34 (37)
Self-harm recent	13 (14)
Personality disorder	15 (16)
Childhood trauma	32 (35)
Adult trauma	41 (45)

Limitations

Patients referred to this center for tertiary referral are more complex than those seen in a general urology clinic, and the generalizability of the findings is therefore limited. The data were elicited during a semistructured clinical interview, and only brief 2-item screening measures for anxiety and depression were used in this study rather than longer, more detailed measures. Future studies should capture patient-reported outcomes and quality of life using more comprehensive validated instruments.

Interpretation for Patient Care

We suggest that these problems should be identified in clinic so that a more holistic approach to managing and treating these patients can be taken. Young women with chronic idiopathic urinary retention report a high burden of psychiatric disorders, affective symptoms, trauma, post-traumatic stress disorder, self-harm, and functional neurological disorder, particularly in those with Fowler’s syndrome. These factors can undermine the engagement with health care professionals and affect management, and should therefore be addressed during the urological assessment.