Urethral Inflammation Research Articles

Advances in the Understanding and Treatment of Male Urethritis.

Neisseria gonorrhoeae and Chlamydia trachomatis are well-documented urethral pathogens, and the literature supporting Mycoplasma genitalium as an etiology of urethritis is growing. Trichomonas vaginalis and viral pathogens (herpes simplex virus types 1 and 2 and adenovirus) can cause urethritis, particularly in specific subpopulations. New data are emerging regarding the potential role of bacterial vaginosis-associated bacteria in urethritis, although results are inconsistent regarding the pathogenic role of Ureaplasma urealyticum in men. Mycoplasma hominis and Ureaplasma parvum do not appear to be pathogens. Men with suspected urethritis should undergo evaluation to confirm urethral inflammation and etiologic cause. Although nucleic acid amplification testing would detect N. gonorrhoeae and C. trachomatis (or T. vaginalis if utilized), there is no US Food and Drug Administration-approved clinical test for M. genitalium available in the United States at this time. The varied etiologies of urethritis and lack of diagnostic options for some organisms present treatment challenges in the clinical setting.

Effects of Urethral Stricture on Allografts in Kidney Transplantation

BackgroundIatrogenic urethral stricture after renal transplantation is mostly seen after urethral manipulations. Early diagnosis and treatment are crucial for the safe continuity of the graft functions. In this study, the effect of urethral strictures on graft functions during the post-transplantation period was investigated. MethodsA total of 477 kidney transplantations were carried out from both live and cadaveric donors in our center from 2004 to 2014. Thirty-two patients who had insufficient data were excluded from the study. All the patients' urine cultures were negative before the surgery, and antibiotic prophylaxis were applied to all. Urethral catheters were taken out 4–7 days after transplantation. Double-J catheters were removed 6 weeks later. Internal urethrotomy and open urethroplasty surgeries were done for the patients who had urethral stricture. The results of creatinine, post-micturitional residual urine (PMR), International Prostate Symptom Score (IPSS), and uroflow examinations were evaluated. ResultsAverage preoperative creatinine and postoperative creatinine values were, respectively, 1.74 ± 0.65 mg/dL (range, 0.83–3.03) and 1.24 ± 0.57 mg/dL (range, 0.9–2.24). A meaningful improvement was observed in terms of preoperative and postoperative IPSS values. A significant difference was seen between preoperative and 6th-month postoperative PMR values: 192.6 ± 57.2 mL and 36.7 ± 17.4 mL, respectively. ConclusionsUrethral strictures in transplant patients may arise due to many factors, such as repetitive urethral catheterization and inflammation. Early diagnosis helps to have better results for the treatment of the kidney functions.

Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis

ObjectivesGram-stained urethral smear (GSUS), the standard point-of-care test for non-gonococcal urethritis (NGU) is operator dependent and poorly specific. The performance of rapid automated urine flow cytometry (AUFC) of first void...

Management of Long-Segment and Panurethral Stricture Disease.

Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.

Where Do Patients Go for Treatment of Urethritis?

Background:Urethritis is characterized by urethral inflammation, and it can result from both infectious and noninfectious conditions. Physicians and other health care providers play a critical role in preventing and treating urethritis.Objectives:The aim of this study was to describe and identify predictors of health care seeking behavior among men with urethritis.Patients and Methods:In total, 98 male patients aged between 16 to 52 years-of-age (mean 30.9 ± 8.0 years), who attended our clinic with symptoms of urethritis, were included in the study. We conducted face-to-face interviews with the patients using a 9-item survey questionnaire. Patients were divided into three groups according to their level of education as follows: group I (n = 44), elementary school; group II (n = 38), high school; and group III (n = 16), university.Results:Among the 98 patients evaluated, the source of treatment was physicians in 44 patients (44.9%), drugstores in 38 cases (38.77%), and friends in 16 patients (16.32%). There was a statistically significant difference found between the groups according to the source of treatment (P < 0.001). The most common factors associated with seeking care from other sources, rather than physicians, were economic reasons in 19 patients (35.18%), confidentiality concerns in 24 (44.4%), and ease of access in 11 patients (20.37%).Conclusions:A substantial proportion of patients with urethritis sought help from other sources, rather than physicians. The results of our study show that the patients with higher levels of education were more likely to seek help from health care services. It is important to promote the public’s knowledge through informative studies and educational materials in order to encourage patients to seek rapid and effective treatment from proper sources.

