Urethral syndrome is defined as symptoms suggestive of a lower
urinary tract infection
A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney ...
but in the absence of significant
bacteriuria with a conventional
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
.
It is a
diagnosis of exclusion
A diagnosis of exclusion or by exclusion (''per exclusionem'') is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or ...
in patients with
dysuria
Dysuria refers to painful or uncomfortable urination.
It is one of a constellation of ''irritative'' bladder symptoms (also sometimes referred to as lower urinary tract symptoms), which includes nocturia and urinary frequency.
Diagnosis
The clin ...
and frequency ''without'' demonstrable
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
.
[Wilkinson I.B. et al, Oxford Handbook of Clinical Medicine, 10th edition, page (296), Oxford University Press, 2017] In women,
vaginitis
Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.
The three main ...
should also be ruled out.
Causes
Signs indicative of urethral syndrome include a history of chronic recurrent
urinary tract infections (UTI) in the absence of both conventional bacterial growth and
pyuria (more than 5
white blood cells
White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...
per
high power field).
Episodes are often related to
sexual intercourse
Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...
.
Some physicians believe that urethral syndrome may be due to a low grade infection of the
Skene's gland
In female human anatomy, Skene's glands or the Skene glands ( , also known as the lesser vestibular glands, paraurethral glands) are glands located around the lower end of the urethra. The glands are surrounded by tissue that swells with blood ...
s on the sides and bottom of the
urethra
The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...
. The Skene's glands are embryologically related to the
prostate gland in the male, thus urethral syndrome may share a comparable cause with chronic
prostatitis.
Possible non-infective causes include hormonal imbalance,
trauma,
allergies, anatomical features such as
diverticula, and post-surgical scarring and adhesions.
Treatment
In a small minority of cases of the urethral syndrome, treatment with antibiotics is effective, which indicates that in some cases it may be caused by a bacterial infection which does not show up in either
urinalysis
Urinalysis, a portmanteau of the words ''urine'' and ''analysis'', is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic e ...
or urine
culture
Culture () is an umbrella term which encompasses the social behavior, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups.Tyl ...
.
For chronic urethral syndrome, a long term, low-dose antibiotic treatment is given on a continuous basis or after intercourse each time if intercourse appears to trigger symptoms.
As low
oestrogen
Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal activ ...
may also be considered a source for urethral syndrome,
hormone replacement therapy and
oral contraceptive pill (birth-control pills) containing oestrogen are also used to treat the symptoms of this condition in women.
See also
*
Interstitial cystitis
*
Prostatitis
References
External links
patient.info
{{Urinary tract disease
Urethra disorders
Syndromes