[Psychosomatic urology: how to treat chronic urological diseases]

Abstract

In specialist urology clinics, 50 - 70 % of patients have chronic urological diseases such as recurrent urinary tract infections, a somatoform overactive bladder, adult and infantile enuresis, a chronic pelvic pain syndrome, and the psychosomatic form of post-prostatectomy incontinence. The 12-month prevalence of psychological disorders in the general adult population is 28 % 1. As many as 20 % of children and adolescents are found to have psychological abnormalities 2. These are frequently accompanied by somatoform symptoms, often consisting of a psychosomatic voiding disorder with a consecutive complex pelvic floor dysfunction 3 4 5 6. Most patients report a long history of suffering as both the functional nature and the psychosocial stress causing and perpetuating the discomfort have remained unrecognised. Therefore, most patients have undergone various treatment attempts that were not indicated and thus unsuccessful and maybe even associated with complications. This tends to further increase the somatisation and the symptoms.To treat the root cause, it is necessary to eliminate the underlying psychosomatic voiding disorder and pelvic floor dysfunction. This requires a multimodal treatment approach such as PELVICFIT^®, which combines a body-oriented training based on progressive muscle relaxation, training of body perception, and medical psychotherapy. This is crucial because patients must learn how to (re)gain control of the external urethral sphincter, achieve a physiological voiding behaviour, and reduce psychosocial stress in order to successfully treat the chronified symptoms 7 8 9.