The final diagnoses of the patients were somatoform/conversion disorder in six, anxiety disorder in four, and depression and other mental illnesses[28] (Table 1). The LUTS in the 16 PUD patients included OAB alone in five, difficult urination alone in one, and both OAB and difficult urination in 10 (Table 2). In most patients, there was a dissociation between LUTS in their daily life and urodynamic findings (Tables 2 and 3) as described below. Lower urinary selleck screening library tract

symptoms often occurred only in particular situations. For example, in one case (case 5), OAB occurred only when the patient was riding on a train with many people standing in the aisle. The psychodynamics underlying these patients may well be reproduced by healthy individuals under stressful conditions in daily life, e.g. a person may need to use the toilet just before starting an important presentation[26] or have difficulty urinating when in close proximity to another person.[26, 31] The severity of such a phenomenon is usually mild and the duration selleckchem is short. However, if an individual feels such symptoms are an extreme bother, he or she may have hypochondria or a phobia involving toileting (mental disorder caused

by toileting); or, if the symptoms are severe and chronic, the individual has PUD (bladder dysfunction caused by mental disorder). Both conditions could occur together. In addition to OAB and difficult urination, two of our patients also showed extremely infrequent voiding (once or twice a day) cases 2, 4 or even an unwillingness to use the toilet. Similar

episodes have been described before.[32] Toileting phobia Rebamipide has been reported to underlie this condition, originating from previous pain in micturition as a result of a urinary tract infection[33] or painful urological investigations.[32] However, no such histories were obtained in our patients. Since there were no urodynamic data available in the depression cohort, we discuss those in PUD patients who visited a urodynamic laboratory because of LUTS. The diagnosis of PUD is basically exclusionary, particularly from urologic, gynecologic, and neurologic causes, and this disorder accompanies more obvious mental features.[29, 34] Within this context, neurologic diseases are not always easy to diagnose, since they may present with LUT dysfunction as the sole initial manifestation, as seen in tethered cord syndrome/spina bifida occulta and multiple system atrophy. In our study, the incidence rate of PUD was 0.7% (16 cases) of 2300 urodynamic cases,[28] after carefully excluding other causes by means of history (with relevant neurologic, urologic, gynecologic, traumatic, or other specific history), neurological examination and, where applicable, electrophysiology, sphincter electromyography (EMG), and magnetic resonance imaging (MRI). The prevalence rate was almost the same as those reported in studies with similar sample sizes, e.g. 2% among 1015 urodynamic cases,[30] 2.