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Paruresis, also known as shy bladder, refers to the condition where the perception of perceived scrutiny of others leads to a difficultly (or inability) in urinating in restrooms. The aim of the study was to identify the prevalence of public urinal avoidance and the potential efficacy of an extended bivalent fear of evaluation model of paruresis to predict public urinal avoidance. 191 male university students (mean age = 28.66 years) completed an online questionnaire which included ten public urinal vignettes. The results indicated that an average of 35.08% of participants avoided an available urinal due to anxiety associated with being around others, while a further 42% avoided urinals due to fears relating to contamination. Based on structural equation modelling, the extended bivalent fear of evaluation model of paruresis was found to predict public urinal avoidance (χ2p-value =.123, Normed Chi-square = 1.446, Comparative Fit Index =.986, Tucker–Lewis index =.973, Steiger-Lind Root Mean Square Error of Approximation =.049, Standardised Root Mean Squared Residual =.048). Paruresis symptoms were found to be influenced by several socio-cognitive processes, including dysfunctional attitudes, fear of positive and negative evaluation and concerns of social reprisal. Extending past research was the finding that the extended bivalent fear of evaluation model of paruresis predicted urinal avoidance. Overall, the results provide evidence that public urinal avoidance is common and is likely to be underpinned by socio-cognitive processes and paruresis symptoms. [ABSTRACT FROM AUTHOR]

Paruresis has been recognized as a subtype of Social Anxiety Disorder (SAD). A well-established model of SAD is the extended bivalent fear of evaluation model (extended BFOE) which include socio-cognitive processes such as fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). In addition to the extended BFOE, dysfunctional attitudes (DAs) have also been recognized to contribute towards social anxiety symptoms and distress. The aim of this study was to examine whether an extended BFOE model for SAD could be used to explain paruresis and parcopresis symptoms. Three-hundred-and-sixteen undergraduate students (76.6% female; mean age = 31.25 years) completed a cross-sectional online study. A structural equation model (SEM) indicated the data supported the proposed model very well (χ2p value =.345, CMIN/df = 1.064, CFI = 1.00, TLI =.999, RMSEA =.014, SRMR =.0107) with significant direct relationships being found between DAs and FNE (p =.002), DAs and FPE (p =.002), FNE and CSR (p =.001), FPE and CSR (p =.001), CSR and paruresis score (p =.045), CSR and DAs (p =.006), FPE and paruresis score (p =.001), FPE and parcopresis score (p =.004), FNE and paruresis score (p =.004), and FNE and parcopresis score (p =.002). Although this research should be replicated, the current study provides evidence that DAs, FNE, FPE and CSR are important contributory factors in paruresis and parcopresis symptoms. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the validity of a single, self-report measure for bladder and bowel anxieties (Bladder and Bowel Anxiety Grouping Item; BABAGI), using two appropriate scales entitled the Shy Bladder and Bowel Scale (SBBS) and the Bladder and Bowel Incontinence Phobia Severity Scale (BBIPSS). This study also aimed to examine the similarities and differences in dysfunctional attitudes (DAs), fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO) across individuals who self-identify as having paruresis/parcopresis, incontinence anxiety, or neither condition according to the BABAGI measure. Three-hundred-and-six undergraduate students (77.1% female; mean age = 31.18 years) completed a cross-sectional, online study. The results supported the hypothesis that by using the BABAGI, self-reported paruresis/parcopresis could be reliably identified by SBBS scores of above 6.75 and that self-reported incontinence anxiety could be reliably identified by BBIPSS scores above 15.21. The results also supported the hypothesis that individuals who self-identified as having paruresis/parcopresis or incontinence anxiety would score higher in socio-cognitive processes (DAs, FNE, FPE, CSR, DPSO) compared to individuals who self-identified as having neither condition. Given that the paruresis/parcopresis and incontinence anxiety groups do not significantly differ from each other with respect to socio-cognitive processes, this suggests that both sets of conditions share similar underlying psychosocial processes. [ABSTRACT FROM AUTHOR]

Urine doping controls have become a regular part of athletes' lives, and approximately one half of all athletes suffer at least once from urination difficulties during these tests. Previous studies could not satisfactorily explain why athletes are affected. This paper examines the relation between urination difficulties during doping controls and psychological reactance. It is assumed that psychological reactance is positively correlated to urination difficulties. The results are based on a study involving 187 German-speaking athletes participating in elite sports at the national team level. In addition to demographic data and information about doping controls, the Psychogenic Urine Retention during Doping Controls Scale (PURDS) and Therapeutic Reactance Scale (TRS) were used. The results do not confirm our hypothesis and indicate that reactance correlates negatively rather than positively to urination difficulties during doping controls. The results are surprising as they suggest that athletes who show low oppositional potential toward doping rules are most strongly affected. Suggestions for interventions are given. [ABSTRACT FROM AUTHOR]

