Urethral syndrome or urinary tract infection?

Urodynamic studies of 25 women between eleven and forty-five years of age whose history included frequent urinary tract infections disclosed urethral activity different from that of women with pure stress incontinence. Often the former had associated symptoms of urge, although the latter did not. Not all symptoms of infections were documented by culture, hence could have been related to tension in the pelvic floor rather than to bacteriuria. Urodynamic studies showed spasticity of the urethral musculature. The women with frequent urinary tract infections uniformly had hyperactive urethral striated muscle, those with the most severe form of urge showing varying resting tension in the urethral sphincter. In all cases, discomfort or urge was proportional to the elevation in urethral sphincter pressure and dramatically diminished with drop in closure tonus. In many cases relief of urge occurred only with voiding-when relaxation of the pelvic floor musculature could be induced by the patient. Urethral symptoms result from physiologic imbalance in urethral activity and may predispose to urinary tract infection. Thus, physicians treating urge complaints in young women should be aware that both entities have to be treated.