New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome.

Olga Streltsova,Ekaterina Tararova,Svetlana Zubova,Muhhamad Shuaib Abdul Malik Molvi,Anton Kuyarov,Valery Lazukin,Elena Kiseleva

doi:10.3390/diagnostics10110860

Olga Streltsova, Ekaterina Tararova + Show 5 more

Open Access

https://doi.org/10.3390/diagnostics10110860

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Abstract

Introduction: Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a “diagnosis of exclusion”. The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. Methods and Participants: A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. Results: TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. Conclusion: This paper showed that the introduction of new technology—CP OCT—in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.

Highlights

Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a “diagnosis of exclusion”
The results of transvaginal ultrasound (TVUS) studies showed that in the norm group in women, the urethra looks like a tube with a uniform lumen diameter without dilatations and contractions, which was 4.6 ±
According to research by a group of authors [40], diameter of the urethra is 10.0 mm, the inner lumen of the urethra is closed during TVUS or 0.3 mm

Summary

Introduction

Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a “diagnosis of exclusion”. The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. Institutes of Health, one third of women with chronic pelvic pain (CPP) have urethral pain syndrome (UPS) [2,3]. Diagnostics 2020, 10, 860 episodic pain lasting for more than 6 months, and felt in the urethra, in the absence of proven infection or other obvious local pathology. It is often associated with negative cognitive, behavioral, sexual or emotional consequences [4], as well as with symptoms suggestive of lower urinary tract, sexual, intestinal, or gynecological dysfunction [5]. The approach should be interdisciplinary and the treatment should be multimodal, with the general principles of chronic pain syndrome management being applied [11,12,13]

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