Urethral Syndrome

Synonym: abacterial cystitis

Urethral syndrome is now used to describe those women with typical symptoms but no recognised urinary pathogen cultured from urine.

• Urethral syndrome is characterised by various lower urinary tract symptoms (especially episodic or persistent dysuria, urgency or frequency) in the absence of obvious bladder or urethral abnormality, or urinary tract infection.
• Diagnosis is based upon the history, negative urine cultures, dynamic cystourethroscopy and urodynamic studies.
• The cause of urethral syndrome is often unknown.

• Urethral syndrome is thought to affect 20-30% of all adult women and it is particularly seen in young women.
• Risk factors include grand multiparity, delivery without episiotomy and two or more abortions.¹

• Acute urethral syndrome is characterised by dysuria, frequency, and urgency, with no significant bacteriuria.²
• Chronic urethral syndrome is defined as more than three episodes of acute urethral syndrome per year.²

• Stress
• Atrophic urethritis in peri- or post-menopausal women
• Urinary tract infection (UTI) with a low number of bacteria
• Urethritis due to Chlamydia trachomatis,³ lactobacilli, Neisseria gonorrhoeae, Ureoplasma urealyticum
• Urethral stenosis (including post-surgical scarring) and spasm
• Other structural abnormalities, e.g. diverticulae
• Allergy
• Cold
• Nylon underwear
• Trauma during sexual intercourse
• Vaginal infection or atrophy

• Urethral swab for chlamydia, chlamydial-antigens in first-pass urine sample.
• If chlamydia-negative and persistent symptoms, obtain sample by suprapubic aspiration or urethral catheterisation and culture under special conditions for 'fastidious' or slow-growing organisms. Any organisms detected in this way are clinically significant.
• If no infection found, consider cystoscopy to exclude non-infective causes.

• Avoid labelling patient as having psychological problems. Underlying psychological problems should be considered but are often irrelevant.
• Urethral massage may help by encouraging drainage of mucus from chronically infected periurethral glands.
• Chlamydial urethritis; tetracycline for patient and their partner(s). Other antibiotics as determined by culture and sensitivity, prolonged course to ensure complete eradication of organism.
• Vaginal oestrogen cream may be curative in patients with atrophic urethritis.
• Urethral dilatation; assumes that symptoms are due to urethral spasm or stricture; however there is very little clinical evidence of effectiveness and may cause periurethral fibrosis leading to urethral strictures.