The term urethral syndrome describes a complex of symptoms involving the lower urinary tract including urinary frequency, urgency, dysuria, suprapubic discomfort, postvoid fullness, incontinence, and/or dyspareunia with no objective findings of urologic pathology. Grandmultiparity, delivery without episiotomy, two or more abortuses, and pelvic relaxations appear to predispose.3 The true incidence of urethral syndrome in the United States among adult women is unknown, as is the cause. The most widely accepted etiology of this enigmatic syndrome is an inflammatory process. Other etiologies include psychogenic factors, Chlamydia or Mycoplasma infection, atrophic urethritis in the perimenopausal/postmenopausal patient, fastidious organism bacterial infection, urethral stenosis and/or spasm, allergy, neurogenic, and trauma during intercourse. The diagnosis is one of exclusion founded on a thorough history and physical examination, followed by urine microscopic examination and culture. Referral is often obtained then for dynamic cystourethroscopy and urodynamic studies. Treatment encompasses many modalities because the etiology is uncertain.4 The first approach is often pharmacologic, with antibiotics (doxycycline) or anticholinergics, followed by instillation of dimethyl sulfoxide, periurethral injection of triamcinolone, serial urethral dilation with or without massage, cryosurgery (internal urethrotomy and urethrolysis), bladder neck reconstruction, biofeedback, and psychotherapy. Recent research has led to the use of urethral suppositories with multiple medications including lidocaine, hydrocortisone, and topical estrogens. Lastly, supportive therapy is helpful in all patients.
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