Urethral Pain Syndrome: A Systematic Review
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Purpose of Review
Urethral pain syndrome (UPS) is defined as pain localized to the urethra with an unpleasant sensation, dysuria often accompanied by urinary frequency and urgency present greater than 6 months in the absence of an identifiable cause. A paucity of information exists on the subject as it is often combined with conditions such as interstitial cystitis or prostatitis. The aim is to provide and explain different definitions and diagnostic work-up and discuss treatment options for providers.
Few recent studies exist addressing urethral pain syndrome. Most literature is decades old. Thirty-five full-text articles were included in the review. This syndrome occurs most commonly in females of childbearing age. Patients must be evaluated thoroughly with full history and physical. Etiologies proposed include sensory dysfunction, pelvic floor dysfunction, psychogenic factors (depression and anxiety), diet, obstruction, infections, and hypoestrogen status. Treatment strategies include behavioral management of stress management, diet modification, pelvic floor treatments, local estrogen, anesthetic with or without cooling, oral medications for related lower urinary tract symptoms, or anxiolytics/antidepressants. Psychological support is recommended for these patients.
UPS can have multiple etiologies and a multimodal therapy should be applied to these patients. Therapy should be individualized, oftentimes including concurrent therapy for overlapping conditions. Serious pathology should be ruled out and a stepwise approach to treatment should be utilized after setting treatment expectations with the patient.
KeywordsUrethral pain Dysuria Non-infectious urethritis Urethral syndrome
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, et al. A standard for terminology in chronic pelvic pain syndromes: a report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn. 2017;36(4):984–1008 Defines how to evaluate and diagnose patients with pelvic pain syndromes. CrossRefGoogle Scholar
- 5.Cakici OU, Hamidi N, Urer E, Okulu E, Kayigil O. Efficacy of sertraline and gabapentin in the treatment of urethral pain syndrome: retrospective results of a single institutional cohort. Cent Eur J Urol. 2018;71(1):78–83.Google Scholar
- 9.Fiander N. Painful bladder syndrome and interstitial cystitis: treatment options. Br J Nurs. 2013;22(9):S20–7.Google Scholar
- 10.• Clemens JQ, Stephens-Shields A, Naliboff BD, Lai HH, Rodriguez L, Krieger JN, et al. Network MR: correlates of health care seeking activities in patients with urological chronic pelvic pain syndromes: findings from the MAPP cohort. J Urol. 2018;200(1):136–40 Addresses the impact of pain syndromes on healthcare from the frequency of visits. CrossRefGoogle Scholar
- 11.Engeler DS, Baranowski AP, Dinis-Oliveira P, Elneil S, Hughes J, Messelink EJ, et al. European Association of U: the 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol. 2013;64(3):431–9.CrossRefGoogle Scholar
- 13.•• Engeler DS, Baranowski AP, Borovicka J, Dinis-Oliveira P, Elneil S, Hughes DJ, Messelink EJ, de Williams AC. Guidelines Associates: A. Cottrell SG: EAU Guidelines on Chronic Pelvic Pain. In: European Association of Urology Guidelines Limited Update March 2016. 2016. Specifically addresses possible etiologies of urethral pain syndrome and general management strategies. Google Scholar
- 14.Kullmann FA, McDonnell BM, Wolf-Johnston AS, Lynn AM, Getchell SE, Ruiz WG, Zabbarova IV, Ikeda Y, Kanai AJ, Roppolo JR, et al. Inflammation and tissue remodeling in the bladder and urethra in feline interstitial cystitis. Front Syst Neurosci. 2018;12.Google Scholar
- 23.Lindstrom B, Hellberg D, Lindstrom A. Urethral instillations of clobetasol propionate and lidocaine: a promising treatment of urethral pain syndrome. Clin Exp Obstet Gynecol. 2016;43(6):803–7.Google Scholar
- 25.Mirkin Y, Malinina O, Zayceva A. Overactive pelvic floor and urethral pain syndrome. Florence: International Continence Society; 2017. abstract 1012Google Scholar
- 28.Bhomi KK, Rizal S, Pradhan M, Rijal A, Bhattachan CL. Pain during rigid cystoscopy: a prospective randomized controlled study comparing the benefit of cooled and room temperature lignocaine gel. Nepal Med Coll J. 2011;13(1):55–7.Google Scholar
- 31.Zheng H, Wang S, Shang J, Chen G, Huang C, Hong H, et al. Study on acupuncture and moxibustion therapy for female urethral syndrome. J Tradit Chin Med. 1998;18(2):122–7.Google Scholar
- 35.Palleschi G, Pastore A, Al Salhi Y, Leto A, Fuschi A, Capone L, et al. Efficacy of treatment with Hyaluril in females with urethral syndrome: a prospective analysis comparing naive patients with subjects who experienced previous ineffective treatments. Florence: International Continence Society; 2017. Abstract 291Google Scholar