Severity Of Dysuria Research Articles

Evaluation of the clinical efficacy of the use of oxidized dextran in the form of suppositories in the treatment of patients with chronic prostatitis

BACKGROUND: Increasing the efficacy of treatment of patients with chronic prostatitis / chronic pelvic pain syndrome remains an urgent problem of modern urology.
 AIM: The aim of the study is to evaluate the clinical efficacy of rectal suppositories with oxidized dextran in the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.
 MATERIALS AND METHODS: 52 patients with chronic prostatitis / chronic pelvic pain syndrome were treated (mean age 33.1 1.7 years). The patients were divided into 2 groups. Patients of the 1st group (n = 25) received oxidized dextran in the form of rectal suppositories for 50 days according to the following scheme: for the first 10 days, 1 rectal suppository at night, daily; the next 40 days 1 rectal suppository every other day. A total of 30 rectal suppositories per course. Patients of the 2nd group (n = 27) received a placebo in the form of rectal suppositories according to the same scheme. Treatment efficacy was assessed on the basis of the original IPPS-MS Genitourinary Disease Assessment questionnaire, the NIH-CPSI and IIEF-5 questionnaires, as well as the results of microscopic examination of prostate secretions.
 RESULTS: In patients of the 1st group a significant clinical improvement was revealed by the end of treatment. According to the IPPS-MS questionnaire there was a decrease in the severity of dysuria by 67%, pain syndrome by 80%, psychosomatic disorders by 47.6%. There was a decrease in the total score of the NIH-CPSI questionnaire by 66.2% (from 25.4 2.4 to 8.6 2.1 points, p 0.05) and an increase in the total score of the IIEF-5 questionnaire by 79.3 % (from 11.6 1.8 to 20.8 2.1 points, p 0.05). Positive changes in the clinical parameters of patients of the 1st group were accompanied by an improvement in the results of microscopy of the secretion of the prostate a decrease in the number of leukocytes and an increase in the number of lecithin grains. There were no significant changes in any of the studied parameters in patients of the 2nd group. None of the patients in both groups had side effects from the therapy.
 CONCLUSIONS: Oxidized dextran in the form of rectal suppositories has a pronounced anti-inflammatory activity and significantly reduces the severity of dysuria, pain and psychosomatic disorders in patients with chronic prostatitis / chronic pelvic pain syndrome. The results of the study indicate the promise of using oxidized dextran in the form of rectal suppositories for the treatment of patients with chronic prostatitis / chronic pelvic pain syndrome.

Современные тенденции в лечении хронического рецидивирующего бактериального цистита

INTRODUCTION Every year, more than 7 million women go to the doctor for chronic cystitis. An important factor is the psychoemotional component of this disease. OBJECTIVE comparative analysis of various options for complex treatment of women with chronic recurrent bacterial cystitis using phototherapy, chronotherapy and correction of psychoemotional disorders with the anxiolytic drug Adaptol. MATERIALS AND METHODS 90 women with chronic recurrent bacterial cystitis in the acute stage were examined and divided into 3 groups of 30 people. In group 1, patients received basic therapy with Furamag (furazidin kalium). In group 2, patients received standard therapy in combination with phototherapy in the acrophase of the chronorhythm. In group 3, basic therapy was performed in combination with phototherapy in the acrophase of the chronorhythm and Adaptol. The severity of dysuria and pain, leukocyturia, bacteriuria, chronobiological and psychoemotional status were evaluated. RESULTS Initially, all patients showed signs of desynchronosis and psychoemotional disorders. All groups showed signs of exacerbation of chronic cystitis. The results obtained on the 5th day of therapy in groups 2 and 3 were statistically significantly different (p<0.05) from those in group 1. In group 3, the number of nocturnal urination (0.9+/-0.7), the number of imperative urges per day (0.7+/-0.5), and the intensity of pain (0.7+/-0.6) were the closest to normal. By day 10, clinical and laboratory parameters in all three groups reached normal values, which indicates the effectiveness of the therapy in each of the groups. CONCLUSION Thus, the use of Furamag and Adaptol in combination with phototherapy at the maximum peaks of psychoemotional and physiological activity of the body effectively stops the clinical and laboratory manifestations of the disease, corrects the mental status and improves the quality of life of women in a shorter period of treatment.

