Urethral syndrome is a condition seen commonly in women who present with dysuria and frequency suggestive of cystitis but the voided urine is sterile.

The syndrome consists of frequency, urgency, dysuria and suprapubic discomfort without any detectable abnormality to account for the symptoms. It is a diagnosis of exclusion and is sometimes difficult to distinguish from interstitial cystitis.

Causes

The precise aetiology is unknown, but the following possible causes have been suggested:

  • • hormonal imbalance
  • • reactions to environmental chemicals
  • • allergies
  • • psychological.

There is no robust evidence to support any of these possible causes.

Diagnosis

Urethral syndrome is a diagnosis of exclusion:

  • • It is important to rule out infective causes (the presence of pyuria is a strong indicator of infection).
  • • Atypical infections should be eliminated.
  • • Gynaecological evaluation is often necessary as there is an important symptomatic overlap with gynaecological conditions in young women such as endometriosis or hormonal dysfunctions.
  • • Urethrogram/MRI/transvaginal ultrasound scan may be performed to rule out urethral diverticulum.
  • • Cystoscopy+hydrodistension +/- biopsies may be useful to rule out interstitial cystitis.
  • • Urodynamics is of doubtful significance, but can sometimes unmask underlying atypical detrusor overactivity.

Management

  • • A course of antibiotics should be given even in the absence of positive cultures, especially if there is pyuria.
  • • Antibiotics should be selected to cover organisms such as chlamydia and anaerobes.
  • • Local oestrogen supplementation has been found to be effective in some cases.

Urethral dilatation is a procedure of historical interest only and there is no evidence base to suggest that the procedure has any benefit in this group of patients, although anecdotal reports abound.

Supportive treatment is essential as both the physician and the patient can find this condition extremely frustrating.

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