Urethral syndrome
🚺 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
