[Iatrogenic urethral coitus]. / Iatrogene urethrale coïtus.

This case discussion on urethral coitus in Mayer-Rokitansky-Küster-Hauser syndrome shows that this rare syndrome can have major physical and psychological consequences. Further consideration shows that a lack of common sense and a lack of action concerning sexual history-taking and careful vulvar examination is the reason that an iatrogenic sexual problem arose in this case. This was not the result of the initial denial of a rare diagnosis. Both attention to these aspects during training and supervision are necessary, since other disorders and medical treatments can also have a negative impact on sexuality.

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

Urethral pain syndrome has had several sobriquets, which have led to much confusion over the existence of this pathological condition and the useful options in the care of the afflicted patient. Our aim was to explore the proposed etiologies of this syndrome, and to provide a critical analysis of each proposed etiology and present a balanced argument on the plausibility of the proposed etiology and therapeutic approaches. We carried out an English language electronic search in the following databases: Medline, Embase, Amed, Cinahl, Pubmed, Cochrane Library, Trip Database and SUMSearch using the following search terms: urethral syndrome, urethral diseases, urethra, urologic diseases etiology/etiology, presentation, treatment, outcome, therapeutics and treatment from 1951 to 2011. In excess of 200 articles were recovered. With the clearly defined objectives of analyzing the proposed etiologies and therapeutic regimes, two author(s) (HP and IO) perused the abstracts of all the recovered articles, selecting those that addressed the etiologies and therapeutic approaches to treating the urethral pain syndrome. The number of articles was reduced to 25. The full text of all 25 articles were retrieved and reviewed. Through the present article, we hope to elucidate the most probable etiology of this condition whilst simultaneously, advance a logical explanation for the apparent success in the treatment of this condition using a range of different therapeutic modalities. We have carried out a narrative review, which we hope will reduce some of the confusion around this clinical entity by combining the known facts about the disease.

Salvage irrigation-suction in gracilis muscle repair of complex rectovaginal and rectourethral fistulas.

AIM: To evaluate the efficacy of gracilis muscle transposition and postoperative salvage irrigation-suction in the treatment of complex rectovaginal fistulas (RVFs) and rectourethral fistulas (RUFs). METHODS: Between May 2009 and March 2012, 11 female patients with complex RVFs and 8 male patients with RUFs were prospectively enrolled. Gracilis muscle transposition was undertaken in all patients and postoperative wound irrigation-suction was performed in patients with early leakage. Efficacy was assessed in terms of the success rate and surgical complications. SF-36 quality of life (QOL) scores and Wexner fecal incontinence scores were compared before and after surgery. RESULTS: The fistulas healed in 14 patients after gracilis muscle transposition; the initial healing rate was 73.7%. Postoperative leakage occurred and continuous irrigation-suction of wounds was undertaken in 5 patients: 4 healed and 1 failed, and postoperative fecal diversions were performed for the patient whose treatment failed. At a median follow-up of 17 mo, the overall healing rate was 94.7%. Postoperative complications occurred in 4 cases. Significant improvement was observed in the quality outcomes framework scores (P < 0.001) and Wexner fecal incontinence scores (P = 0.002) after the successful healing of complex RVFs or RUFs. There was no significant difference in SF-36 QOL scores between the initial healing group and irrigation-suction-assisted healing group. CONCLUSION: Gracilis muscle transposition and postoperative salvage wound irrigation-suction gained a high success rate in the treatment of complex RVFs and RUFs. QOL and fecal incontinence were significantly improved after the successful healing of RVFs and RUFs.

Urinary symptoms and quality of life in women following urogenital fistula repair: a long-term follow-up study.

Using the Bristol Female Lower Urinary Tract Symptom questionnaire, we have investigated urinary and sexual symptoms and quality of life in a group of 31 women 50 months (median) after successful repair of urogenital fistula. All had undergone urodynamic investigation prior to their repair surgery, and only 36% had normal findings. Almost all women reported one or more symptoms, and for 65%, these caused at least 'a bit of a problem', although 87% said that their urinary symptoms had little or no impact on their quality of life. Symptoms were similar in urethrovaginal and vesicovaginal fistulae and were not significantly associated with prior functional abnormality.

Socio-cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India.

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men's sexual health - sexually transmitted infections, psychosexual concerns and psychological distress - but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic-based survey of 366 symptomatic men who presented at rural private provider clinics. Men's urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12- items). Results revealed that local and traditional notions of health influenced men's symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non-infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51-4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.

Urethral pain syndrome and its management.

UNLABELLED: Urethral pain syndrome is occurrence of persistent or recurrent episodic urethral pain usually on voiding with daytime frequency and nocturia, in the absence of proven infection or other obvious pathology. This is a condition of uncertain etiology. The objective of this article is to review etiology, diagnosis, and management of urethral pain syndrome. Since there is paucity of information on randomized trials, search of published literature has been made using keywords such as "urethral pain syndrome", "painful bladder syndrome", "urethral stenosis", and "lower urinary tract symptoms". Urethral pain syndrome is a disease of ambiguous etiology. Diagnosis is mainly based upon symptoms, and investigations are aimed to exclude other conditions affecting lower urinary tract. Various modalities of treatment including antibiotics, alpha-blockers, acupuncture, and laser therapy have been proved successful. Psychological support is very important in this group of women. Management requires multidisciplinary approach, and treatment at its best is by trial and error. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain that the urethral pain syndrome (UPS) has specific signs and symptoms without specific responses to a variety of treatment options and recall that treatment may require a multidisciplinary approach and a lot of sensitivity by the physician.

