The efficacy of naftopidil in treatment of female urethral syndrome / 医学研究生学报

Objective: To evaluate the efficacy and safety of Naftopidil on patients with female urethral syndrome (FUS). Methods: Self-controlled clinical trial was performed in patients with FUS. Thirty-eight patients were treated with naftopidil tablet 25mg/po/qn for 4 weeks after one-week washout period. The effects were evaluated mainly by female urethral syndrome score (FUSS) and quality of life (QOL). Results: FUSS began to decrease after 2 (week's) administration and decreased significantly after 4 weeks' treatment. It had statistically significant difference of FUSS and QOL after treatment compared with control (P

Etiologic Classification of Female Urethral Syndrome by Urodynamic Study / 대한비뇨기과학회지

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.

Etiologic Classification of Female Urethral Syndrome by Urodynamic Study / 대한비뇨기과학회지

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.

Treatment of Female Urethral Syndrome Refractory to Antibiotics

Various methods of treatment, other than antibiotic therapy, have been proposed for the treatment of female urethral syndrome; however, the results of these treatment methods are disappointing, due perhaps to the use of the wrong treatment approach. The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback (BFB) with electrical stimulation therapy (EST) in patients who do not respond well to antibiotics. One hundred and five patients with a diagnosis of female urethral syndrome were entered into this study. Antibiotics were given as a first-line therapy for about 3 months. In cases of recurrent or incurable urethral syndrome, antibiotic therapy combined with external sphincter relaxant or BFB with EST were performed. External sphincter relaxant group was composed of 31 patients (29.5%) who showed functional urethral obstruction. Biofeedback group was composed of 41 patients (39.0%) who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire. Thirty-three patients (31.4%) were treated with antibiotic therapy alone and 7 (21.2%) of these patients recurred. The symptom score of this group changed from 10.51 to 2.85. In the antibiotics plus external sphincter relaxant group (N=31), the symptom score changed from 12.39 to 3.96. Five (16.1%) of these patients recurred and 3 of these 5 underwent urethral dilatation. In the antibiotics plus biofeedback group (N=41), the average urinary frequency changed from 12.2 to 7.7 times a day and nocturia changed from 2.4 to 0.6 times a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response). Female urethral syndrome is not due to a single factor but is a complex disease due to various combined symptoms and mechanisms. This condition needs to be treated with an appropriate treatment protocol. We believe that satisfactory results could be obtained in female urethral syndrome, which has shown poor prognosis until now, by appropriately combining treatment methods, which include the use of external sphincter relaxants, biofeedback therapy and bladder training, according to indication, and depending on whether symptoms continue after initial antibiotic therapy.

Treatments of Female Urethral Syndrome Refractory to Antibiotics / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback with electrical stimulation therapy (EST) in patients who did not respond well to antibiotics. MATERIALS AND METHODS: One hundred-five patients with a diagnosis of female urethral syndrome were entered in this study. Antibiotics were given as first-line therapy for about 3 months. In cases of recurrent or persistent urethral syndrome, antibiotic therapy combined with external sphincter relaxant or biofeedback with EST were performed. According to video-urodynamic analysis, 31 patients (29.5%) were external sphincter relaxant group who showed functional urethral obstruction and 41 patients (39.5%) were biofeedback with EST group who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS: Thirty-three patients (31.4%) of all patients (n=105) were terminated with antibiotic therapy alone and 7 (21.2%) patients were recurred. The symptom score changed 10.51 to 2.85. In antibiotics with external sphincter relaxant, the symptom score changed 12.39 to 3.96. In five (16.1%) of them symptoms were recurred and 3 of 5 patients underwent urethral dilatation. In antibiotics with biofeedback, average frequency changed from 12.2 to 7.7 times a day and nocturia changed 2.4 to 0.6 time a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response). CONCLUSIONS: Biofeedback and external sphincter relaxant therapy as an alternative therapeutic option are effective and appropriate for the treatment of female urethral syndrome especially in patients who did not respond well to antibiotics. For the better outcomes, selection of the most appropriate therapeutic modality with the diagnostic work up is warranted.

The Biofeedback therapy in Female Urethral Syndrome

No abstract available in English.