To date, research exploring the socio-cognitive processes associated with paruresis and parcopresis symptomology is lacking. The current study aimed to investigate how the socio-cognitive processes dysfunctional attitudes (DAs) and fear of negative and positive evaluation (FNE and FPE respectively) relate to paruresis and parcopresis symptomology. In total, 254 undergraduate students (74.0% female; mean age = 31.67 years) completed a cross-sectional online study. A structural equation model indicated the data fit reasonably well (χ2p value =.209, CMIN/df = 1.514, CFI =.995, TLI =.983, RMSEA =.045, SRMR =.0272), with FPE mediating the relationship between DAs and paruresis symptom severity (p =.001) along with parcopresis symptom severity (p =.001). However, secondary analyses identified that FPE and FNE act as mediators between DAs and paruresis and parcopresis symptom severity when placed in separate models. This is the first study to provide evidence that the psychosocial-cognitive processes DAs and fear of evaluation play an important role in paruresis and parcopresis symptomology. Although this research should be replicated, the current study provides evidence that DAs, and FPE are important contributory factors in paruresis and parcopresis symptoms. [ABSTRACT FROM AUTHOR]

Objective: Paruresis refers to the inability to initiate or sustain urination where individuals are present due to the fear of perceived scrutiny from others. The aim of this systematic review was to evaluate four key questions: (1) What is the prevalence of paruresis and its associated demographic features; (2) What is the prevalence of psychopathology in paruresis cohorts, how does it compare to other chronic-health conditions, and what percentage of paruresis patients also have social anxiety disorder? (3) How does quality of life, and levels of anxiety and depression compare between those with and without paruresis; and (4) do psychological interventions for paruresis patients reduce paruresis symptoms, or, anxiety, or depression, or improve quality of life?Method: A review was conducted using PRISMA protocol for search strategy, selection criteria, and data extraction. Searched databases included PubMed, CINAHL, and PsychINFO. Over the 1418 studies screened, ten were found relating to at least one review question.Results: The prevalence of paruresis ranged between 2.8 and 16.4%, and around 5.1-22.2% of individuals with paruresis also had Social Anxiety Disorder. Paruresis symptoms were shown to reduce in one intervention study. Paruresis was also associated with poorer quality of life. A key limitation of the research to date has been the notable methodological problems and lack of standardisation relating to the measurement of paruresis.Conclusion: Little is known about the prevalence of paruresis and more rigorous studies of paruresis are required. Recommendations in terms of clinical implications, diagnostic criteria and future research relating to paruresis are discussed. [ABSTRACT FROM AUTHOR]

Social facilitation theory is one of the most paradigmatic examples of social psychology, understood as an experimental science. However, in this paper we intend to demonstrate that the research that allegedly supports it suffers from a number of defects. It uses biased population samples, and the tasks it sets its experimental subjects are limited to the practical or productive, ignoring the broader range of everyday activities such as conversing or, indeed, urinating. Social facilitation theory, far from being objective, is a microcosm of American social psychology ideology insofar as it ignores basic human functions, and fails to include stigmatized communities such as stutterers and people with bladder problems.

Background: Paruresis, or “shy bladder syndrome”, is a relatively common anxiety disorder, yet little is known about the causes of, and effective treatments for this disabling condition. Aim: This report describes a case study in which a man (Peter) presenting with paruresis was treated using formulation-driven CBT, which aimed to address the idiosyncratic processes that were maintaining his anxiety and avoidance of urinating in public. Method: Peter attended 12 sessions of CBT including one follow-up session a month after treatment had ended. Treatment involved collaboratively developing an idiosyncratic case conceptualization (identifying longitudinal and cross-sectional factors involved in the development and maintenance of his difficulties), followed by a number of standard cognitive and behavioural interventions commonly used in evidence-based CBT protocols for other anxiety disorders. Peter completed sessional outcome measures of paruresis symptomatology, anxiety, depression, social anxiety and functional impairment. Results: Peter subjectively found the intervention helpful and his scores on all of the outcome measures reduced over the course of his therapy, and were maintained at one month follow-up. Conclusions: This report adds to the scarce literature regarding effective treatments for individuals suffering with paruresis. Limitations of the design are acknowledged and ideas for further research in this area are discussed. [ABSTRACT FROM AUTHOR]