Вспомогательные технологии в лечении больных урогенитальным туберкулезом

Currently, the limits of therapeutic efficiency in urogenital tuberculosis have been achieved. The etiological therapy should be supplement by pathogenetic drugs. to determine the efficiency of deoxyribonucleate sodium in the complex treatment of patients with urogenital tuberculosis. Single-center open-label randomized comparative prospective study was carried out. A total of 62 patients with active urogenital tuberculosis were included. All patients received therapy in accordance with National clinical guidelines for urogenital tuberculosis. In the main group, patients additionally received pathogenetic therapy in form of deoxyribonucleate sodium via intramuscular injection of 75 mg every 48 hours. Whole one-month course consisted of 15 injections. Pathogenetic therapy was started immediately after the choosing of anti- tuberculosis drugs and confirmation of good tolerability. The efficiency of treatment was evaluated after one and three months. The assessed criteria included the intensity of pain and severity of dysuria, signs of inflammation, bacterial isolation and changes in the quality of life. The addition of deoxyribonucleate sodium in the form of intramuscular injections of 75 mg every 48 hours for 1 months resulted in a significant increase in the efficiency of treatment. Quality of life in patients receiving deoxyribonucleate sodium improved twice (from 11.1 to 21.5 points), while in the control group this value was twice as low (from 10.8 to 15.9 points).

General clinical and laboratory and instrumental characteristics of the chronic nonbapterial prostatite with the inflammatory component in men of the first period of mature age

To investigate the course of CNPIC in young men treated with general and local ozone therapy. 306 patients underwent standard treatment concurrently with local and systemic ozone therapy. Clinical-laboratory and instrumental parameters were evaluated before and after treatment. In addition, the blood flow of the prostate, prostatic urethra and skin at the projection point of the prostate was studied. Standard treatment of CNPIC with the concurrent use of general and local ozone therapy resulted in a reduction of pain intensity and severity of dysuria, improvement of the sexual function and quality of life of men. There was an increase in blood flow in the arteries and veins of the prostate, a decrease in the prostate size and volume. The study findings showed an almost twofold decrease of the mean values of the CNPIC clinical index during treatment. In the prostate secretion, the leukocyte count decreased from 29.29+/-0.67 to 4.75+/-0.15. A statistically significant (p<0.001) decrease in all sizes of the prostate was observed: height (upper) from 40.99+/-0.22 to 39.13+/-0.21 mm, width (transverse dimension) from 41.94+/-0.21 to 39.94+/-0.22 mm, and thickness (anteroposterior size) from 30.52+/-0.20 to 29.15+/-0.18 mm. Prostate volume also decreased from 27.78+/-0.42 to 24.10+/-0.36 cm (p<0.001).

Preventive effect of Malva on urinary toxicity after radiation therapy in prostate cancer patients: A multi-centric, double-blind, randomized clinical trial.

Background:For patients receiving external beam radiation therapy (EBRT) after radical prostatectomy as adjuvant treatment or patients receiving EBRT as definitive treatment, partial irradiation of the urinary bladder is common. Many of such patients experience some degree of radiation-induced cystitis during or after EBRT. There is currently no efficient treatment for preventing radiation cystitis.Objective:The aim of this study was to evaluate the effectiveness of one of the safe mucilaginous herbs (Malva) in preventing radiation-induced dysuria in patients who are undergoing EBRT for prostate cancer.Methods:From April 2013 to August 2014, 68 patients were randomized into two groups using four block randomization, 34 to the drug (Malva) group and 34 to the placebo group. Of the 68 patients who began the study, 60 completed it. They were instructed to use the medication, i.e., Malva or the placebo, three times a day for six weeks. They were followed by a physician every two weeks for eight weeks, and urinary function was assessed in each visit by asking questions based on the Visual Prostate Symptom Score (VPSS) and a dysuria severity score. The changes in the VPSS and dysuria severity score between baseline and each follow-up visit were compared between the two groups in the study using repeated measures analysis of variance (ANOVA) and t-tests.Results:The median age of the 68 patients was 66. Twenty-one of 27 patients in the control group (77.7%) suffered from dysuria, while dysuria was detected in 23 of 33 patients (69.6%) who received Malva (odds ratio=2.70 for dysuria). After two weeks, four weeks, and six weeks of treatment with Malva, dysuria due to EBRT was milder in the treatment group than in the control group, and the differences were statistically significant (p = 0.005, p = 0.004, p = 0.001, respectively).Conclusion:To the best of our knowledge, our study is the first study to assess the protective effect of a mucilaginous herb (Malva) against urinary toxicity induced by EBRT. The positive results of this study warrant further studies in this field.