A Study on the Evaluation of the Psychogenic Etiology by the Symptom Checklist-90-Revigion(SCL-90-R) and Treatment in Female Urethral Syndrome Patients / 대한비뇨기과학회지

From March 1983 to February 1988, 248 patients of female urethral syndrome were studied retrospectively. The results were as follows: 1. Both 113 cases of the patients group who showed female urethral syndrome and the same numbers of 113 as the control group who had been treated at this hospital with other medical diseases, were tested the Korean Manual of Symptom Checklist-90-Revision. In this way, female urethral syndrome patients scored up significantly higher on the anxiety, depression, and phobic anxietic symptoms than did the control group, and the results showed the evidence or psychosomatic etiologies on the female urethral syndrome (p<0.05 ). 2. Among the patients, the 135 patients were treated with transurethral fulguration, urethral dilatation and antibiotics. Tranquilizer and antidepressants were added to above mentioned treatment in another patients group, 113 patients. In this group, excellent result was obtained in cure rate. The cure rate was 83.2% (94 out of 113 cases) while only 57.8% (78 out of 135 cases) in group without tranquilizer and antidepressants in their treatment (p<0.06). 3. The tranquilizer and antidepressants did not influence on recurrence rate( p value ; not significant).

The Value of Ureaplasma Urealyticum and Chlamydia Trachomatis in Female Urethral Syndrome / 대한비뇨기과학회지

We have experienced the female urethral syndrome in many patient, but we are embarrassed in identifying the exact cause of each case and searching for the treatment modalities. I thought there was a possibility of infection or local irritation by Ureaplasma urealyticum and Chlamydia trachomatis as an evoking factor of this syndrome. We have reviewed 32 women referred to Severance Hospital who complained irritative symptom of lower urinary tract without evidence of UTI and have come to the conclusion as follows 1. There was high isolation rate of ureaplasma urealyticum and Chlamydia trachomatis in female urethral syndrome. 2. There was no difference between isolation rate and age, or menopause. 3. There was high correlation between urethral and cervical isolation.

The Value of Urodynamic Study in the Female Urethral Syndrome / 대한비뇨기과학회지

We have experienced the female urethral syndrome in many patients, but we are embarrassed in identifying the exact cause of each case and searching for the treatment modalities. Until now there have been many explanations on the causes of the female urethral syndrome without effective treatment methods. I thought there was a possibility of lower urinary tract dysfunction as an evoking factor of this syndrome and so we conducted this study with urodynamic examination on the cause of female urethral syndrome. We took urodynamic studies in female urethral syndrome at Yonsei University Hospital tom April 1984 till March, 1985 and have come to the conclusion as follows; 1: Among the 49 patients of female urethral syndrome, normal urodynamic findings was revealed in 13 cases (26.5%). 2. There were single abnormal finding in 22 cases (44.9%) which were composed of 10 cases (20.4%) of hypersensitive bladder findings, 1 case (2%) of unstable detrusor, 9 cases (18.3%) of high maximum urethral closure pressure and 2 cases (4%) of detrusor-sphincter dyssynergia. 3. The combined abnormal findings were noticed in 14 cases (28.6%), 12 cases (24.4%) of combined hypersensitive bladder and high maximum urethral closure pressure and 2 cases (4%) of combined hypersensitive bladder and detrusor-sphincter dyssynergia. 4. Hypersensitive bladder finding, which was main abnormal one was found in 24 cases (49.9%),while high maximum urethral closure pressure in 21 cases (42.9%) among 49 patients of female urethral syndrome. The urodynamic abnormalities must be considered as the causes of female urethral syndrome when we cannot find the exact cause of such as infection, gynecologic disease, urethral stricture and so. And I consider the further studies of treatment in female urethral syndrome are needed.