Currently research exploring paruresis and parcopresis, anxiety relating to urinating and having bowel motions in public respectively is limited. While there are several validated measures of paruresis, no valid measure assessing parcopresis is currently available. The present study investigates the development and validation of the Shy Bladder and Bowel Scale (SBBS) which assesses both paruresis and parcopresis. Two participant groups were utilised to validate this scale, a student psychology cohort (n = 387) and a public cohort (n = 334). An eight-item two-factor model was identified in the psychology cohort and confirmed in the public cohort. The two-factor SBBS was found to be a valid and reliable measure of paruresis and parcopresis. Paruresis and parcopresis-related concerns were associated with social anxiety in both cohorts. Subscales for both paruresis and parcopresis (i.e. difficulty, interference and distress) were positively correlated, suggesting individuals are likely to report similar levels of concerns across both conditions. Further, individuals self-identifying with either paruresis or parcopresis reported significantly higher scores on the respective SBBS subscales than non-identifying paruresis and parcopresis individuals. The SBBS also demonstrated strong test–retest reliability in a small sample of adults (n = 13). Overall, the developed scale provides clinicians and researchers with a valuable tool to evaluate both paruresis and parcopresis. [ABSTRACT FROM PUBLISHER]

This article outlines the challenges and negative experiences athletes encounter during urine doping controls and how they can be dealt with. Negative experiences can be caused by physiological (e.g., inability to urinate) and psychological (e.g., feelings of embarrassment) factors relating to the control as well as to the way in which the doping control officer (DCO) conducts the procedure. Negative experiences can lead to short- and long-term effects on athletes' well-being and potentially also performance. The article outlines a number of strategies that can be applied to minimize negative experiences of urine doping controls. Furthermore, recommendations for how policy regarding urine doping tests could be changed are given. [ABSTRACT FROM AUTHOR]

Paruresis, considered a category of social phobia, is the fear of being unable to initiate or sustain urination in the presence of others or in situations where others may become present. Many clients who struggle with paruresis present with symptoms commonly associated with other types of social phobia, which makes assessment, diagnosis, and treatment difficult. Although panuresis is relatively common, many counselors know little about it. This article focuses on the prevalence, etiology, course, assessment, diagnosis, and treatment of paruresis. Case scenarios are presented to guide counselors in assessing and diagnosing paruresis. Implications for counselors are discussed. [ABSTRACT FROM AUTHOR]

Urethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) ( HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease. [ABSTRACT FROM AUTHOR]

Urine doping controls have become a part of the daily lives of elite athletes. However, little knowledge is available on how athletes perceive these controls. In order to investigate this question, four hundred elite athletes completed an online survey in which they replied to open and closed questions about their experiences. The results showed that athletes approve of doping testing and that the majority of them are careful to report all substances they have consumed. Fear of a false positive test result despite not having taken forbidden substances is of concern for about half of the athletes, and significantly more for female and younger athletes. Furthermore, a third of the athletes report about experiencing stress caused by urination difficulty during the control, and a smaller group (approximately one out of seven) feel their personal integrity is violated because someone is watching them urinate. In addition, a quarter of the athletes feel that urine doping controls performed at their home are an invasion of privacy. Suggestions for the improvement of urine doping controls as well as for future research are given in the article. [ABSTRACT FROM AUTHOR]

La teoría de la facilitación social es una de las más paradigmáticas de la psicología social porque representa el carácter científico y experimentalista de la disciplina; sin embargo, en este artículo creemos demostrar que dicha teoría recurre a muestras sesgadas de población para validar sus hipótesis: las tareas investigadas son prácticas o productivas omitiendo otras más humanas y cotidianas como dialogar u orinar. La teoría de la facilitación social, lejos de alcanzar la objetividad, refleja la ideología de la psicología social americana porque ignora funciones humanas básicas y comunidades estigmatizados como tartamudos y paruréticos.