Urethral inflammation in male chimpanzees caused by ureaplasmas and Chlamydia trachomatis

Specimens from men with acute non-gonococcal urethritis were tested to determine their microbial content and then given intra-urethrally to male chimpanzees. Two animals received ureaplasmas only and one became infected. The second did so when given a different strain. Both developed a polymorphonuclear leukocyte (PMNL) response. Two chimpanzees received a mixture of ureaplasmas and Chlamydia trachomatis and there was a suggestion that the ureaplasmas delayed or suppressed the chlamydial response. The latter, that is urethral infection with a pronounced PMNL response, was most clearly seen in a chimpanzee given C. trachomatis only. No inflammation was detected in two chimpanzees acting as controls. Three of five chimpanzees given ureaplasmas genitally, and one that had them endogenously, had them transiently in the oropharynx about 2 weeks later. The occurrence of ureaplasmas in the conjunctiva of three chimpanzees inoculated at this site was also transient and without inflammation. The possibility that Mycoplasma genitalium might have been in the inocula and caused urethral inflammation was discounted largely because no animal had antibody to this mycoplasma.

Demographic, Behavioral, and Clinical Characteristics of Men With Nongonococcal Urethritis Differ by Etiology: A Case-Comparison Study

Nongonococcal urethritis (NGU) is common, yet up to 50% of cases have no defined etiology. The extent to which risk profiles and clinical presentations of pathogen-associated and idiopathic cases differ is largely unknown. Urethral swabs and urine specimens were collected from 370 NGU treatment trial participants who sought care at a sexually transmitted disease clinic in Seattle, WA from 2007 to 2009 and had a visible urethral discharge and/or microscopic evidence of urethral inflammation assessed by Gram-stain (≥5 polymorphonuclear leukocytes per high-powered field [PMNs/HPF]). Neisseria gonorrhoeae, Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), and Ureaplasma urealyticum (UU) were detected in urine, using nucleic acid amplification tests. Cases negative for all assessed pathogens were considered idiopathic. Bivariate and multivariate analyses identified clinical, sociodemographic, and behavioral factors associated with detection of specific pathogens. After excluding 3 participants with gonococcal infection, pathogens were detected in only 50.7% of the 367 eligible cases: CT in 22.3%, MG in 12.5%, TV in 2.5%, and UU in 24.0%, with multiple pathogens detected in 9.5%. In all, 3.5% of cases were negative for CT, MG, and TV but lacked speciated ureaplasma results. The remaining cases (45.8%) were considered idiopathic. Pathogen detection was associated with young age, black race, risky sexual behaviors, cloudy or purulent discharge, and visible discharge plus≥5 PMNs/HPF. In contrast, idiopathic cases were more likely to report prior NGU, were older and less likely to be black, or have an abnormal urethral discharge on examination, compared to all other cases. These cases were not associated with any high risk behaviors. NGU is a heterogeneous condition. Pathogen detection was associated with a variety of traditional risk factors and clinical features; whereas, idiopathic cases tended to be diagnosed among lower-risk men.

Characteristic male urine microbiomes associate with asymptomatic sexually transmitted infection.

BackgroundThe microbiome of the male urogenital tract is poorly described but it has been suggested that bacterial colonization of the male urethra might impact risk of sexually transmitted infection (STI). Previous cultivation-dependent studies showed that a variety of non-pathogenic bacteria colonize the urethra but did not thoroughly characterize these microbiomes or establish links between the compositions of urethral microbiomes and STI.Methodology/FindingsHere, we used 16S rRNA PCR and sequencing to identify bacteria in urine specimens collected from men who lacked symptoms of urethral inflammation but who differed in status for STI. All of the urine samples contained multiple bacterial genera and many contained taxa that colonize the human vagina. Uncultivated bacteria associated with female genital tract pathology were abundant in specimens from men who had STI.ConclusionsUrine microbiomes from men with STI were dominated by fastidious, anaerobic and uncultivated bacteria. The same taxa were rare in STI negative individuals. Our findings suggest that the composition of male urine microbiomes is related to STI.

