The urethral syndrome.

The urethral syndrome is defined as lower urinary tract symptoms in women in the absence of bladder bacteriuria. It is a common disorder in general practice in Saudi Arabia. The aetiology and pathogenic factors involved in its development are still incompletely understood. Many factors have been suggested as causative of this syndrome, including non-specific infections, urethral obstruction and spasm, senile atrophy, psychosomatic and traumatic factors. An aetiological diagnosis should be made if possible and this will depend on clinical examination, mid-stream urine specimen for quantitative culture and microscopy. Cervical and urethral swabs for microscopy and culture are necessary when infection with urethral pathogens such as C. trachomatis and N. gonorrhoea is suspected. Urethral calibration and uroflowmetry may be needed in some patients. Treatment with a course of tetracycline is indicated for patients with urethral syndrome who have pyuria, urethral dilatation for patients with urethral syndrome secondary to stenosis, and skeletal and smooth muscle relaxants when spasm is found to be the cause. Local vaginal oestrogen application is effective in the treatment of urethral syndrome secondary to hypoestrogenaemia.