Abstract: Psychogenic urine retention during doping controls (PURD) refers to an athlete''s inability to urinate during a doping control. This paper reports PURD to occur quite frequently in elite athletes, investigates the relationship to the clinical disorder of paruresis (PAR), and investigates its relation to recovery, performance, and self-perception of professionalism and athletic excellence. Furthermore, a scale developed especially for the close description and measurement of PURD is presented. A questionnaire was used for measuring paruresis. The results are based on two online and one paper and pencil study involving 222 German-speaking athletes from various sports. The results indicate that 60% of these athletes have experienced psychogenic urine retention during doping controls, with only 39% of them showing symptoms of paruresis. PURD impacts athlete recovery and self-perception of professionalism and athletic excellence. Suggestions for psychological interventions and recommendations for improving the doping control system are given. [Copyright &y& Elsevier]

Paruresis, characterized by the difficulty or inability to urinate in a variety of social contexts, is a scientifically under-studied phenomenon. One reason for this state of affairs is the paucity of reliable and valid measures for assessing this problem. The present article attempted to address this limitation by investigating the psychometric properties and validity of a new measure of paruresis: the Shy Bladder Scale (SBS). In two undergraduate samples, the SBS demonstrated excellent internal consistency and a stable factor structure assessing difficulty urinating in public, impairment and distress, and paruresis-related fear of negative evaluation. Undergraduate students evidenced very low levels of paruresis-related concerns. In contrast, SBS scores were markedly elevated among individuals recruited from an online support network who appeared to meet diagnostic criteria for paruresis-specific social phobia. Our findings highlight the SBS's potential utility as a measure of paruresis in clinical and research contexts. [ABSTRACT FROM PUBLISHER]

Abstract: Congenital lower urinary tract obstruction (LUTO) is a heterogeneous group of pathologies, the most common being posterior urethral valves (PUV) or urethral atresia. The bladder neck obstruction in utero leads to a spectrum of disease including mild oligohydramnios with normal renal function to a picture of severe oligohydramnios associated with chronic obstructive macro/microcystic renal parenchymal disease leading to chronic renal impairment. These anomalies may be isolated or complex; the latter being associated with other structural or chromosomal abnormalities. If isolated, the congenital bladder neck obstruction may be amenable to in-utero therapy. In a significant proportion of babies affected by LUTO there is severe oligohydramnios (occurring before 20weeks gestation) and associated with pulmonary hypoplasia, a scenario almost always associated with perinatal death. For those babies that survive the perinatal period there is a significant risk of renal impairment, often necessitating renal dialysis or transplantation in childhood. In addition, there may be other morbidities such as chronic filling anomalies of the bladder that may require treatment. [Copyright &y& Elsevier]

Die Paruresis ist als Unterform der sozialen Phobie klassifiziert, bei der die Betroffenen über Ängste und Unfähigkeit klagen, auf öffentlichen Toiletten zu urinieren. Verfügbare Therapiemanuale sowie Fallstudien basieren hauptsächlich auf behavioralen Methoden wie Desensibilisierung, Entspannungsverfahren oder graduierter Exposition. Trotz nachgewiesener Effektivität der kognitiven Therapie der sozialen Phobie nehmen kognitive Interventionen bisher eher einen kleinen Stellenwert in der Behandlung ein. Am Beispiel einer Falldarstellung eines 19-jährigen Patienten mit Paruresis wird ein kognitiver Therapieansatz beschrieben, der sich in der Therapie der sozialen Phobie bereits bewährt hat. Konkrete kognitiv-verhaltenstherapeutische Interventionen werden aus dem kognitiven Modell nach Clark und Wells logisch abgeleitet. In 33 Therapiesitzungen konnten die Ziele des Patienten, die zu Beginn der Therapie aufgestellt wurden, erreicht werden. Die Falldarstellung zeigt, dass die Anwendung des kognitiven Modells der sozialen Phobie bei Paruresis erfolgreich sein kann. Die rein kognitive Vorgehensweise stellt eine Neuerung zu den bisher stark behavioral angelehnten Therapieansätzen dar. Weitere Forschung zur Entstehung, Aufrechterhaltung und Behandlung der Paruresis ist notwendig. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Gram-negative (G(−)) bacterial spinal epidural abscess (SEA) in adults is uncommon. Of the 42 adult patients with bacterial SEA admitted to the Chang Gung Memorial Hospital – Kaohsiung, between 2003 and 2007, 12 with G(−) SEA were included in this study. Of these 12 patients, seven were men and five were women; their ages ranged between 17years and 81years (median=72.5years, mean=62.5years). The patients were admitted at different stages of symptom onset (four were in the acute stage and four each in the subacute and chronic stages) and at different levels of neurologic deficit severity, ranging from back pain to paraplegia. Of these 12 patients, 11 had a medical and/or neurosurgical condition as the preceding event and four had a concomitant infection at other sites. Back pain (83%, 10/12) was the most common clinical presentation, followed by paraparesis (50%, 6/12), radiating pain (33%, 4/12), and urinary retention (25%, 3/12). The following causative G(−) pathogens were detected: Klebsiella pneumoniae (three patients), Salmonella spp. (three), Escherichia coli (two), Enterobacter spp. (two), Aeromonas hydrophila (one), and Prevotella melaninogenica (one). Both Enterobacter strains were resistant to multiple antibiotics. Of the 12 patients, eight (66.7%) had spontaneous SEA, whereas the remaining four had postneurosurgical SEA. Thoracic, lumbar, and thoracolumbar spine segments were the most commonly affected. After receiving medical and/or surgical treatment, 10 of the 12 patients (83%) survived, and all 10 recovered well. In conclusion, G(−) bacterial SEA accounted for 28.5% (12/42) of adult SEA. The causative G(−) pathogens found in this study were different from those reported in Western countries, and the strains noted in our study had multiple antibiotic resistance. Our findings suggest that the choice of initial empirical antibiotics for SEA should be carefully considered. [ABSTRACT FROM AUTHOR]

