Rigi10™ Malleable Penile Prosthesis
Also Known As
Urethral pain syndrome, symptomatic abacteriuria, painful urination syndrome, chronic urethral syndrome, acute urethral syndrome, urethral discomfort syndrome
Definition
Urethral syndrome is defined as a condition characterized by symptoms suggestive of a lower urinary tract infection but in the absence of significant bacteriuria with a conventional pathogen.1 It presents as persistent or recurrent episodic urethral pain, usually occurring during urination, accompanied by daytime urinary frequency and nocturia, without evidence of proven infection or other obvious pathology.2 The condition is characterized by urinary urgency, frequency, dysuria, and, at times, suprapubic and back pain and urinary hesitancy in the absence of objective urological findings.3 Urethral syndrome is more common in women, particularly during their reproductive years, though it has also been reported in children and men.3
Clinical Context
Urethral syndrome is a very common condition; approximately half of the patients visiting their General Practitioner due to urinary frequency and/or dysuria do not have significant bacteriuria.1 The condition typically affects women during their reproductive years, though it has been reported in both children and men.3
Diagnosis of urethral syndrome is primarily based on symptoms and is essentially a diagnosis of exclusion.3 A thorough diagnostic evaluation is crucial as its symptoms are indistinguishable from those caused by urinary infections, tumors, stones, interstitial cystitis, and many other entities.3 The first diagnostic step includes a comprehensive urological examination with urine analysis, culture, and cytology.3 In selected patients, further radiographic studies, urodynamic studies, and cystoscopy may be necessary.3 In females, gynecological problems need to be ruled out, and a psychological evaluation should be part of the multidisciplinary assessment.3
Both infective causes (such as lactobacilli and sexually-transmitted pathogens) and non-infective causes (such as trauma, allergies, anatomical features, and co-existing medical conditions) have been suggested as potential etiologies.1 Risk factors may include sexually transmitted infections, certain foods (caffeine, spicy foods, alcohol), chemical irritants in personal hygiene products, previous urinary tract infections, and sexual intercourse.4
Treatment options vary depending on whether the condition is acute or chronic. For acute urethral syndrome, antibiotics are often prescribed since it is difficult to distinguish between urinary infection and urethral syndrome in the clinical setting.1 For chronic urethral syndrome, treatment depends on whether attacks are associated with bacteriuria or if urological investigations reveal any abnormalities.1 Various modalities of treatment including antibiotics, alpha-blockers, acupuncture, and laser therapy have shown success.2 Psychological support is very important for affected individuals, particularly women.2 Management requires a multidisciplinary approach, and treatment at its best is often by trial and error.2