Makindo Medical Notes

Urethral syndrome is a set of symptoms from inflammation or irritation of the urethra. It is not related to an infection from bacteria or a virus. The exact cause is often unknown but can be linked to trauma, chemical irritants, or sexual activity. This condition primarily affects women and can be chronic, leading to persistent discomfort.

About

• Presents with symptoms similar to cystitis (urinary tract infection), but without significant bacteriuria (bacteria in the urine).
• Symptoms may come and go, making diagnosis and treatment difficult.
• Some patients respond to antibiotics, though the condition is not typically caused by bacterial infections.
• More common in females than males, especially in peri-menopausal or post-menopausal women.

Clinical

• Dysuria: Painful or burning sensation during urination, often accompanied by increased urinary frequency.
• Difficulty urinating: A feeling of incomplete bladder emptying or hesitancy in starting urination.
• Suprapubic discomfort: Pressure or pain in the lower abdomen, just above the pubic bone, that may worsen with a full bladder.
• Intermittent symptoms: Periods of symptom flare-ups alternating with symptom-free periods.

Differential

• Bacterial cystitis: Infection-related inflammation of the bladder, usually accompanied by bacteriuria.
• Painful bladder syndrome (Interstitial cystitis): A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain.
• Vulvodynia: Chronic pain or discomfort around the opening of the vagina, without an identifiable cause.
• Genital herpes: Viral infection causing painful sores and inflammation in the genital area.
• Vaginitis: Inflammation of the vagina due to infection, irritants, or hormonal changes.

Investigations

• Full blood count (FBC), U&E, CRP, Calcium levels: Blood tests to check for signs of infection, inflammation, and electrolyte imbalances.
• Urinalysis: A urine test to detect blood, protein, or other abnormalities. It may not show infection in urethral syndrome, but helps exclude other causes.
• Mid-stream specimen of urine (MSSU) and cultures: To exclude bacterial infections by checking for bacterial growth.
• Cystoscopy: A procedure using a scope to visually inspect the bladder for signs of infection, inflammation, or abnormalities.
• Intravenous pyelography (IVP) or computed tomography (CT) scan: Imaging tests to assess the upper urinary tract (kidneys, ureters) and detect structural abnormalities.

Management

• General care: Ensure the patient is well-hydrated and encourage a balanced diet. Exclude other infections (fungal, bacterial). Dietary therapy aims to increase urinary pH, reducing irritation.
• Urethral dilation: In cases where urethral stenosis (narrowing) is identified, dilation can significantly improve symptoms, particularly in women.
• Hormone replacement therapy: Useful in post-menopausal women to reduce vaginal and urethral atrophy, which may contribute to symptoms.
• Anaesthetics: Local anesthetics may be used to manage pain, either topically or through nerve blocks.
• Antispasmodics: Medications to relieve muscle spasms in the bladder and urethra, reducing discomfort.
• Tricyclic antidepressants (TCAs): Low-dose TCAs (e.g., amitriptyline) may be used to manage chronic pain and neuropathic symptoms.
• Muscle relaxants: These help reduce bladder muscle spasms, easing urinary discomfort and frequency.
• Alpha-blockers: These drugs relax the muscles of the bladder neck and urethra, facilitating easier urination and relieving obstruction.
• Behavioral therapy: Including bladder retraining and pelvic floor exercises may also be helpful in reducing symptoms.

Links

• Urology Health - Urethral Syndrome
• Mayo Clinic - Urethral Syndrome Overview