Abstract: Most studies on coping among persons with severe mental illness have relied on retrospective self-report methods; a limitation of this methodology is susceptibility to recall bias. The purpose of the present investigation was to expand the current understanding of the impact of coping among persons with severe mental illness by examining coping strategies, mood, and social functioning (operationalized as productive time use) using a daily process design. Twenty-seven adults diagnosed with severe mental illness completed baseline clinical interviews and up to 20days of nightly telephone interviews addressing coping and daily life. A total of 198 coping efforts were reported for 387days. Mixed-effects regression analyses examined the association between type of daily coping strategy (problem-centered, neutral, or avoidant) and both daily proportion of time participants spent in productive activity and daily negative mood, controlling for demographic and clinical variables. The results indicated that productive time use was significantly lower on days when avoidant strategies were used, in contrast with days when problem-centered strategies and neutral strategies were used. There was no significant main effect of coping on negative mood, although there was a trend in the expected direction. Findings support the hypothesis that the types of coping strategies adults with severe mental illness use are related to better social functioning on a daily level. [ABSTRACT FROM AUTHOR]

Paruresis is a social anxiety disorder characterized by a fear of being unable to urinate in the presence of others. This condition has not been covered in the social work literature, yet is a perfect example of a person-in-environment problem. This article explores the use of graduated exposure therapy during weekend-long workshops for the treatment of paruresis. One hundred one participants participated in workshops and were administered pretreatment, posttreatment, and 1-year follow-up treatment scales. Repeated measures analysis of variance indicated significant improvement in shy bladder symptoms. Significant improvement in global severity of shy bladder was observed posttreatment and at the 1-year follow-up point. Findings suggest that graduated exposure therapy improves self-reported global severity of shy bladder symptoms and that these gains were maintained at 1-year follow up. [ABSTRACT FROM AUTHOR]

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Abstract Introduction and hypothesis  Multiple sclerosis is a chronic, debilitating, neurological disease with numerous urological manifestations including urinary detrusor overactivity, detrusor sphincter dyssynergia, and urinary retention. Can sacral neuromodulation be successfully implemented for urinary retention in ambulatory women with multiple sclerosis? Methods  Between January 2002 and January 2008, we conducted an observational retrospective case–control study where 12 of 14 consecutive, ambulatory women with multiple sclerosis had stage 1/2 sacral neuromodulation performed under general anesthesia for urinary retention. Results  Twelve of 14 patients (86%) were successfully implanted, with a mean follow-up of 4.32 ± 1.32 years and mean postvoid residual of 50.5 ± 21.18 ml. The mean maximum uroflow was 17.7 ± 7.9 ml/s. Two of the 12 patients (17%) required revisional surgeries for lead migration, and 40% needed battery replacement. Conclusion  Urinary retention in multiple sclerosis female patients can be successfully and safely managed with sacral neuromodulation with few complications with a mean of 4 years follow-up. [ABSTRACT FROM AUTHOR]