Longterm Follow-Up of Idiopathic Urethritis

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.

Azithromycin treatment for nongonococcal urethritis negative for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum

Some patients with nongonococcal urethritis (NGU) are negative for Chlamydia trachomatis, mycoplasmas, and ureaplasmas. The optimal antimicrobial chemotherapy for such NGU has not fully been clarified. We assessed the efficacy of azithromycin for treatment of nonmycoplasmal, nonureaplasmal, nonchlamydial NGU (NMNUNCNGU). Thirty-eight men whose first-pass urine was negative for Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were treated with a single dose of 1 g azithromycin. Urethritis symptoms and polymorphonuclear leukocytes in urethral smears or in first-pass urine were assessed before and after treatment with azithromycin. Thirty-two (84.2%) of the 38 men with NMNUNCNGU showed no signs of urethral inflammation after treatment. The efficacy of this azithromycin regimen was comparable to that of the 7-day regimen of levofloxacin, gatifloxacin, minocycline, or clarithromycin reported previously. A single dose of 1 g azithromycin, which is effective not only for NGU due to specific pathogens but also for NMNUNCNGU, is an appropriate treatment for NGU.

Mycoplasma genitalium in women with lower genital tract inflammation

Objectives:To examine the prevalence of Mycoplasma genitalium in a large number of female patients attending a sexually transmitted infections (STI) clinic and to determine if there is an association with...

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Burden of CAUTIsa. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter.b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay.c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ.2. Outcomes associated with CAUTIa. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients.b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial.c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.

Antibiotic treatment of symptomatic Mycoplasma genitalium infection in Scandinavia: a controlled clinical trial

Objectives:To evaluate the microbiological cure rate after treatment with tetracyclines or azithromycin in patients infected with M genitalium.Methods:One hundred and fifty-two men and 60 women positive for M genitalium were...

Application of Dorsal Preputial Island Flap in Meatoplasty

Introduction and Objectives: Meatal stenosis usually presents in adults with a history of urethral trauma or inflammation or as a complication after hypospadias repair. The objective of this study is to present the correction of meatal stenosis using a preputial island flap, created on the dorsal surface of the penis. Methods: During the last 3 years 12 patients were subjected to meatoplasty using a preputial flap. A meatotomy was performed and a preputial island flap was raised on the dorsal surface of the penis, that was brought to the ventral surface and anastomosed to the opened fossa navicularis. Results: Mean follow-up is 22.3 (range 6–40) months and urethral meatus remains normal with good caliber in routine examination mainly with dilators and uroflowmetry. Conclusions: The described method was based on the on-lay preputial island flap procedure (Duckett’s method) for correction of anterior hypospadias. The cosmetic result is excellent and normal penile morphology and function are well preserved.

Treatment of men with urethritis negative for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum

Some patients with symptomatic non-gonococcal urethritis (NGU) are negative for Chlamydia trachomatis, mycoplasmas and ureaplasmas. The optimal antimicrobial chemotherapy for such NGU has not fully been elucidated, though many studies of antimicrobial chemotherapies for C. trachomatis-positive NGU have been performed. We assessed the efficacy of antimicrobial agents that are active against C. trachomatis on non-mycoplasmal, non-ureaplasmal and non-chlamydial NGU (NMNUNCNGU). One hundred men whose first-pass urine samples were negative for C. trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were treated with levofloxacin, gatifloxacin, minocycline, or clarithromycin for 7 days. Urethritis symptoms and the presence of polymorphonuclear leukocytes (PMNL) in urethral smears were assessed before and after treatment. Eighty-eight (88.0%) of 100 men with NMNUNCNGU showed no signs of urethral inflammation after treatment, but two men complained of some symptoms of urethritis. Twelve (12.0%) of 100 men had significant numbers of PMNL in urethral smears, but five of these 12 men had no symptoms of urethritis. The efficacy for normalization of urethral smears was 90.7% for clarithromycin, 89.7% for levofloxacin, 87.5% for gatifloxacin, and 75.0% for minocycline. The 12 men who showed signs of urethral inflammation were retreated with levofloxacin, gatifloxacin, minocycline or clarithromycin for an additional 7 days. The 10 men who returned after the second treatment had negative urethral smears. Our present findings suggest that antimicrobial agents active against C. trachomatis are effective against NMNUNCNGU and that a 7-day treatment regimen with an appropriate antimicrobial agent may be sufficient to manage patients with NMNUNCNGU.

