Longterm Follow-Up of Idiopathic Urethritis

Abstract

Purpose To study clinical features longterm outcomes of peripubertal boys presenting with dysuria haematuria diagnosed endoscopically with idiopathic urethritis. Material and Methods The case notes of all the patients presenting over the last 7yrs with idiopathic urethritis were retrospectively reviewed for age, symptoms, radiological evaluation, cystoscopy findings and outcome. Mean follow up was 3.7y (Range 2-7yrs). Results Ten boys, Mean age 11.5y (Range 5-14yrs) have been identified. Eight boys presented with dysuria/haematuria alone, 2 boys presented with significant obstructive symptoms. All patients were assessed and diagnosed endoscopically. Endoscopic features fell into 2 distinct groups at presentation. (Group A) Bulbar urethral erythematous inflammation with multiple fronding of urethral mucosa(8). (Group B) Major disruption of bulbar urethra with membranous obstruction and severe haemorrhagic inflammation(2). Biopsy showed non specific inflammation or no inflammation. Urine cultures have always been negative. Urinary tract ultrasound has not shown any abnormality Group A. Five boys (62%%) have had complete resolution of symptoms after several years Two (22%) still have intermittent non-obstructive symptoms One has progressed to obstructive symptoms and endoscopic changes after 5 years, necessitating dilatation. Group B. One has eventually developed complete obstruction and eventual urethroplasty. This patient had undergone successful distal Hypospadias repair 11 years previously. The other has ongoing obstructive symptoms 4 years after diagnosis. Conclusions 1. Idiopathic urethritis may be 2 different conditions 2. Patients with Bulbar urethral erythematous inflammation will generally resolve slowly, even after endoscopic examination, but not always. 3. Patients who present with stricture may obstruct completely and require urethroplasty.