Dysuria Following Stereotactic Body Radiation Therapy for Prostate Cancer.

Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients' quality of life and may be difficult to manage. Two hundred four patients treated with stereotactic body radiation therapy (SBRT) from 2007 to 2010 for localized prostate carcinoma with a minimum follow-up of 3 years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25 Gy in five fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination) of the expanded prostate index composite-26 and the American Urological Association (AUA) Symptom Score at baseline and at routine follow-up. Two hundred four patients (82 low-, 105 intermediate-, and 17 high-risk according to the D'Amico classification) at a median age of 69 years (range 48-91) received SBRT for their localized prostate cancer with a median follow-up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at 1 month (p < 0.0001). There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first 2 years of follow-up, it returned to below baseline by 2 years (p = 0.91). The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p < 0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis. The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.

Dysuria Following Stereotactic Body Radiation Therapy for Prostate Cancer

Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients QOL and may be difficult to manage. This study sought to evaluate the incidence and severity of dysuria following stereotactic body radiation therapy (SBRT) for prostate cancer, testing the hypothesis that SBRT treatment has comparable rates of dysuria to those of IMRT and/or brachytherapy. 204 patients treated with SBRT monotherapy from 2007 to 2010 at a single institution for localized prostate carcinoma with a minimum follow up of three years were included in this retrospective review of data that was prospectively collected. All patients were treated to 35-36.25Gy in 5 fractions delivered with robotic radiosurgery with real time fiducial tracking. Dysuria and urinary function were assessed via Question 4b (Pain or burning on urination) of the Expanded Prostate Index Composite (EPIC)-26 and the American Urological Association (AUA) Symptom Score at baseline and at 1, 3, 6, 12, 18, and 24, 30 and 36 months. Medication utilization was documented at each visit. 204 patients (82 low-, 105 intermediate-, and 17 high risk according to the D’Amico classification) at a median age of 69 years (range 48-91) received SBRT monotherapy for their localized prostate cancer, having a median follow up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at one month (p<0.0001), improving to 21% at 3 months. However, only 18% of all patients felt that pain or burning on urination was a moderate to big problem. Of those patients, 92% reported return to baseline within a median time of 3 months. There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria symptom flare. While a low level of dysuria was seen through the first two years of follow-up, it returned to below baseline by three years. The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p<0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. 28 % of patients utilized alpha-agonists prior to treatment, which increased to 55% at 1 month before returning to baseline at 2 years post-SBRT. The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities. Dysuria correlates with other urinary symptoms. Conservative management, including alpha-agonist utilization, may help minimize the bother associated with dysuria.

The impact of acute urinary morbidity on late urinary function after permanent prostate brachytherapy

Purpose Acute prostate brachytherapy-related morbidity is dominated by urinary symptomatology. In this study, we evaluated the effect of severe early brachytherapy-related urinary morbidity on late urinary function. Methods and materials From January 1998 to September 2003, 1029 patients were implanted for clinical stage T1b–T3a (2002 American Joint Committee on Cancer [AJCC] criteria) prostate cancer. Five hundred sixteen (50.1%) received supplemental external beam radiation therapy and 440 (42.8%) received androgen deprivation therapy. Severe acute urinary morbidity (SAUM) was defined as a dysuria frequency score of at least 4 (of 5), a dysuria severity score of at least 8 (of 10), an internation prostate symptom score (IPSS) elevated to at least 30 or 15 above preimplant value for 4 weeks, and/or requirement of a urinary catheter for at least 5 days. Dysuria severity and frequency resolution were defined as a return to within one point of baseline. IPSS resolution was defined as a return to within two points of baseline. Results Of the 1029 patients, 175 met at least one of the criteria for inclusion. Dysuria frequency resolved in 5.0 vs. 1.3 weeks and dysuria severity in 5.7 vs. 1.4 weeks, for patients with and without SAUM. The mean time for IPSS resolution was 13.8 vs. 6.6 weeks, for patients with and without SAUM. The incidence of transurethral resection (2.3% [4/173] vs. 1.5% [13/841]) and bulbomembranous urethral strictures (2.2% [4/175] vs. 1.8% [15/854]) were comparable among patients with and without SAUM. Conclusions Patients experiencing brachytherapy-related SAUM have long-term urinary function and complications comparable to patients who did not develop SAUM.

