Abstract
T
Case Report
A 17-year-old female patient was admitted to our clinic 1 year ago with complaints of repetitive thoughts and behaviors such as counting up to specific numbers and walking without treading on pavement lines because otherwise her loved ones could get hurt. Physical examination and laboratory test results were all normal. There was no history of medical comorbidity, including of urogenital diseases. Psychiatric evaluation suggested the diagnosis of OCD. Fluvoxamine treatment was titrated up to 200 mg/day. Fluvoxamine was stopped after 3 months because it was ineffective, and the patient was treated with sertraline 100 mg/day with risperidone 1 mg/day for 6 months by another psychiatry center, which was found to be ineffective. Fluoxetine 20 mg/day was started by the same center 1 month and she started to have difficulty urinating, in the first week of fluoxetine treatment. Her complaints had gradually increased to a point at which she had not been able to urinate for 2 days. Urodynamic evaluation showed a normocompliant bladder with high capacity. There were no masses or urinary stones according to a urinary ultrasonogram (USG). The patient was unable to urinate for 2 hours with a Foley catheter, and her bladder was emptied with Cystofix® because of the vesical globe. We stopped the fluoxetine and followed the patient unmedicated, and she has had no additional urinary problems at the 1st week and the 1st month.
Discussion
Many factors may play a role in the etiology of urinary retention. It can be seen as a side effect of SSRIs, albeit a very rare one. Serotonin increases the storage of urine by activating the sympathetic pathway and inhibiting the parasympathetic pathway. SSRIs may inhibit serotonin reuptake around the motor neurons of the Onuf's nucleus, which may increase the external sphincter activity. Urinary retention in our case can be conceptualized probably through the abovementioned mechanism, and it is reported very rarely with SSRIs: Fluoxetine in combination with haloperidol and risperidone (Benazzi 1996; Bozikas et al. 2001), and ziprasidone in combination with fluoxetine and citalopram (Chung and Chua 2007). The patient had not been using risperidone for >3 months; therefore, urinary retention was unlikely to have been caused by risperidone. In our case, the fact that symptoms started right the initiation of fluoxetine and ceased when fluoxetine was stopped strongly indicates that urinary retention was caused by fluoxetine alone without combination with any antipsychotics.
Footnotes
Disclosures
No competing financial interests exist.