The subject, its biology, and the chronic recurrent cystitis

Abstract

Functional disorders in urology are troubling for both patients and physicians. Moreover, advances in recent research promise to provide biological insights into psycho-neuro-endocrino-immunological pathways that are one important facet of chronic urogenital inflammations. We present a case of a middle-aged woman with long-lasting recurrent cystitis for which especially a psychosomatic approach helped to understand and cure the disorder. Altogether, as practitioners treat subjects, not illnesses, a biopsychosocial understanding of human disease should be taken into account in cases of chronic recurrent cystitis.

Figure 1

Illustration of the patient's self-assessment using the symptoms checklist SCL-90 R at 3 measurement points: start of inpatient therapy (t1), end of inpatient therapy (t2), and follow-up (t3). All 9 subscales (SOM: somatization, O-C: obsessive-compulsive, I-S: interpersonal sensitivity, DEP: depression, ANS: anxiety, HOS: hostility, PHOB: phobic anxiety, PAR: paranoid ideation, and PSY: psychoticism) and the GSI (Global Severity Index) are presented. Specifically, the subscales of compulsiveness, depression, and paranoia are elevated. At the end of therapy, the patient's values lie very close to the mean values of the healthy population in all scales. While the subscales of depression and paranoia have slightly increased again at the end of her treatment, they remain far below the initial values. (T50, T60, and T70: thresholds for the standard female German population. T60 is considered as “clinically suspicious” and T70 as “clinically relevant.” For the GSI, the T60 is already considered as “clinically relevant”).