Study on the Minnesota Multiphasic Personality Inventory (MMPI) and Treatment in Female Urethral Syndrome Patients / 대한비뇨기과학회지

Female urethral syndrome is a common disorder in women consisted of urinary frequency, urgency, dysuria and suprapubic discomfort without any specific organic changes on corroborative physical and laboratory findings. Allergy, psychic factors, senile atrophy, obstruction and chronic infection of periurethral gland have been implicated at etiologic factors. From Jan. 1982 to Jan. 1983, 22 patients of the female urethral syndrome underwent laboratory examinations and cystourethroscopic examinations. In addition, both 22 cases of the patient group who showed female urethral syndrome with polypoid at the bladder neck and the same numbers of 22 as the control group who had been treated at this hospital with other medical diseases were tested the Minnesota Multiphasic Personality Inventory. Concomitantly, no specific abnormalities were found in both urine findings and cystourethroscopic findings except polypoids at the bladder neck in 22 cases. Female urethral syndrome patients in this study scored up significantly higher on the hypochondriasis, hysteria and depression scales than did the control group, and the results revealed evidence of conversion and psychosomatic etiology. All 22 cases were treated with transurethral fulguration, urethral dilatation and antibiotics. Chlordiazepoxide was added to above mentioned treatment in 15 cases which scored up significantly higher on hypochondriasis, hysteria, and depression scales among 22 cases Excellent result were obtained in 12 out of 15 cases while only 3 out of 7 cases which didn`t add chlordiazepoxide in their treatment had good result.

Urodynamic study in Female Urethral Syndrome / 대한비뇨기과학회지

Female urethral syndrome is one of the most common urologic disease in middle age women, but much remains to be known about its etiology and management. For the purpose of identifying underlying voiding dysfunction of this disease, urodynamic studies were done on 28 patients with female urethral syndrome seen in Urologic Department of Seoul National University hospital during the past 14 months from January 1983 to February 1984. Results were as follows: 1. Twenty cases showed normal urodynamic findings, and no significant findings were found in urethral pressure profile studies. 2. Three cases showed functional bladder outlet obstruction due to failure of urethral sphincter relaxation during voiding, two of which were treated by diazepam, and one of which by diazepam and phenoxybenzamine, and all three cases showed improvement of symptoms and maximum roflow rate. 3. Six cases showed detrusor instability, and three were sensory detrusor instability, other three were idiopathic detrusor hyperreflexia. 4. We conclude that routine whole urodynamic study is unnecessary in evaluation of female urethral syndrome, but uroflowmetry can be used as a simple screening study. when uroflowmetry curve shows interrupted pattern, maximum uroflow rate is less than 15 cc/sec., and urethral calibration and castopandoscopy reveals no anatomical bladder outlet obstruction, combined cystometry-urethral sphincter electromyography is necessary to rule out functional obstruction due to failure of relaxation of urethral sphincter during voiding. A new flow chart for the management of female urethral syndrome is presented.

Clinical Significance of Otis Internal Urethrotomy in the Treatment of Urethral Syndrome and Urethral Stricture / 대한비뇨기과학회지

Patient with urethral syndrome constitute by far the largest percentage of women in the urologist' office. Many have already to its prevalence but also to the frustration in therapy for both patient and doctor. Anatomic obstruction in the urethra of these women has been widely reported as a etiology by bougie-a-boule calibration and also by uroflowmetry. So we applied internal urethrotomy to reduce urethral resistance in urethral syndrome patient. Because there is no clear-cut best treatment there are many different modalities available to treat urethral strictures. Nearly all strictures can be cured by aggressive treatment with urethroplasty but these methods often involve multiple stages and considerable patient inconvenience. One technique used to treat urethral strictures with a minimum of morbidity is internal urethrotomy. We herein report our experience with internal urethrotomy for the treatment of urethral stricture in men and urethral syndrome in women. Of 41 urethral syndrome treated by internal urethrotomy, 24 patients were followed and 18 patients of them were cured. Of 9 urethral stricture patients in men, 6 patients werecured completely and 2 patients needed periodic dilatation.

Endoscopic Evaluation of the Female with Lower Urinary Tract Symptoms / 대한비뇨기과학회지

