A study of the bladder outlet in lower urinary tract infections in women.

Abstract

A group of 17 female patients complaining of recurrent cystitis was studied. Investigation was by voiding cinecystography, urethrography, pressure/flow measurements, and cystourethroscopy. The astiology of cystitis is discussed, and in 15 of these patients there was no immediately obvious cause for their symptoms. Definite evidence was found in 10 of these patients of increased outflow resistance, and this was seen to be particularly marked in those patients who had evidence of renal infection. The mechanism of this obstruction was not discovered, but it is thought to be an important ætiological factor in the genesis of cystitis. Voiding cystography suggested that abnormal function of the detrusor or urethra rnay be found in such patients (eight patients in this series), but a large series would be necessary to establish particular patterns. Cystography is recommended in those patients who fail to respond to treatment. Urethrography revealed one diverticulum, but was otherwise valueless. It is recommended only when there is definite periurethral induration. Treatment of these patients was by urethral dilatation to 1–5 cm. (45 French, 15 Hegar). Complete relief or improvement was found in ail patients, although four required further dilatation. An unusual finding was of increased force of flow described spontaneously by six patients. Renal pain was relieved or improved in ail cases.