Abstract Introduction and hypothesis  The purpose of the study was to evaluate the efficacy of postoperative transvaginal tape mobilization (TM) in treating urinary retention after tension-free vaginal tape (TVT) procedures. Methods  A 3-0 Vicryl loop was made at the midpoint of the vaginal tape for tension adjustment. If urinary retention occurred postoperatively, TM was applied in the ward under local anesthesia. The TM procedure could be repeated until the patient voided well. Results  Of the 80 women, five (6.3%) patients who had to void with extreme strain or with urinary retention received TM on postoperative days 1∼3. It was successful immediately in four patients, and only one patient required repeated adjustment three times. None of these five patients had recurrent stress urinary incontinence (SUI) after tensioning off of the tape. Overall, 67 patients (84%) had been cured of SUI, and 13 (16%) patients had improvement of SUI 3 months after TVT operation. Conclusion  TM is efficacious in treating voiding difficulty after the TVT procedure. [ABSTRACT FROM AUTHOR]

Abstract: Background: Combination therapy with dutasteride and tamsulosin provides significantly greater benefit than either monotherapy for various patient-reported outcomes in men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) and prostatic enlargement. Objective: To investigate whether combination therapy is more effective than either monotherapy in reducing the relative risk for acute urinary retention (AUR), BPH-related surgery, and BPH clinical progression over 4 yr in men at increased risk of progression. Design, setting, and participants: The Combination of Avodart® and Tamsulosin (CombAT) study was a 4-yr, multicenter, randomised, double-blind, parallel-group study in 4844 men ≥50 yr of age with a clinical diagnosis of BPH, International Prostate Symptom Score ≥12, prostate volume ≥30cm3, prostate-specific antigen 1.5–10ng/ml, and maximum urinary flow rate (Qmax) >5 and ≤15ml/s with minimum voided volume ≥125ml. Intervention: Oral daily tamsulosin, 0.4mg; dutasteride, 0.5mg; or a combination of both. Measurements: The 4-yr primary end point was time to first AUR or BPH-related surgery. Secondary end points included BPH clinical progression, symptoms, Qmax, prostate volume, safety, and tolerability. Results and limitations: Combination therapy was significantly superior to tamsulosin monotherapy but not dutasteride monotherapy at reducing the relative risk of AUR or BPH-related surgery. Combination therapy was also significantly superior to both monotherapies at reducing the relative risk of BPH clinical progression. Combination therapy provided significantly greater symptom benefit than either monotherapy at 4 yr. Safety and tolerability of combination therapy was consistent with previous experience with dutasteride and tamsulosin monotherapies, with the exception of an imbalance in the composite term of cardiac failure among the three study arms. The lack of placebo control is a study limitation. Conclusions: The 4-yr CombAT data provide support for the long-term use of dutasteride and tamsulosin combination therapy in men with moderate-to-severe LUTS due to BPH and prostatic enlargement. Clinicaltrials.gov identifier: NCT00090103 (http://www.clinicaltrials.gov/ct2/show/NCT00090103). [Copyright &y& Elsevier]

During the last decades, erectile dysfunction was considered a direct consequence of aging and, although of a great concern for the affected patient, little was available to evaluate and treat this problem. If aging could not be invoked in all cases, than the psychogenic etiology was the only explanation. Over the coming years, a better understanding of the physiology involved in the penile process of tumescence and detumescence has allowed for better approach of each disease asociated with erectile dysfunction so that adequate treatment modalities can be applied to the pacient. As we all know, every pacient is a particular case. The development of modern PDE-5 inhibiters, along with other more or less invasive therapies, puts a new light on the medical approach of ED. [ABSTRACT FROM AUTHOR]

Aim: To determine the spectrum, outcome of treatment and the challenges of managing surgical lesions of lower genital tract in girls in a low-resource setting. Method: Retrospective study of 87 girls aged 13-years and younger, with lower genital tract lesions managed between February 2002 and January 2007 at the University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Clinical charts were reviewed to determine the types, management, outcome of treatment and management difficulties. Results: The median age at presentation was 1 year (range 2 days–13 years). Congenital lesions comprised 67.8% and acquired lesions 32.2%. The lesions included: masculinised external genitalia (24), vestibular fistula from anorectal malformation (23), post-circumcision labial fusion (12), post-circumcision vulval cyst (6), low vaginal malformations (6), labial adhesion (5), cloacal malformation (3), bifid clitoris (3) urethral prolapse (3), and acquired rectovaginal fistula (2). Seventy-eight (89.7%) had operative treatment. Procedure related complications occurred in 19 cases (24.4%) and consisted of surgical wound infection (13 cases), labial adhesion (4 cases) and urinary retention (2 cases). There was no mortality. Overall, 14 (16.1%) abandoned treatment at one stage or another. Challenges encountered in management were inadequate diagnostic facilities, poor multidisciplinary collaboration and poor patient follow up. Conclusion: There is a wide spectrum of lower genital lesion among girls in our setting. Treatment of these lesions may be challenging, but the outcome in most cases is good. High incidence of post-circumcision complications and poor treatment compliance may require more efforts at public enlightenment. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Sportpsychologie is the property of Hogrefe Verlag GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents abstracts related to dermatology which include the treatment of erosive vulvovaginal lichen planus with methotrexate, the literature concerning psychogenic purpura, and the results of a prospective observational study of the homeopathic treatment of patients with psoriasis.