Prostate High Dose Rate Brachytherapy in a Free-Standing Cancer Center Setting

To determine the safety and acute tolerance of performing prostate high dose rate (HDR) brachytherapy in a free-standing cancer center setting, and to report our approach in delivering such treatment. Patients treated with prostate HDR from the inception of our program through December 2004 were included. Disease- and treatment-related information was gathered from chart review. Acute side effects were obtained from both chart review and questioning the patient at follow-up visits. A total of 234 patients were treated with 459 HDR needle insertions. Nearly all patients were treated with external beam irradiation, and the majority also received adjuvant hormonal manipulation. There were no adverse events related to transport to the free-standing cancer center. Treatment was well tolerated, with only 3.7% of procedures developing retention requiring catheter placement; 20% of patients reported significant postimplant dysuria, mean duration of any dysuria being 7.5 days. Postimplant retention and length of any dysuria were not found to be related to any of the analyzed factors. Severity of dysuria was found to be related only to timing of external beam. Postimplant retention was more frequent for some physicians, but this finding was not statistically significant. Prostate HDR brachytherapy can be delivered safely and effectively in an ambulatory free-standing cancer center setting when done by a urology and radiation oncology team working in close conjunction. Treatment combining HDR brachytherapy as described with external beam radiation, with or without androgen manipulation, is well tolerated by the patient.

Relationship between site and size of bladder endometriotic nodules and severity of dysuria

Study objective The purpose of this study was to evaluate the relationship between frequency/severity of dysuria with anatomic location and diameter of bladder endometriotic lesions. Design Retrospective analysis (Canadian Task Force classification II-3). Setting Tertiary care university hospital. Patients Forty-one patients with bladder endometriosis (endometrial glands and stroma microscopically diagnosed to infiltrate the muscularis propria). Interventions Laparoscopic partial cystectomy, preoperative scoring of dysuria using 10-point verbal analog scale (VAS). Measurements and main results Records of all patients with bladder endometriosis were assessed for frequency/severity of preoperative dysuria, anatomic location (base or dome), and diameter of bladder endometriotic nodule. Basal bladder lesions were observed in 18 (43.9%) of 41 patients versus 23 (56.1%) of 41 in the dome. Of the patients with basal lesions, 14 (77.8%) of 18 had preoperative dysuria versus 8 (34.8%) of 23 with dome lesions. Mean VAS score was 8.5 ± 2.37 and 5.75 ± 1.91 for base and dome lesions, respectively. Preoperative dysuria was found in 22 (53.7%) of 41 patients. Mean lesion diameter in patients with dysuria was 25.0 ± 12.6 mm versus 16.3 ± 6.8 mm in patients without dysuria. Conclusion Frequency and severity of preoperative dysuria were significantly higher in patients with basal endometriotic nodules. There was a positive correlation between severity of dysuria and lesion diameter.

Brachytherapy‐related dysuria

To evaluate the incidence and temporal resolution of dysuria after permanent prostate brachytherapy, and to identify predictors of brachytherapy-related dysuria. The study included 130 patients with no history of transurethral resection of the prostate before treatment, who had brachytherapy on one of two prospective randomized trials, with explicitly planned and executed urethral-sparing techniques (100-150% minimum peripheral dose) using either 103Pd or 125I for clinical T1c-T2c prostate cancer. The median follow-up was 22.6 months. An alpha-blocker was initiated either prophylactically 2 weeks before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to normal, or withheld until the onset of significant brachytherapy-related urinary morbidity. Dysuria was evaluated on a 0-10 scale, before brachytherapy and then at 1, 3, 6 and 12 months afterward, with a median of four dysuria questionnaires per patient. Clinical, treatment and dosimetric variables evaluated included alpha-blocker, age, IPSS before and the maximum after treatment, prostate volume on ultrasonography, hormonal status, supplemental radiotherapy, isotope, urethral dose, V(100/200), D90, and time to obtaining a normal IPSS. The maximum incidence of dysuria was 85% at 1 month after brachytherapy, with subsequent resolution over time. The use of prophylactic tamsulosin resulted in a statistically lower dysuria severity score (difference of 2.7 vs 4.2, P < 0.005) at 1 month, with no discernible differences at 3, 6, 12 and 18 months. Patients with dysuria had a statistically higher IPSS. The dysuria resolved faster in patients implanted with 103Pd but was unaffected by the use of supplemental radiotherapy and/or androgen deprivation therapy. In multivariate analysis, prophylactic alpha-blockers resulted in statistically lower maximum dysuria scores, while the maximum IPSS after implantation and isotope type (but only at 6 months) were the best predictors of the resolution of dysuria. Dysuria is common after brachytherapy but is typically mild. Prophylactic alpha-blockers gave significantly lower maximum dysuria scores but did not affect the time to the resolution of dysuria. The maximum IPSS after the implant was the best predictor of the resolution of dysuria.