463 female patients visited our hospital due to lower urinary tract symptoms during the period from March 1st, 1980 to February 28th, 1981. Among them, 127 female patients whose urinalysis was normal were performed endoscopic examination and studied clinically, based on endoscopic findings. The results are summerized as follows. 1) The endoscopic findings were classified into 5 groups. Group I: Almost normal urethral mucosa, bladder neck and vesical mucosa, 11 cases. Group II: Gray-whitish velvety trigone with almost normal urethra and bladder neck, 16 cases. Group III: Mild granular hyperemia of the urethra, bladder neck and trigone 31 cases. Group IV: Mild bullous hyperemia of the urethra, bladder neck and trigone with a few pseudopolyps, 43 cases. Group V: Marked granular hyperemia of the urethra with many pseudopolyps and bullous hyperemia of bladder neck and trigone, 26 cases. 2) The most common age group was in 4th decade (33.8%). Group I and group II were younger than group IV and group V. 3) Common symptoms were frequency (78.0%), tenesmus (68.5%), painful urination (26.8%), urgency (20.5%), suprapubic discomfort (33.1%) and lumbago (18.9%). There were no significant differences among 5 groups. 4) 47 cases had the history of urethritis-cystitis and it was outstanding in group IV and group V. 5) Trabeculation (52.8%) was the most common change in bladder on cystoscopic examination. Meatal stenosis which was found in 44 cases (34.6%) was the most common associated disease. Endoscopic examination was necessary to establish the correct diagnosis and determine the therapeutic choice such as conservative, surgical and psychological treatment in female urethral syndrome.

Urinary Prostaglandin E in Female Urethral Syndrome / 대한비뇨기과학회지

The levels of prostaglandin E were studied in the urine of 25 female patients with irritative bladder symptoms but no evidence of organic disease or urinary infection (female urethral syndrome). Twenty five healthy women served as a control group. A significant elevation of prostaglandin E in the urine of patient with female urethral syndrome was demonstrated (by Wilcoxon rank sum test; z= -2.32, p<0.05). The results suggest that prostaglandins may be responsible for the lower urinary tract symptoms in the patients. The potential beneficial clinical effects of prostaglandin syntheses inhibitors in treatingthe severe discomfort associated with urethral syndrome need to be evaluated further.

Clinical Observation of the Irritation Symptoms on Female Urinary Tract / 대한비뇨기과학회지

In general, the irritation symptoms of the female lower urinary tract such as frequency, dysuria, urgency, supra-pubic discomfortness and back pain are not uncommon urological, obstetric and gynecological, and psychological problems in female. These irritation symptoms are more frequently developed in female than male, because these symptoms can be occurred not only from the inflammatory and organic disorders of the lower urinary tract in female, but pregnancy, delivery and psychosomatic syndrome. In order to be helpful in determining the etiology. Diagnosis management and treatment of the patient, who are suffered from urinary frequency, urgency, dysuria, suprapubic discomfortness and back pain, author studied the clinical observation of 580 patients who are visited in out patient clinic and 55 patients who are admitted to the urologic department with lower urinary tract irritation symptoms. Total 580 patients are analyzed according to the age distribution, past history, chief complaints, laboratory results, and cystoscopic findings. The results of this study are summarized as follows. 1. The age distribution revealed 476 cases (80.2%) in between 16 and 45 years old. 63 cases(10.8) in postmenopausal, 21 cases(3.6%) in under 15 years old, and 20 cases (3.4%) in over 60 years old, among the total 580 cages. 2. The most common past history was 127 cases (68.8%) of cystitis. 27 case (14.5%) of gynecological operation. 3. The most common chief complaints were 262 cases (45.1%) of urinary frequency. (19. 1%) of dysuria, 90 cases (15. 5%) of hematuria. 4. There were 175 cases (30%) of pyuria, 116 cases (30%) of microscopic hematuria,43 cases (7.4%) of bacteriuria. 5. Endoscopic findings revealed 28 cases (32.1%) of trabeculation, 20 cases (22.9%) of hyperemia and congested trigone with highest incidence of urinary frequency. 6. Distribution of the underlying disease in inpatients were 12 cases (21.8%) of pyelonephritis, 12 cases(2l. 8%) of urethral stricture. 8 cases(I4. 5%) of stone, an 7 cases (12.7%) of urethral caruncle. 7. Results of treatment. I) 246 cases (42. 4%). under the impression of urethral syndrome, were treated with medical and psychological methods, the majority of cases were improved the symptoms 2) 47 cases (8. 1%) with underlying diseases were treated with operation, almost cases were imp_ roved. 3) 12 cases of urethral stricture were treated with internal urethrotomy, 1I cases were relieved the symptoms. 4) 16 cases of mild urethral stricture were treated by dilatation with sound and antimicrobial agents application into the urethra, 12 cases were relieved the symptoms.