The article discusses the definition and management of paruresis, shy bladder syndrome. The author explores the effect of physiological and psychological stress on the bladder and its relationship to paruresis, as well as neurological mechanisms that might cause it. The nurse's role in intervention is also presented.

Paruresis is a condition characterized by difficulty or inability to urinate in situations where others are present, or may soon be present. Despite knowledge that paruresis can significantly impact on occupational functioning, social functioning, and quality of life, there exists a paucity of research into effective treatments. Although cognitive conceptualizations have been advanced for other anxiety disorders, there has not been a comprehensive cognitive behavioral model of paruresis. This article presents a revised cognitive and behavioral conceptualization of paruresis, drawing on empirical evidence from other anxiety disorders. Using this conceptualization, a cognitive-behavioral intervention strategy is outlined, with clear targets for cognitive and behavioral strategies. Depression and Anxiety, 2008. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Social facilitation theory is one of the most paradigmatic examples of social psychology, understood as an experimental science. However, in this paper we intend to demonstrate that the research that allegedly supports it suffers from a number of defects. It uses biased population samples, and the tasks it sets its experimental subjects are limited to the practical or productive, ignoring the broader range of everyday activities such as conversing or, indeed, urinating. Social facilitation theory, far from being objective, is a microcosm of American social psychology ideology insofar as it ignores basic human functions, and fails to include stigmatized communities such as stutterers and people with bladder problems. [ABSTRACT FROM AUTHOR]

Abstract: Paruresis manifests in an inability to urinate in public restrooms followed by a considerable avoidance behavior. According to DSM-IV TR this disorder is classified as social phobia. A sample of N =226 subjects completed different questionnaires concerning paruresis, social phobic symptoms, lower urinary tract symptoms and depressive symptoms. These individuals were divided into four groups: no symptoms, suffering primarily from paruresis, non-generalized social phobia and generalized social phobia. The paruretic group differs significantly in all symptom variables from both the non-generalized and the generalized social phobia groups. Regression analysis separated by groups shows that the interference with everyday life can be mainly explained by paruretic symptoms (in the paruretic group) or by social anxiety and depressive symptoms, respectively (in the social phobic groups). These results question the classification of paruresis as simply being a form of social phobia. [Copyright &y& Elsevier]

Urinary retention in women is a diagnostic and therapeutic challenge to urologists and to all involved in the treatment of the condition. The patients referred to a single institution with this condition over a 4-year period were audited and the data are presented. The importance of Fowler's syndrome is described, as is the value of sacral nerve stimulation in this condition. In another paper, authors from France present evidence of occult dysautonomia in Fowler's syndrome. OBJECTIVE To report the experience of the last 4 years from a centre to which women with voiding difficulties and urinary retention were referred nationally, describing what investigations were helpful in making a diagnosis and the management strategies used PATIENTS AND METHODS Women with voiding difficulties and urinary retention remain a diagnostic and management challenge, and those with no anatomical or neurological basis for their symptoms may be dismissed, assuming that their retention has a psychogenic basis. The finding of an electromyographic (EMG) abnormality of the striated urethral sphincter explaining their disorder (Fowler's syndrome) has led to the referral of women for consideration of that diagnosis. Thus we audited the referrals to the centre over a 4-year period of such women. RESULTS In all, 247 women (mean age 35 years) with complete (42%) or partial retention (58%) were referred; 175 (71%) had urethral pressure profilometry, 141 (57%) had a transvaginal ultrasonographic measurement of the sphincter volume, and 95 (39%) had sphincter EMG. The mean maximum urethral closure pressure difference between patients with an EMG abnormality (101.5 cmH2O) and the patients with known other causes of voiding dysfunction (66.2 cmH2O) was 35.3 cmH2O ( P < 0.05). In patients with complete retention there was a significant difference in sphincter volume between those who were EMG-positive (2.14 mL) or EMG-negative (1.64 mL) ( P < 0.05). CONCLUSION These investigations helped to classify the cause of retention in two-thirds of cases. The commonest diagnosis was Fowler's syndrome, in which sacral nerve stimulation is the only intervention that restores voiding. [ABSTRACT FROM AUTHOR]

