What is the management approach for a 25-year-old male patient with shy bladder (paruresis) requiring intermittent self-catheterization for urinalysis (UA)?

From the Guidelines

I strongly recommend providing the 25-year-old male inmate with a renewed memo authorizing self-catheterization when needed for urinalysis due to paruresis (shy bladder syndrome). The memo should clearly state that the patient has a documented history of difficulty providing urine samples under observation and is permitted to perform clean intermittent self-catheterization in these specific circumstances.

Key Considerations

• The patient's condition, paruresis, is a recognized psychological condition that produces a genuine physiological response, preventing normal urination in the presence of others or in public facilities 1.
• Self-catheterization provides a practical solution that allows for necessary testing while minimizing psychological distress to the patient.
• The memo should include the patient's name, ID number, diagnosis of paruresis, and specify that this accommodation is medically necessary for obtaining urine samples for testing purposes only.
• The use of clean intermittent self-catheterization is supported by studies, which have shown that it is associated with a lower incidence of UTI and asymptomatic bacteriuria compared to other methods 1.
• A Cochrane review concluded that there is a lack of reliable evidence that any specific catheter type, method, technique, or person is superior in preventing UTI, making clean intermittent self-catheterization a suitable option 1.

Recommendations for Implementation

• The memo should be valid for a defined period (typically 6-12 months) before requiring reassessment.
• The patient should be educated on proper catheter hygiene and technique to minimize the risk of UTI, including hand hygiene and cleaning of the perineal region and proximal catheter with soap and water 1.
• The patient should be advised to use catheters for single use only, as per manufacturer guidelines, to reduce the risk of UTI 1.

From the Research

Patient's Condition

The patient is a 25-year-old male experiencing shy bladder, which is causing difficulty in urinating in public places, including the prison's OPC. He has requested a memo for self-catheterization when needed for urinalysis (UA).

Relevant Studies

• There are no direct studies on shy bladder in the provided evidence. However, studies on urinary retention and lower-urinary-tract symptoms may be relevant 2, 3, 4, 5, 6.
• Urinary retention can be caused by various factors, including obstructive, infectious, and inflammatory conditions, as well as pharmacologic and neurologic factors 2.
• Alpha blockers have been shown to be effective in increasing the success rates of trial without catheter (TWOC) in men with acute urinary retention 3, 4.
• The use of alpha blockers in women with lower-urinary-tract symptoms and dysfunction is less clear, with some studies showing improvement in symptoms, but also reporting adverse effects such as dizziness and hypotension 6.

Management

• The patient's request for self-catheterization may be a reasonable accommodation for his shy bladder condition.
• However, it is essential to rule out any underlying medical conditions that may be contributing to his urinary retention or shy bladder.
• Further evaluation and management may be necessary to address the patient's condition, including referral to a urologist or other specialist.

Key Points

• Shy bladder is not directly addressed in the provided studies.
• Urinary retention and lower-urinary-tract symptoms can be caused by various factors.
• Alpha blockers may be effective in increasing TWOC success rates in men with acute urinary retention.
• The use of alpha blockers in women with lower-urinary-tract symptoms and dysfunction is less clear.