Chronic urethral pain

Specialty: Nephrology and urology.

• uretradynia
• chronic urethral syndrome
• persistent urethral pain

Why it occurs

• Unresolved or recurrent chronic urethritis (due to germs that are difficult to isolate such as Mycoplasma genitalium or Chlamydia trachomatis with incomplete previous treatment)
• Urethral stricture (turbulent urinary flow generates shearing and continuous burning pain in the anterior urethral mucosa)
• Female urethral syndrome (clinical entity characterized by persistent urethral pain associated with dysuria and polyakiuria in women with repeated negative urine cultures, linked to inflammation of the paraurethral glands of Skene)
• Pudendal nerve neuropathy or chronic pelvic neuralgia
• Urethral diverticulum in women (with chronic accumulation of purulent urine and irritation of the wall)

Initial workup

Specific urethral culture and multiplex molecular PCR for atypical microorganisms in urethral sample or first urine fraction; high-resolution diagnostic urethrocystoscopy to rule out urethral strictures, polyps, or diverticula; transperineal or transvaginal ultrasound in women; Pelvic MRI if there is suspicion of pudendal nerve entrapment.

Standard management

• Doxycycline — 100 mg every 12 hours orally for 10-14 days if persistent urethral infection due to intracellular germs is suspected or confirmed
• Amitriptyline — 10-25 mg orally in the evening for the management of chronic idiopathic or neuropathic urethral pain
• Lidocaine gel 2% (gentle local application to the external urethral meatus intermittently to relieve episodes of acute burning pain).