Makindo Medical Notes

🚺 Urethral syndrome is a set of symptoms from inflammation or irritation of the urethra. ❌ It is not caused by bacterial or viral infection. 🔎 The exact cause is often unknown but may be linked to trauma, chemical irritants, or sexual activity. 👩 Primarily affects women and can be chronic, leading to persistent discomfort.

📖 About

• 🔬 Mimics cystitis (UTI-like symptoms) but without significant bacteriuria.
• ⏳ Symptoms may fluctuate, complicating diagnosis and management.
• 💊 Some patients respond to antibiotics, though bacterial infection is not the cause.
• 👩‍🦳 More common in females, especially peri- or post-menopausal women.

🩺 Clinical Features

• 🔥 Dysuria: Pain/burning during urination with frequency.
• 🚽 Difficulty urinating: Hesitancy or incomplete emptying.
• ⚡ Suprapubic discomfort: Pressure/pain above pubic bone, worse with full bladder.
• 🔄 Intermittent: Periods of flare-ups alternating with remissions.

🔍 Differential Diagnosis

• 🦠 Bacterial cystitis: Infection with bacteriuria.
• 💥 Painful bladder syndrome (Interstitial cystitis): Chronic bladder/pelvic pain.
• 🌸 Vulvodynia: Chronic vulval pain without clear cause.
• 🧬 Genital herpes: Painful vesicles/ulcers with inflammation.
• 🌺 Vaginitis: Vaginal inflammation due to infection, irritants, or hormones.

🧪 Investigations

• 🩸 Blood tests (FBC, U&E, CRP, Calcium): Look for infection/inflammation/electrolyte changes.
• 💧 Urinalysis: May show abnormalities but often no bacteriuria.
• 🧫 MSSU & culture: To exclude bacterial UTI.
• 🔦 Cystoscopy: Direct inspection of bladder/urethra.
• 🖼️ Imaging (IVP or CT): To rule out upper tract or structural pathology.

💊 Management

• 💧 General care: Hydration, exclude infection, diet to reduce urine acidity/irritants.
• ➕ Urethral dilation: For urethral narrowing in women.
• 💊 HRT: Post-menopausal women with atrophic changes.
• 🩹 Local anaesthetics: Topical/nerve blocks for pain.
• 💊 Antispasmodics & muscle relaxants: Reduce bladder/urethral spasm.
• 🌙 TCAs (e.g. amitriptyline): For chronic pain/neuropathic features.
• 🔓 Alpha-blockers: Relax bladder neck/urethra, improve flow.
• 🧘 Behavioural therapy: Bladder retraining, pelvic floor exercises.

🔗 Links

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