Persistent need to urinate: A common sensory symptom leading to urinary discomfort. A study of 79 cases

Abstract

An unpleasant, inappropriate, and persistent need to urinate (PNU) is a sensory symptom reported by some patients with lower urinary tract symptoms (LUTS). However, no detailed definition of this symptom exists. This study aimed to describe the characteristics of patients reporting PNU and to discuss the pathophysiology and therapeutic approach. The clinical and urodynamic findings of patients presenting with PNU without chronic bladder pain syndrome or neurological or urological conditions between October 2019 and December 2020 were retrospectively reviewed. The treatment efficacy was self-reported at follow-up as “total cure”, “significant improvement” or “no modification”. Seventy-nine patients were included (51 women (65%), mean age 49 years (Standard Deviation (SD) 18)). The mean duration of symptoms was 7 years (SD 11). Frequency was commonly associated with PNU (mean interval between voids 103 min (SD 69)) and 50 patients (63%) reported nocturia. Voiding difficulties were described in 33 cases (40%). The mean first desire to void was 112mL (SD 93) with normal maximum cystometric capacity of 397mL (SD 135), and 5 patients had detrusor overactivity. Proposed treatments were tibial nerve stimulation (n=25) with a total cure or significant improvement in 17 cases, alpha-blockers (n=8) with an improvement in 4 patients, antimuscarinics (n=29) with an improvement in only 3 patients, and antidepressant or antiepileptic (n=8) with an improvement in 5 patients. PNU is poorly described but could be responsible for LUTS. Further studies to understand the underlying mechanisms and to assess the therapeutic efficacy of the different options are required.