The impact of radiation dose to the urethra on brachytherapy-related dysuria

Purpose To determine the effect of urethral dose on dysuria after permanent prostate brachytherapy. Methods and materials One hundred eight patients without a preimplant history of a transurethral resection underwent brachytherapy on one of two prospective randomized trials for clinical T1c–T2c (2002 AJCC) prostate cancer. Urethral dose was stratified into cohorts of <150% and ⩾150% minimum peripheral dose (mPD) respectively. No patient received prophylactic alpha blockers. The median follow-up was 27.4 months. Dysuria was defined as pain and/or burning on urination and was evaluated on a 0–10 scale. Normalization of dysuria was defined as a return to within 1 point of baseline. Dysuria surveys were obtained before brachytherapy and at 1, 3, 6, and 12 months after implantation. Clinical, treatment, and dosimetric parameters evaluated included urethral dose, age, preimplant International Prostate Symptom Score (I-PSS), ultrasound volume, hormonal status, supplemental XRT, isotope, V 100/200, D 90, the maximum post-implant I-PSS, and the time to I-PSS resolution. Results The incidence of dysuria peaked at 85% one month after brachytherapy with subsequent resolution over time. Radiation dose to the urethra (stratified into cohorts of <150%, and ⩾150% mPD) was not a significant predictor of prevalence, severity, or resolution of dysuria. In a multivariate analysis, isotope predicted for dysuria normalization while preimplant I-PSS and D 90 predicted for maximum dysuria; however, the area under the ROC curve and the Pearson correlation coefficient revealed weak correlations. Conclusions Dysuria is common after brachytherapy, but typically minimal in severity. Urethral doses did not predict for either dysuria severity or normalization. Although preimplant I-PSS was the strongest predictor of maximum dysuria and isotope the best predictor for dysuria normalization, robust predictors for brachytherapy-related dysuria were not identified.

Dysuria after permanent prostate brachytherapy

Purpose: Although numerous prostate cancer quality-of-life studies have been reported, a paucity of data exists regarding brachytherapy-related dysuria. In this study, we evaluated the incidence and temporal resolution of dysuria, along with the influence of multiple treatment, clinical, and dosimetric parameters. Methods and materials: Five hundred eighty-one consecutive patients without a preimplant history of transurethral resection of the prostate underwent brachytherapy between January 1998 and December 2001 for clinical T1c–T3a (1997 AJCC) adenocarcinoma of the prostate gland. The evaluated population consisted of the 546 patients who had completed at least two postimplant dysuria evaluations. The median patient follow-up was 26.4 months. In all patients, α-blocker therapy was initiated before implantation and continued at least until the International Prostate Symptom Score (IPSS) returned to baseline. The frequency of dysuria was assessed on a 1–5 scale using the IPSS scoring criteria. The dysuria severity was scored on a 1–10 scale. The clinical parameters evaluated included age, T stage, preimplant IPSS, ultrasound volume, and elapsed time since implantation. The treatment parameters included the use of neoadjuvant hormonal manipulation, use of supplemental external beam radiotherapy, isotope, and total implanted seed strength. The dosimetric parameters included values of the minimal dose received by 90% of the prostate, the percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed minimal peripheral dose, and the median and maximal urethral doses. Results: The incidence of dysuria peaked at 52% 1 month after implantation. The median dysuria frequency score was 0 of 5 for all patients and 2 of 5 for those reporting dysuria. The median severity score was 0 of 10 for the entire cohort and 3 of 10 for those reporting dysuria. For the entire group, both the frequency and the severity of dysuria steadily improved with time, with near complete resolution of dysuria at 45 months. For those patients reporting dysuria, neither the frequency nor the severity revealed any durable improvement for approximately 36 months. Patients with dysuria displayed higher postimplant IPSSs. Of the 7 IPSS questions, nocturia and incomplete voiding were the best surrogates for dysuria. The isotope, supplemental external beam radiotherapy, hormonal status, minimal dose received by 90% of the prostate, and urethral dose did not predict for dysuria. Conclusion: After permanent prostate brachytherapy, dysuria is a relatively common event, but only rarely severe in frequency or intensity. At approximately 45 months after brachytherapy, dysuria appears to resolve in almost all patients.

