The urethral syndrome and its management.
J Antimicrob Chemother 1994 May;33 Suppl A:63-73
Department of Medical Microbiology, Royal Free Hospital School of Medicine, London, UK.
The urethral syndrome and its management are reviewed. Urethral syndrome is defined as 'symptoms suggestive of a lower tract urinary infection but in the absence of significant bacteruria with a conventional pathogen' with three provisos concerning symptomatology and the definition of significant bacteruria and conventional pathogens.
The urethral syndrome is a very common condition; about half the patients visiting their General Practitioner by reason of frequency and/or dysuria do not have significant bacteriuria. Both infective causes (such as lactobacilli and sexually-transmitted pathogens) and non-infective causes (such as trauma, allergies, anatomical features and co-existing medical conditions) have been suggested as causes and are discussed.
Treatment options include antibiotics in the case of acute urethral syndrome, since it is not possible to distinguish between urinary infection and the urethral syndrome in the consulting room. For those with chronic urethral syndrome, treatment depends upon whether attacks are associated with bacteriuria or if urological investigations reveal any abnormalities.
Female urethral syndrome. A female prostatitis?
Gittes RF, Nakamura RM
West J Med 1996 May;164(5):435-438
Department of Surgery, Scripps Clinic and Research Foundation, La Jolla, California, USA. The cause of the female urethral syndrome has previously been obscure, as it has been associated by definition with a lack of objective findings but a plethora of subjective complaints of retropubic pressure, dyspareunia, urinary frequency, and dysuria.
There is now strong evidence that the microscopic paraurethral glands connected to the distal third of the urethra in the prevaginal space are homologous to the prostate. They stain histologically for prostate-specific antigen and, like the prostate, are subject to both infection and cancer. The most important aspect of recognizing this microscopic "female prostate" as an anatomic feature is that its infections may completely explain many cases of the urethral syndrome.
Further, the diagnosis is not elusive if trained clinicians palpate for localized and objective paraurethral tenderness through the anterior vagina wall to one or both sides of the urethra.
Treatment parallel to that for male prostatitis is usually rewarded by the elimination of symptoms and the objective finding of the loss of tenderness of the paraurethral glands. As with prostatitis, the localized problem often recurs.
It is time to alert primary care physicians to this disorder and to eliminate the widespread practice of treating affected women with either invasive urethral dilation or tranquilizers.