Differential diagnosis and treatment of neurogenic and psychogenic dysuria in case of overactive bladder syndrome

The diagnosis of neurogenic and psychogenic dysurias is the most difficult and controversial problem of modern urology, the solution of which requires a differentiated approach based on the comparison of neurological, psychic, and urologic symptoms. The basis for their diagnostic search is the method of substitution of found symptoms in the schemes of known urologic, neurological diseases and psychopathological states in the direction from the general to the particular, i.e. by the method of deductive reasoning. The results of diagnostic tests and pharmacological analysis only clarify the details of final diagnosis. When one patient has an organic lower urinary tract lesion concurrent with neurogenic dysuria is the most difficult diagnostic case. The diagnosis of such conditions necessitates the performance of ultrasound, neurophysiological, neuroimaging, and urodynamic studies. The neurogenic disorders are characterized by a concomitance of neurological and urologic symptoms that generally occur at the same time, by a change in urodynamic parameters, and by a positive effect of specific therapy encompassing anticholinergic, sympatholytic, and other neurotropic agents. Psychogenic dysurias are not attended by neurological deficit and the instrumentally signs of organic urinary tract lesion, but is always accompanied by the psychopathological symptoms of anxiety or depression. Moreover, there is a positive effect of psychotropic drugs (anxiolytics or antidepressants) and indifference to the use of neurourologic agents.