Placebo-Controlled Evaluation of the Efficacy and Tolerability of Permixon® in Benign Prostatic Hyperplasia after Exclusion of Placebo Responders

A double-blind placebo-controlled multicentre study was conducted to assess the efficacy and tolerability of the 5α-reductase inhibitor Permixon® in patients with symptomatic benign prostatic hyperplasia (BPH) who had previously been shown to be unresponsive to the placebo effect. Following a 30-day single-blind placebo run-in period, 176 nonresponders to placebo (those patients showing <30% improvement in peak urinary flow rate) were randomised to double-blind oral treatment with Permixon® 160mg twice daily or matching placebo for 30 days. Improvement in dysuria severity was seen in a significantly greater proportion ofPermixon® recipients (31.3%) than placebo recipients (16.1%). Daytime urinary frequency fell significantly in Permixon®-treated patients (11.3% reduction), but was unchanged in placebo recipients. Nocturnal urinary frequency fell to a significantly greater extent with Permixon® (32.5% reduction) than with placebo (17.7% reduction). Permixon® produced a significantly greater increase in mean peak urinary flow rate than did placebo (28.9 vs 8.5%). The global efficacy of Permixon® was judged by the patients and physicians to be satisfactory or better in 71.3 and 56.6% of cases, respectively; corresponding values for placebo were 67.5 and 47.2%, respectively. The overall tolerability of Permixon® was comparable to that of placebo. In conclusion, Permixon® appears to be significantly more effective than placebo and well tolerated in the short term treatment of mild to moderate symptomatic BPH.

JCPTGP: from the other side of the fence.

Two years after a microbiological study of the uretbral 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 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 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 are a 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 recognise the psychosomatic aspect of the problem. Introduction While studying the urethral along traditional microbio? logical lines we noticed that it was a short self limiting illness; and that general practitioners were able to predict, before a midstream urine specimen was analysed, which patients had conventional urinary tract infection and which had the urethral as evidenced by their antibiotic prescribing. Doctors seemed to be able to distinguish between the two conditions from the severity of dysuria and on the psychological make up of the patient. Patients with the urethral were more likely to present with frequency only than women with urinary tract infection and also presented more psychological illness to their general practitioners than the women with urinary tract infection or control patients matched for age and sex. Furthermore, patients who suffered from the urethral had made regular visits to the doctor before the study with urinary symptoms, but in a median observation period of 12 months after the study none had consulted with the urethral syndrome. We were sufficiently puzzled by these observations to investigate whether something had happened as a result of the research encounter(s) which altered the subsequent pattern of consulting the doctor for urinary problems in women with the urethral syndrome. The investigation was designed to measure: (a) if these patients had any further urinary symptoms; (ft) if they had symptoms that they were now able to manage on their own; (c) if they had had symptoms but had been reassured by the time spent and the thoroughness of the investigation; and ( investigations frightened them away. We also wondered if the fall off in consultations for urinary S^^iZZ BRITIS IAL JORNAL OLm 292 4 jANUARY 1986 31 Symptoms was more generalised or if patients had focused on another part or parts of their bodies and thus began to present with other psychosomatic symptoms. study sample !n=39) using in depth interviewing to explore the women's perceptions of their symptoms, the possible causes, the problems it created in their lives, and their reactions to the research investigations. For the main practice population ;n-40j were sent a letter explaining the purpose of the studv and requesting permission to visit. Both groups were interviewed at home iRPi using a semistructured schedule. The interview was lape i 97% > of the women with the urethral had presented with lower mltclH^During tha^amu^ir 'su ?23% ?O?ll, had more relationship problems (p--0 011, and wiih Ihc ureihral focused on another area of their bodies.