What Is Urethral Syndrome?

Urethral syndrome is a condition in which urinary symptoms and problems, including frequent urination, burning with urination, urgency, and pain in the lower abdomen, are present, but no organism is seen on urine culture and further evaluation does not show a urinary or genital system disorder. Another name for this condition is non-gonococcal urethritis, or inflammation of the urethra. Urethritis is inflammation of the tube that carries urine out of the body, meaning the urethra.

Diagnosis of this condition is based on ruling out other causes. In a person with a compatible history, if the urine culture is negative and bladder endoscopy, imaging tests such as CT scan and ultrasound, and urodynamic testing do not show a significant finding, this condition should be considered.

Risk factors for urethral syndrome

The causes of this condition are not well understood because there is still no worldwide agreement on its definition and diagnosis. It is more common in women, especially women with lighter skin color. Some experts consider inflammation of the submucosal glands of the urethra, the Skene glands, to be responsible. Other possible causes include:

• Repeated childbirth

• Vaginal delivery without incision and episiotomy

• Miscarriage 2 or more times

• Hormonal disorders

• Allergy

• Trauma to the urethra

Symptoms of the condition

This condition usually presents with lower abdominal pain, frequent urination, and burning with urination. During the examination, a complete abdominal and gynecologic examination is needed. Symptoms of urethral syndrome usually improve with age, although they may persist throughout life .

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Symptoms that are similar to this condition

Several diseases are included in the differential diagnosis of this condition and should be considered, including the following:

• Stress urinary incontinence

• Atrophy, thinning, and dryness of the vagina during and after menopause

• Urinary tract infections

• Other causes that can produce inflammatory cells while the urine culture remains negative.

• Urethral inflammation caused by chlamydia, lactobacillus organisms, gonorrhea bacteria, and ureaplasma organisms.

• Urethral stricture and spasm

• Other structural disorders, such as urethral diverticulum

• Inflammation and sensitivity, for example to synthetic underwear fabric

• Trauma and injury during sexual intercourse

• Gynecologic and vaginal infections

• Anxiety and stress

Evaluations and diagnostic tests

• A midstream urine sample is needed for complete urinalysis and urine culture.

• A urethral swab sample or first-catch urine sample should be tested for chlamydia.

• If the chlamydia test is negative and symptoms persist, a sample should be obtained for slow-growing organisms either by aspiration with a needle through the lower abdomen or by catheterization. Any organism found in this evaluation is important. If no organism is found, cystoscopy, meaning bladder endoscopy, should be performed.

• Other diagnostic tests include MRI, contrast X-ray imaging, ultrasound, and urodynamic testing.

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Treatment of urethral syndrome

General essentials include the following:

• Underlying psychological and emotional problems should be considered and may need treatment, although these problems are usually indirectly related.

• Behavioral treatments including biofeedback, meditation, and hypnosis have been successful in some studies.

• Highly acidic foods, including spicy and hot foods, should be avoided.

• Exercise and massage therapy

• Urethral massage may help by draining mucus and secretions that have been chronically irritating or infected in the glands around the urethra.

• Treatment of urinary tract infection and chlamydia is necessary.

• Use of vaginal estrogen creams may help patients with vaginal dryness and atrophy.

Surgery for urethral syndrome

Urethral widening, or dilation, can help in cases where symptoms are caused by urethral spasm or stricture. However, evidence for its effectiveness is limited, and if it is performed unnecessarily, this method can lead to more scarring and narrowing of the urethra. Therefore, dilation of a urethral stricture should be done only when a true urethral stricture is evident.

Complications of surgery for urethral syndrome

Because this pain is chronic and disrupts personal life, it can have significant psychological effects on the person's quality of life.