Urethral Syndrome

Synonym: abacterial cystitis

Now used to describe those women with typical symptoms but no recognised urinary pathogen cultured from urine. 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 cysturethroscopy and urodynamic studies. Small proportion of women with persistent symptoms do not respond to antibiotic treatment and the cause of the syndrome is often unknown.

May be induced by:

• Stress
• Atrophic urethritis in peri- or post-menopausal women
• UTI with a low number of bacteria
• Urethritis due to Chlamydia trachomatis¹, lactobacilli, Neisseria gonorrhoeae, Ureoplasma urealyticum
• Urethral stenosis and spasm
• Allergy, cold, nylon underwear
• Trauma during sexual intercourse

• It is thought to affect 20-30% of all adult women, and particularly, is seen in young women
• Risk factors include grand multiparity, delivery without episiotomy and two or more abortions²

• Acute urethral syndrome is characterized by dysuria, frequency, and urgency, with no significant bacteriuria³.
• Chronic urethral syndrome is defined as more than three episodes per year.³

Need to exclude 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: cystoscopy to exclude non-infective cause.

• Avoid labelling patient as having psychological problems. Underlying psychological problems should be considered but are rare.
• 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: assume that symptoms are due to urethral spasm or stricture, however, very little clinical evidence and may cause periurethral fibrosis later causing actual urethral strictures.