Case series of urinary retention in young adults with severe autism hospitalized for behavioral crisis

Leslie NollaceDrolapas PanagiotisJosephine ConvertiniNuno GriloNicolas AnsermotVincent Guinchat^*

• Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

Background: Behavioral regressions in low verbal patients with severe autism constitute a dramatic challenge for clinicians. A physical comorbidity burden is often involved but difficult to evidence. Aim: We present five cases of patients under 30 years old (three males, two females), recently hospitalized in a specialized multidisciplinary inpatient unit, settled in Lausanne university hospital, and for which at some point, a urinary retention contributed to the constitution of a complex behavioral picture. Methods: For each patient, we report the individual risk factors, clinical presentation and the conditions for making the diagnosis. Results: As usual guidelines for screening, management and follow-up of urinary retentions are irrelevant in this population, we provide and discuss some recommendations: limitation of anticholinergic burden, strict application of the protocol for going to the toilet with training protocol, regularization of intestinal transit, daily bladder-scan control, and eventually use of Tamsulosin Hydrochloride. These recommendations significantly improved the urinary status of our patients. Conclusion: We conclude that chronic urinary retention is probably a recurrent and unrecognized feature in many young adults with autism and challenging behaviors, reflecting the long-term impact of iatrogenic medication, and requiring a specific attention.