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(also known as frequency-dysuria syndrome) is controversial, and the term (coined by Powell and Powell in 1949) may be outdated, partially because of the lack of consensus on specific diagnostic criteria and overlap with other diseases such as interstitial cystitis and painful bladder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.
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.
The exact incidence of urethral syndrome is unknown because of a lack of consensus in diagnosis.
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.  Patients diagnosed with urethral syndrome are typically 13-70 years of age.
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