[Junctional epidermolysis bullosa non-Herlitz with urethral affection]. / Junktionale Epidermolysis bullosa non-Herlitz mit Affektion der Harnröhre.

Epidermolysis bullosa (EB), a hereditary, blistering form of dermatosis, can be divided into the following three main groups: epidermolysis bullosa simplex (EBS), junctional epidermolysis bullosa (JEB) and dystrophic epidermolysis bullosa (DEB). The previously known form of generalized atrophic benign epidermolysis bullosa (GABEB) is classified as junctional epidermolysis bullosa non-Herlitz (JEB-nH) today. An 11-year-old boy with junctional epidermolysis bullosa non-Herlitz with urethal involvement had a complicated course with bladder obstruction and secondary renal insufficiency. According to currently available literature, this is the earliest case known of JEB-nH with involvement of the urinary tract in childhood. Taking into account the complicated course in this young patient, it must be emphasized that in cases of epidermolysis bullosa hereditaria, uncommon affections occurring in infancy should be given careful attention, as such types of associated manifestations are mainly responsible for the lethality in this disease.

Stress urinary incontinence due to a low-pressure urethra: a socially invalidizing disease.

To compare the quality of life and clinical findings of patients with low-pressure urethra (LPU: < or = 20 cm H2O) with those of stress urinary incontinent (SUI) patients without LPU, and to compare the quality of urethral sphincter (US) muscle innervation parameters in LPU patients with those in control continent patients. Historical, clinical, urodynamic, and US muscle innervation parameters were compared in 38 LPU (group 1), 241 SUI (group 2), and 7 control patients (group 3). In comparison with group 2, the incidence of previous surgery and daily incontinence episodes, SUI severity, and pad test values were significantly higher in group 1, whereas the incidence of previous traumatic deliveries was the same in both groups. The mobility of the bladder neck assessed by the Q-Tip test was significantly reduced in group 1. In comparison with group 3, US motor unit potential (MUP) duration and pudendal motor latencies to the urethral sphincter (PMLUS) were increased in LPU group 1 patients, whereas there was no difference in these parameters between LPU patients with or without previous incontinence surgery. Fifty-three percent of our LPU patients had normal PMLUS, but showed signs of abnormal reinnervation on quantitative electromyography. Three nullipara LPU patients had normal MUP durations and PMLUS values, but a decreased area in response to pudendal nerve stimulation. Apart from a rare form of LPU in nullipara patients, probably due to a dysgenesis of their US muscle, LPU patients suffer from neuro-muscular damage responsible for a severe urinary invalidity. Previous incontinence surgery, as well as previous vaginal deliveries, may be responsible for such US damage.

Urinary obstruction caused by factitious urethral stones: an amazing manifestation of Munchausen syndrome by proxy.

The diagnosis of Munchausen syndrome by proxy is frequently difficult to document and often delayed. A unique presentation of a case of Munchausen syndrome by proxy involving insertion of factitious stones in the lower urinary tract is reported.

Stressful events and psychological symptoms in patients with functional urinary disorders.

The relationship between micturition, stressful events, and psychological symptoms was studied in 58 female patients with functional micturition disorders (urethral syndrome) and 21 control patients. All received three questionnaires (Symptom Questionnaire, Illness Behavior Questionnaire, and the Biographic Questionnaire). Analysis highlighted the appearance of the urethral syndrome in highly stressful situations and the increase in the patient's anxiety, depression, dysphoria, hostility, and irritability. A tendency to complain of other psychophysiologic symptoms was also noted.

Aspects of urethrality in women.

It has long been noticed that women experience direct sexual stimulation from urethral practices that men do not. However, this empirical finding remains to be integrated with the general theory of female psychosexual development. An attempt is made to begin such an integration, with a focus on urethral perversions or perverse trends.

A psychophysiological evaluation of female urethral syndrome: evidence for a muscular abnormality.

This is a preliminary investigation into a recently defined urological disorder occurring in a subgroup of women with "urethral syndrome" suggestive of pelvic floor muscular (PFM) dysfunction. Symptoms include straining to void, urgency, frequency, hesitation, incontinence and/or retention, and subpubic pain. Finding neither bladder nor urological abnormalities, urologists may consider these women emotionally unstable without organic cause for their symptoms. However, their distress may be a consequence rather than a cause of their voiding problems. Sixteen female urological patients were matched with 16 asymptomatic controls to investigate PFM functioning, psychological status, and symptomatology. Results showed heterogeneity of symptomatology and little elevation of depression or anxiety when comparing patients with controls. Hypotheses of muscular abnormality were confirmed. Patients evidence poor control over testing and relaxing PFM, elevations of PFM activity under various conditions, and chronic pain as a prominent symptom. Treatment approaches specifically designed to address PFM dysfunction are discussed.

Irritable urethral syndrome: follow up study in general practice.

Two years after a microbiological study of the urethral syndrome 25 of 31 women had had further symptoms, but only two had sought medical help for their symptoms in the year after the study. Analysis of patients' records showed that women with the urethral syndrome had higher consultation and sterilisation rates and more psychosomatic symptoms and relationship problems than matched control patients. Using the Nottingham health profile women with the urethral syndrome were more likely to mention that health problems affected their sex lives and were more likely to see themselves as having health problems than control patients. Women who have the urethral syndrome are considerable drain on the doctor's time, and management needs to be directed towards the anxious patient who makes such demands. Seeing the condition as the "irritable urethral syndrome" may help both doctor and patient to recognize the psychosomatic aspect of the problem.