Urethral Pain Syndrome

Urethral pain syndrome, previously known as chronic ure-thritis or urethral syndrome is a rare sensory disorder of the urethra recently defined by the International Continence Society as persistent or recurrent urethral pain, with frequency and nocturia, lasting at least 6 months, in the absence of proven infection or other obvious pathology.27

Similar to vestibulitis, the etiology of this disorder remains unknown. Evaluation must be thorough to rule out infection, anatomic abnormalities (urethral diverticulum), atrophy, and other more generalized conditions of the bladder and/or vagina. Cultures, voiding diaries, urody-namics, and cystoscopy should all be included in the work-up.

Figure 9-2.2. Vestibulectomy technique: A horseshoe area of vestibule from hymen to vulva is excised.

Figure 9-2.3. Vestibulectomy technique: The vaginal mucosa is dissected free.

Figure 9-2.4. Vestibulectomy technique: The defect is closed in a running manner.

Treatment is focused on symptomatic relief. Urethral massage can be therapeutic and aids in making the diagnosis. Removing local and dietary irritants in the same manner as with vestibulitis is necessary. Biofeedback, including functional electrical stimulation, and physical therapy may be helpful. Pain sensation can be reduced with local anesthetics, analgesics, and tricyclics. A bladder-training regimen may decrease associated frequency. On occasion, multichannel urodynamics may demonstrate urethral instability, which may typically respond to functional electrical stimulation. Urethral dilation is no longer recommended as a treatment option, but has historically yielded good results.

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