• Urethral Syndrome

    (Urethral Irritation)

    Definition

    Urethral syndrome is a term used to describe symptoms of urethritis that does not have evidence of a bacterial or viral infection. The urethra is the tube that carries urine out of the body from the bladder. Urethritis is an inflammation, infection, or irritation of the urethra. It is most commonly seen in women.
    Female Urethra
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    Causes

    Because there is no evidence of infection, the cause of urethral syndrome is often difficult to determine. Possible causes include:
    • Undetected bacterial or viral infection of the urethra
    • Irritation of the urethra, caused by:
      • Radiation exposure
      • Chemotherapy
      • Spermicidal jellies used during sex
      • Bubble baths
      • Irritating soaps
      • Scents or perfumes
      • Injury to the urethra caused by a blow to the pelvic area
      • Sexual intercourse (especially in women)
      • Urinary irritants, such as caffeine and certain foods
      In women, irritation of the urethra may be caused by:
      • Feminine hygiene sprays or douches
      • Sanitary napkins
      • Contraceptive gels
      • Condoms
    • Structural problems, such as narrowing of the urethra

    Risk Factors

    Risk factors for urethral syndrome include:
    • Sex: female
    • Factors that may lead to an undetected infection:
      • Unprotected sex (without use of a condom)
      • History of sexually transmitted diseases
      • Bacterial infection of other parts of the urinary tract (bladder, kidney)
      • Medications that reduce your ability to fight infections

    Symptoms

    The symptoms of urethral syndrome are similar to those of urethritis. Symptoms may include:
    • Pain and/or burning while urinating
    • Difficulty urinating (especially after intercourse)
    • Increase in urinary:
      • Frequency
      • Urgency
      • Blood in the urine
    • Swelling and/or tenderness in the groin
    • Pain during intercourse
    • In men:
      • Discharge from the penis
      • Blood in semen
      • Pain during ejaculation
      • Swollen and/or tender testicles

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. It will include a pelvic exam. Urethral syndrome is usually diagnosed when symptoms of urethritis are present without evidence of an infection.
    Tests may include:
    • Urine tests or urethral swab tests for lab study
    • Tests for sexually transmitted diseases
    • Cystoscopy and/or urethroscopy
    • Pelvic ultrasound

    Treatment

    Treatment may include:

    Medication

    • Antibiotics—given if your doctor thinks urethral syndrome may be due to an undetected infection
    • Anesthetics
      • Phenazopyridine—may be given by your doctor to ease discomfort while urinating
      • Intraurethral lidocaine jelly
    • Antispasmodics to decrease bladder muscle spasm, such as oxybutynin (Ditropan)
    • Antidepressants, such as a tricyclic antidepressant to relieve pain
    • Alpha-blocking drugs, such as doxazosin (Cardura) to relax smooth muscle tone

    Avoidance of Irritants

    Avoid irritants that may cause urethral syndrome. Then, wait and see if your condition improves.

    Surgery

    Surgery may be done in cases where narrowing of the urethra is thought to be causing the urethral syndrome.

    Prevention

    Measures that may help prevent urethral syndrome include:
      Avoiding the use of:
      • Spermicidal jellies
      • Bubble baths
      • Irritating soaps
      • Scents or perfumes
      • Feminine hygiene sprays and douches
      • Urinary irritant foods and beverages
    • Practicing safe sex, including using condoms
    • Urinating immediately after sexual intercourse
    • Making sure sexually transmitted diseases are treated quickly and completely for you and your partner
    • Regularly drinking plenty of fluids

    RESOURCES

    National Institute of Diabetes & Digestive & Kidney Diseases http://www.niddk.nih.gov

    US National Library of Medicine http://www.nlm.nih.gov

    CANADIAN RESOURCES

    Canadian Urological Association http://www.cua.org

    The Kidney Foundation of Canada http://www.kidney.ca

    References

    Costantine E, Zucchi A, et al. Treatment of urethral syndrome: a prospective randomized study with Nd: YAG laser. Urol Int. 2006;76:134-138.

    Gittes RF, Nakamura RM. Female urethral syndrome. A female prostatitis? West J Med. 1996;164:435-438.

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