Enigma of urethral pain syndrome: Why are there so many ascribed etiologies and therapeutic approaches?

Phillip, H; Okewole, Idris; Chilaka, Victor N.

doi:10.1111/iju.12396

Cited by 16 publications

(25 citation statements)

References 29 publications

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“…It is not specific for women, as it can also occur in men [ 43 ], but in this case, it is customary to speak about prostatic, scrotal, or penile chronic pelvic pain [ 8 ]. A large number of studies have been devoted to the study of UPS and chronic pelvic pain in men [ 44 , 45 , 46 , 47 , 48 ], while UPS in women has been studied significantly less [ 3 , 6 ]. Therefore, one of the motivations was to conduct research on the female urethra.…”

Section: Discussionmentioning

confidence: 99%

“…The most common reason for women to seek medical attention is dysuria, and it is believed that in 40% of cases urethritis and/or urethral syndrome are involved [ 1 ]. According to the US National Institutes of Health, one third of women with chronic pelvic pain (CPP) have urethral pain syndrome (UPS) [ 2 , 3 ]. The European Association of Urology defines UPS as the occurrence of chronic or recurrent episodic pain lasting for more than 6 months, and felt in the urethra, in the absence of proven infection or other obvious local pathology.…”

Section: Introductionmentioning

confidence: 99%

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New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome

et al. 2020

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Introduction: Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a “diagnosis of exclusion”. The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. Methods and Participants: A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. Results: TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. Conclusion: This paper showed that the introduction of new technology—CP OCT—in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome

et al. 2020

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“…The most common reason for women to seek medical attention is dysuria, and it is believed that in 40% of cases urethritis and / or urethral syndrome are involved [1]. According to the US National Institutes of Health, one third of women with chronic pelvic pain (CPP) have urethral pain syndrome (UPS) [2,3]. The European Association of Urology defines UPS as the occurrence of chronic or recurrent episodic pain lasting for more than 6 months, and felt in the urethra, in the absence of proven infection or other obvious local pathology.…”

Section: Introductionmentioning

confidence: 99%

New Findings in the Study of the Pathogenesis of Urethral Pain Syndrome

Streltsova¹,

Kuyarov²,

Molvi³

et al. 2020

Preprint

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Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a "diagnosis of exclusion". The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. The goal of the study was to assess the condition of the tissues in the female urethra in UPS, by using transvaginal ultrasound (TVUS) and cross-polarization optical tomography (CP OCT). TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. When studied with CP OCT it was shown that with UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. This paper showed that the introduction of new technology — CP OCT — in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.

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“…The UK Database of Uncertainties about the Effect of Treatments (DUET) has recognized Urethral Pain Syndrome (UPS) as a knowledge gap [4]. There are few randomized controlled trials and there is no evidence-based treatment of UPS [5, 6]. The syndrome is most frequent in women but is also seen in men and children [5].…”

Section: Introductionmentioning

confidence: 99%

“…There are few randomized controlled trials and there is no evidence-based treatment of UPS [5, 6]. The syndrome is most frequent in women but is also seen in men and children [5]. UPS has a large impact on the patients’ quality of life; a study with clinical interviews showed higher levels of hostility, irritability, anxiety, dysphoria and depression among the UPS patients than in controls [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Urethral Pain Syndrome (UPS) in Sweden

et al. 2019

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BackgroundUrethral Pain Syndrome (UPS) in women is a recurrent urethral pain without any proven infection or other obvious pathology. There are few studies on UPS, and evidence-based treatment is lacking. The primary aim was to study what treatments are used, and to compare the treatment tradition of UPS in Sweden in 2018, with what was used in 2006.MethodsA questionnaire on the treatment of women with UPS was sent to all public gynecology, urology, gynecologic oncology and venereology clinics, and one public general practice in each county in Sweden in 2018. Private practice clinics in gynecology responded to the survey in 2017. Comparisons were made with the same survey sent to gynecology and urology clinics in 2006.FindingsOf 137 invited clinics in 2018, 99 (72.3%) responded to the survey. Seventy-seven (77.8%) of them saw women with UPS and 79.2% (61/77) of these clinics treated the patients using 19 different treatment methods. Local corticosteroids and local estrogens were the methods most used. Treatments were similar in gynecology and urology clinics in 2006 and 2018, although strong corticosteroids had increased in use in the treatment regimens of 2018. More than half of the clinics used antibiotics.InterpretationSince there is no evidence-based treatment of UPS, a wide spectrum of treatments is used, and different specialties use different treatment strategies. Despite the lack of proven infection, a large number of clinics also treated the syndrome with antibiotics. There is thus a need for well-designed randomized controlled clinical trials to find evidence-based treatments of UPS.

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Enigma of urethral pain syndrome: Why are there so many ascribed etiologies and therapeutic approaches?

Cited by 16 publications

References 29 publications

New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome

New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome

New Findings in the Study of the Pathogenesis of Urethral Pain Syndrome

Treatment of Urethral Pain Syndrome (UPS) in Sweden

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