Urethral Syndrome Workup

  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 23, 2012
 

Laboratory Studies

  • A urine sample should be collected for urinalysis and urine culture.
    • Urinalysis may show up to 3 RBCs per high-power field. More pronounced microhematuria or any history of gross hematuria should prompt (1) cystoscopy to evaluate the bladder and (2) intravenous pyelography (IVP) or CT scanning to assess the upper urinary tract. Elevated glucose levels on urinalysis results may suggest uncontrolled diabetes as an etiology of the urinary frequency.
    • Although some urologists feel that 100 colonies of bacteria per milliliter may be significant, especially when accompanied by symptoms, urine cultures of 100,000 colonies per milliliter of urine in a voided specimen (10,000 colonies of bacteria per milliliter in men) confirms urinary tract infection and should prompt treatment with antibiotics. Repeat urine cultures may be warranted for intermediate results. The same bacteria on multiple urine cultures, even at low colony counts, may merit therapy. Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, and Lactobacillus species may be present at small colony counts in urine cultures and usually represent vaginal colonization with these organisms. However, treatment is recommended to rule out urethral colonization, especially with Ureaplasma species.
  • Pap smear results may reveal cervical malignancy, and this test should be performed if the patient has not had one in the past year. Usually, this has been performed by the gynecologist who referred the patient to the urologist. If the patient has not seen a gynecologist, a referral should be made to rule out gynecologic causes of the discomfort.
  • A pregnancy test may be indicated in women in the appropriate age group with an enlarged uterus or history of irregular menstrual cycles. This is particularly true if radiographic evaluation is planned.
  • Vaginal swabs for routine and viral, chlamydial, and gonococcal culture may be indicated. Again, usually these studies have been performed by the gynecologist.
  • Potassium hydroxide preparation of vaginal secretions helps assess for fungal infection and, as with other tests, has usually been performed by the gynecologist.
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Imaging Studies

  • IVP may be considered to help rule out other urological causes if associated symptoms and history suggest them; however, in most cases the IVP results are normal.
  • Cystography can be used to evaluate for vesicoureteral reflux and, if performed correctly with a double-balloon catheter to occlude both the urethral opening and bladder neck, urethral diverticula.[2]
  • MRI is emerging as possibly superior to cystography in the identification of urethral diverticula.
  • In men, prostate ultrasonography to evaluate for a prostatic abscess may prove useful.
  • Pelvic ultrasonography is used to visualize the bladder and bladder neck-trigone and to evaluate the female reproductive organs for masses.[2]
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Procedures

  • Cystometrics and electromyelography of the urinary sphincter are performed to eliminate the possibility of a neurogenic unstable bladder, detrusor sphincter dyssynergia, or hyperactive pelvic floor musculature.
  • Cystourethroscopy with hydrodistention of the bladder under general anesthesia is diagnostic, revealing ulcerations and normal bladder capacity in patients with interstitial cystitis (IC). It is also therapeutic in patients with IC. Cystoscopy under anesthesia also allows an assessment for bladder masses or stones or squamous cell metaplasia at the bladder neck-trigone. Bladder biopsy is used to rule out carcinoma in situ. Eosinophilia and mast cells in bladder biopsy samples support the diagnosis of IC. The pelvic examination is also often easier to perform with the patient under anesthesia, and one should be performed in patients in whom the clinical pelvic examination was suboptimal.
  • Urethral dilation has been used in the past for temporary relief of urethral syndrome. This practice has largely been abandoned.
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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, American College of Surgeons, American Institute of Ultrasound in Medicine, American Society of Clinical Oncology, American Urological Association, Association of Women Surgeons, New York Academy of Sciences, Society of Government Service Urologists, Society of University Urologists, Society of Urology Chairpersons and Program Directors, and Society of Women in Urology

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Christopher A Hathaway, MD, PhD  Resident Physician, Department of Surgery, Medical College of Georgia

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

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: Medscape Salary Employment

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, and Southwest Oncology Group

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

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, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

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  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. Dec 2011;13(4):277-82. [Medline].

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  8. 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].

  9. 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].

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

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

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

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

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

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

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

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

 
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