Indeed, the urine flow is a horrible thing for a paruresis sufferer.
Elbow-to-elbow is most unpleasant for anyone whether they have paruresis or not unless they are totally inhibited but it is good for desensing very later on in working up your hierarchy of challenge as you may find yourself in this position in the future. If elbow-to-elbow was my only option at the moment i would use a cubicle unless i had a high level of urgency.
That's great that troughs are uncommon in Italy.
Last Saturday i went out for my mate's birthday. I used the gents 7 or 8 times (would need to check my paruresis diary to be precise as i wrote notes after each visit by using my coding system) and only went to the gents once in each pub to desense at different places. I also did this to desense with different gentlemen, and to use different styles of urinals which resulted in no misfires.
At one pub i wanted to use the toilet because i recalled it had one long porcelain urinal and i had used it only once before on a previous night out.
I remembered it was busy last time so perfect for desensing. My level of urgency wasn't great but i could also tell that my abdomen wasn't fully relaxed so i knew i shouldn't of gone in there but knew to try would be an achievement in itself.
Indeed there were men in there but fortunately i was able to stand in the right hand end and turn into a corner. Men were coming and going and realising i wasn't able to urinate NOT because of my paruresis but because my level of urgency wasn't high enough was very self-reassuring to me.
I stayed there for a few minutes and didn't even think that the other men would be thinking of me or noticing what i was doing so i stayed calm.
I was faking it for as long as i wanted and left when i was ready feeling perfectly comfortable with what i had done.
A pat on the back to you Karl!