Urethral syndrome presenting as chronic pelvic pain

We present and characterize eight patients who were referred for gynaecologic evaluation of chronic pelvic pain but were found to have their symptoms resulting from urethral syndrome secondary to chronic urethritis. All patients complained of chronic lower abdominal pain, dyspareunia and in some instances vulvar burning. Length of symptoms ranged from 7 months to 6 years. All patients had been treated in the past for vaginitis, pelvic inflammatory disease, endometriosis and/or urinary tract infections with no resolution of symptoms. When questioned specifically, all patients related a history of postcoital voiding dysfunction. Initial pelvic examination revealed urethral and subtrigonal tenderness. All patients then underwent a standard detailed urogynaecologic evaluation. The history, voiding diary and pelvic examination confirmed the initial findings. Urine cultures were all negative. Cystourethroscopy revealed findings of urethral erythema, exudate and cystic inclusions in the urethral wall. All patients stated that urethroscopy reproduced their symptoms of pelvic pain. Six of eight patients who performed uroflowmetry all demonstrated prolonged and intermittent voiding patterns. The cumulative findings were all consistent with a diagnosis of urethral syndrome secondary to chronic urethritis. When therapy was directed toward urethral syndrome, all patients experienced significant improvement in their symptoms. We conclude that patients presenting with chronic pelvic pain should be questioned and examined for urinary manifestations. If present, they should undergo urogynaecologic evaluation. Urethral syndrome is a common cause of pelvic pain, and when diagnosed, can be treated appropriately. Treatment, with resolution of symptoms, may obviate the need for further evaluation such as laparoscopy.