Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Neurourol Urodyn. 2022 Apr;41(4):1012-1024. doi: 10.1002/nau.24917. Epub 2022 Mar 29.
Functional urological disorders are highly prevalent, frequently interrelated, and characterized by a chronic course and considerable treatment resistance. From our point of view, poor treatment outcomes are often attributable to underlying but undetected mental disorders.
To investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of patients with functional urological disorders in a tertiary referral Pelvic Care Centre.
Retrospective observational cohort study in functional urological disorders in combination with psychosomatic co-morbidity. When treatment by a urologist alone was not sufficient, the suitability for a multidisciplinary approach was considered i) if there was a susceptibility for psychiatric comorbidity, ii) if diagnostic procedures did not reveal a treatable somatic cause, or iii) if multiple failed somatic treatments did not relieve complaints. Patients underwent urological treatments before, without reduction of complaints, no treatable somatic cause could be found after diagnostic procedures; or patients suffered from psychiatric comorbidity.
Outcome was measured using patient global impression of improvement, hospitality anxiety and depression scale (HADS), global assessment of functioning (GAF), and a health consumption questionnaire.
A significant reduction in HADS-depression score was found (p = 0.001) after multidisciplinary treatment. The GAF score increased from 61 to 80, leading to no more than slight impairment in social, occupational, or school functioning. Patients reported their situation as better in comparison with before multidisciplinary treatment. An association was found between pelvic pain and anxiety (p = 0.032) and panic disorder (p = 0.040). Psychological trauma was found to be associated with depression (p = 0.044), with an odds ratio of 2.93 (1.01-8.50). Psychological trauma coincided in 62.3% of patients with urological pain syndromes and in 83.3% with pelvic pain.
Overall results indicate that functional urological patients, previously refractory to urological treatment, benefit from an integrated care approach by urologists and psychiatrists. Explanation about the bladder-brain axis and the alarm falsification model enlightens understanding of urological and psychological contributions to functional syndromes and creates an opportunity for integrated care.
功能性泌尿科疾病发病率高，常相互关联，具有慢性病程和相当大的治疗抵抗性。从我们的观点来看，治疗效果不佳通常归因于潜在但未被发现的精神障碍。
调查泌尿科医生和精神科医生联合对三级转诊盆骨护理中心功能性泌尿科疾病患者的症状的治疗效果。
功能性泌尿科疾病与身心共病相结合的回顾性观察队列研究。当仅由泌尿科医生治疗效果不佳时，考虑采用多学科方法的适应证为：i）存在精神共病易感性，ii）诊断程序未发现可治疗的躯体原因，或 iii）多次躯体治疗失败后症状仍未缓解。患者接受泌尿科治疗后症状未减轻，诊断程序后未发现可治疗的躯体原因；或患有精神共病。
采用患者整体改善印象、焦虑和抑郁量表（HADS）、总体功能评估（GAF）和健康消费问卷来衡量结果。
多学科治疗后 HADS 抑郁评分显著降低（p=0.001）。GAF 评分从 61 增加到 80，导致社会、职业或学业功能仅有轻微受损。与多学科治疗前相比，患者自述病情有所改善。盆腔疼痛与焦虑（p=0.032）和惊恐障碍（p=0.040）之间存在关联。心理创伤与抑郁有关（p=0.044），优势比为 2.93（1.01-8.50）。心理创伤与 62.3%的泌尿科疼痛综合征患者和 83.3%的盆腔疼痛患者同时存在。
总体结果表明，先前对泌尿科治疗无反应的功能性泌尿科患者从泌尿科医生和精神科医生的综合护理方法中获益。对膀胱-大脑轴和警报伪造模型的解释阐明了功能性综合征中泌尿科和心理因素的作用，并为综合护理提供了机会。