AbstractBackground: Although research interest in social phobias has expanded during the last decade, a special subtype of social phobia known as paruresis, which manifests in the inability to urinate in public rest rooms, is rarely mentioned. The aim of the present study was to achieve for the first time an estimation of point prevalence in a representative male sample (n = 1,105). Method: Due to the lack of well-established screening instruments for paruresis, the Paruresis Checklist (PCL) must be tested for reliability and validity. An empirically based cutoff score must be determined by using the subjective interference with everyday life as an external criterion. Results: Reliability of the PCL seemed to be sufficient, and adequate evidence for validity was found. Using the empirically based cutoff score of the PCL, 2.8% of the sample was diagnosed as suffering from paruresis. In contrast to other forms of social phobia, paruresis is not associated with a lower educational or occupational level.Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In spite of the success of cognitive behavioral therapy for social phobia in research studies, it remains unclear whether interventions will remain successful in the routine of clinical practice, where patients might differ from those in research samples. This study investigates the possibility that higher effect sizes are achieved under typical research conditions. Thirty studies testing treatment effects for social phobia are re-examined by categorizing them according to the quality and amount of applied sample restriction and laboratory study characteristics. The results indicate that even accumulation of sample restriction, such as excluding patients with comorbid disorders or being outside a certain age range, does not have any predictive value for treatment effect. However, there was a relevant tendency for studies applying a row of laboratory treatment conditions, such as recruiting patients by advertisements, applying treatment in university settings, and using specifically trained therapists, to achieve higher effect sizes. [Copyright &y& Elsevier]

Paruresis is characterized by the fear of not being able to urinate in public bathrooms and has been classified by some to be a sub-type of social anxiety disorder (social phobia). Despite the existence of a consumer advocacy organization, the “Intentional Paruresis Association (www.paruresis.org),” there is sparse literature on this condition. A survey of people affiliated with the “International Paruresis Association” was undertaken using a self-report questionnaire with items that addressed demographic variables, the phenomenology of paruresis, comorbid disorders, and the impact of symptoms on quality of life. Sixty-three patients (59M, 4F) completed the questionnaire. The mean age of the subjects was 38.1±12 years, with the mean duration of symptoms being 24.5±13 years. Paruresis impacts significantly on sufferers' lives, with approximately one third limiting or avoiding parties, sports events, or dating and just over half of the sample limiting the job they choose to do. Social anxiety disorder (SAD) and depression are the most common comorbid disorders and the most common disorders in family members. Analysis of Liebowitz Social Anxiety Scale (LSAS) scores showed higher performance than social interaction subscale scores across the whole sample (whether suffering from SAD or not.) However, compared to subjects without co-morbid SAD, those with comorbidity had higher total, performance, and social interaction scores. Thus, paruresis can be a chronic and disabling symptom, and there seems to be an association between paruresis and other performance anxieties. Further research to characterize paruresis and to determine effective treatments is needed. Depression and Anxiety 16:84–87, 2002. © 2002 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Paruresis, the functional inability to urinate in the presence of others, may be a symptom of social phobia. Although social phobia is common, the frequency of paruresis is uncertain though an epidemiologic study suggests 0.2% incidence of public rest room phobia and a survey of male college students estimated 7% incidence of avoidant paruresis. Paruresis appears to be a form of performance anxiety and many people may have minor symptoms; a questionnaire study of college students suggesting between 50-70% of students had some difficulty initiating micturition in public rest.

The present study reports on the psychometric properties of the Social Phobia and Anxiety Inventory (SPAI; Turner et al., 1989a) in two nonclinical samples of college undergraduates. Exploratory principal-components analysis with varimax rotation replicated the five-factor solutions reported for the 32-item Social Phobia subscale (SP) in sample 1 (N = 200). Confirmatory factor analyses showed that the five-factor structure of the SP and the two-factor structure of the SPAI were appropriate for the second sample (N = 210) data. Coefficient alpha values were high for all the SP and the SPAI subscales. Furthermore, we examined the relations between the SPAI subscales and measures of social fear and anxiety, social desirability, and general psychopathology. Results support the research use of the SPAI in our undergraduate samples. [ABSTRACT FROM AUTHOR]