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Urethral Syndrome

  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 21, 2015
 

Background

Urethral syndrome was originally described as urinary frequency and dysuria without demonstrable infection. As a diagnosis, urethral syndrome (also known as frequency-dysuria syndrome) is controversial, and the term (coined by Powell and Powell in 1949) may be outdated, partially because of the lack of consensus on specific diagnostic criteria and overlap with other diseases such as interstitial cystitis and painful bladder syndrome. Up to one quarter of patients presenting with lower urinary tract symptoms may have urethral syndrome.

Urethral syndrome is characterized by urinary frequency, dysuria, and suprapubic discomfort without any objective finding of urological abnormalities. It is also characterized by sterile urine culture results and urinary frequency that is typically worse during the day than during the night. The dysuria and constant suprapubic discomfort is partially relieved by voiding. Patients with urethral syndrome may also report difficulty in starting urination, a slow stream, and a feeling of incomplete emptying of the bladder.

Most patients diagnosed with urethral syndrome are women, typically aged 30-50 years. Vaginal discharge and vaginal lesions must be excluded. The patient’s history is important, as the diagnosis of urethral syndrome is one of exclusion.

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Etiology and Pathophysiology

The etiology of urethral syndrome is unknown. Historically, urethral stenosis was believed to cause urethral syndrome. Currently theorized etiologies include hormonal imbalances, inflammation of Skene glands and the paraurethral glands (the "female prostate"), a reaction to certain foods, environmental chemicals (eg, douches, bubble bath, soaps, contraceptive gels, condoms), hypersensitivity following urinary tract infection, and traumatic sexual intercourse.

Regardless of the initial pain-causing event, patients with urethral syndrome have both involuntary spasms and voluntary tightening of the pelvic musculature during the painful episode, which, in addition to any residual irritant or reinjury, starts a vicious circle of worsening dysfunction of the pelvic floor musculature. In many cases, the original cause of the pain has healed, but the pelvic floor dysfunction persists and is worsened by the patient’s anxiety and frustration with the condition.

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Epidemiology

The exact incidence of urethral syndrome is unknown because of a lack of consensus in diagnosis.

Mortality/Morbidity

Urethral syndrome is not a fatal condition; however, the urinary hesitancy, frequency, and dysuria characterized by the syndrome can greatly impair quality of life, as follows:

  • As a result of the unrelenting symptoms, many patients with urethral syndrome have concomitant depression, anxiety, or other secondary psychological morbidities caused by the condition; the coexistence of neurosis has prompted many physicians to categorize urethral syndrome as a psychosomatic illness
  • Many patients with urethral syndrome seek out multiple physicians in order to secure symptom relief and are at risk for polypharmacy and narcotic abuse

Race-, Sex, and Age-related Demographics

Urethral syndrome is more common in females than in males, and is more common in white women in westernized societies than in women of other races or groups.[1] Patients diagnosed with urethral syndrome are typically 13-70 years of age.

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Contributor Information and Disclosures
Author

Martha K Terris, MD, FACS Professor, Department of Surgery, Section of Urology, Director, Urology Residency Training Program, Medical College of Georgia; Professor, Department of Physician Assistants, Medical College of Georgia School of Allied Health; Chief, Section of Urology, Augusta Veterans Affairs Medical Center

Martha K Terris, MD, FACS is a member of the following medical societies: American Cancer Society, Association of Women Surgeons, American Society of Clinical Oncology, Society of Urology Chairpersons and Program Directors, Society of Women in Urology, Society of Government Service Urologists, American College of Surgeons, American Institute of Ultrasound in Medicine, American Urological Association, New York Academy of Sciences, Society of University Urologists

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher A Hathaway, MD, PhD Urologist, Yankton Medical Clinic

Christopher A Hathaway, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Subbarao V Cherukuri, MD Consulting Staff, Department of Urology, St Joseph Regional Health Center

Subbarao V Cherukuri, MD is a member of the following medical societies: American Urological Association and Ohio State Medical Association

Disclosure: Nothing to disclose.

References
  1. Bogart LM, Suttorp MJ, Elliott MN, Clemens JQ, Berry SH. Validation of a quality-of-life scale for women with bladder pain syndrome/interstitial cystitis. Qual Life Res. 2011 Dec 7. [Medline].

  2. Ichim G, Fufezan O, Farcau M, Asavoaie C, Pop D, Staticescu S, et al. Clinical, imaging and cystometric findings of voiding dysfunction in children. Med Ultrason. 2011 Dec. 13(4):277-82. [Medline].

  3. Palleschi G, Carbone A, Ripoli A, Silvestri L, Petrozza V, Zanello PP, et al. A prospective study to evaluate the efficacy of cistiquer in improving lower urinary tract symptoms in females with urethral syndrome. Minerva Urol Nefrol. 2014 Jul 18. [Medline].

  4. Costantini E, Zucchi A, Del Zingaro M, Mearini L. Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser. Urol Int. 2006. 76(2):134-8. [Medline].

  5. Chen YL, Ha LF, Cen J, et al. [Comparative observation on therapeutic effects of electroacupuncture and manual acupuncture on female urethral syndrome]. Zhongguo Zhen Jiu. 2005 Jun. 25(6):425-6. [Medline].

  6. Cruz F, Silva C. Botulinum toxin in the management of lower urinary tract dysfunction: contemporary update. Curr Opin Urol. 2004 Nov. 14(6):329-34. [Medline].

  7. Allen TD. Commentary on dysfunctional abnormalities of the urinary tract. Urol Clin North Am. 1980 Jun. 7(2):357-9. [Medline].

  8. Barrett DM, Wein AJ, Barrett DM, Wein AJ. Voiding dysfunction: Diagnosis, classification, and management. Gillenwater JY, Grayhack JT, Howards SS, eds. Adult and Pediatric Urology. 2nd ed. St. Louis, Mo: Mosby-Year Book; Vol 1: 1073-5.

  9. Bogart LM. Berry SH. Clemens JQ. Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J. Urol. Feb. 2007. 177(2):450-6. [Medline].

  10. Gerstenberg TC, Lykkegaard Nielsen M, Lindenberg J. Spastic striated external sphincter syndrome imitating recurrent urinary tract infection in females. Effect of long-term alpha- adrenergic blockade with phenoxybenzamine. Eur Urol. 1983. 9(2):87-92. [Medline].

  11. Kaur H, Arunkalaivanan AS. Urethral pain syndrome and its management. Obstet Gynecol Surv. May 2007. 62(5):348-51. [Medline].

  12. Lemack GE, Foster B, Zimmern PE. Urethral dilation in women: a questionnaire-based analysis of practice patterns. Urology. 1999 Jul. 54(1):37-43. [Medline].

  13. Schmidt RA. The urethral syndrome. Urol Clin North Am. 1985 May. 12(2):349-54. [Medline].

  14. Sugaya K, Nishijima S, Oda M, et al. Transabdominal vesical sonography of urethral syndrome and stress incontinence. Int J Urol. 2003 Jan. 10(1):36-42. [Medline].

  15. Voelzke BB, Breyer BN, McAninch JW. Blunt pediatric anterior and posterior urethral trauma: 32-year experience and outcomes. J Pediatr Urol. 2011 Jun 9. [Medline].

  16. Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001 Dec. 166(6):2226-31. [Medline].

  17. Wesselmann U, Burnett AL, Heinberg LJ. The urogenital and rectal pain syndromes. Pain. 1997 Dec. 73(3):269-94. [Medline].

  18. Zhang D, Xu Z. [Female prostatitis]. Zhonghua Nan Ke Xue. 2004 Jul. 10(7):547-8, 550. [Medline].

 
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