Syringocele as an etiology of idiopathic urethritis in childhood

Purpose Congenital syringocele is a rare deformity of the male urethra that is a cystic dilatation of Cowper's gland ducts, frecuently asymptomatic, but that can be a possible cause of voiding disorders. We postulate that syringocele can be a cause of idiopathic urethritis in prepubertal boys. Material and methods The records of 14 consecutive boys with idiopathic urethritis were retrospectively reviewed for information regarding age, sympthoms, endoscopic data and resolution rate. Evaluation included history and physical examination, urinalysis and urine culture, renal and bladder ultrasound, electromiogram-uroflow/post-void residual volume and urethrocystoscopy. Two cases of syringocele with urethrorrhagia are included. Diagnosis was made with urethrocystoscopy. Treatment included prophylactic antibiotics and non-steroidal antiiflamatories in group A (12 patients with idiopathic urethritis) and LUT rehabilitation in the group B (2 patients with urethritis and syringocele). Results Mean age of presentation of idiopatic urethrorrhagia was 11,2 years. Sympthoms included: urethrorrhagia in 100% and dysuria in 33,3% in group 1 and urethrorrhagia and symptoms of LUT in 100% in group 2. Cystoscopy revealed bulbar urethral inflammation and hypervascularisation without urethral stricture in all 14 cases. In the boys of group B cystoscopy revealed a perforated syringocele allowing reflux to the bulbourethral gland. A total of 14 patients had a full response to treatment. It took an average of 14,5 months to respond in group A. Rehabilitation of LUT helps to resolve urethritis on average of 6,2 months in group B. Conclusions Congenital syringocele can be a cause of idiopathic urethritis in children as a manifestation of malfunction of LUT. Urethrocystoscopy still has a role in the diagnosis of children with idiopathic urethrorrhagia.

Is there a role for leucocyte esterase testing in non-invasive screening using nucleic acid amplification tests of asymptomatic men?

With the increasing pressure to achieve the government's 48 hour access target for departments of genitourinary (GU) medicine better utilization of resources must be part of the solution. The leucocyte esterase (LE) test has been shown to perform as well as a urethral smear in asymptomatic men in identifying chlamydia-positive individuals and is likely to perform better in detecting genitalium-positive individuals than chlamydia-positive men. The LE test, which is both inexpensive and non-invasive, offers an interim, evidence-based, solution to the issue of whether asymptomatic men attending departments of GU medicine should be screened for the presence of urethral inflammation.

Fulminant Hepatic Failure due to Herpes Simplex Virus in a Previously Healthy Woman

Hepatitis due to herpes simplex virus in immunocompetent adults is a rare and rapidly fatal disease that presents an urgent diagnostic challenge. With few distinguishing clinical features, herpes simplex hepatitis is seldom considered in the differential diagnosis of acute hepatitis; yet case reports suggest that early diagnosis and prompt initiation of antiviral therapy may halt the typical progression to hepatic failure and death. A case of herpes simplex hepatitis leading to fulminant hepatic failure and death within 48 hours of admission in a previously healthy young woman is presented and compared with previously reported cases. Review of known cases occurring in healthy adults suggests that fever, leukopenia, and elevated transaminases, often with thrombocytopenia or evidence of oral, urethral, or vaginal inflammation, should prompt a high clinical suspicion for herpes simplex hepatitis because typical herpetic mucocutaneous lesions are uncommon. Liver biopsy appears to be the most successful means of antemortem diagnosis. Early therapy with acyclovir may be of benefit in this frequently mortal disease.

Quantifying leukocytes in first catch urine provides new insights into our understanding of symptomatic and asymptomatic urethritis

We quantitatively investigated inflammatory cells in the male urethra. Leukocytes in the first catch urine (FCU) from 87 men with and without urethritis were quantitated using haemocytometer counts and stained with an anti-CD45 pan-leukocyte antibody. An increased number of leukocytes in FCU specimens was associated with urethritis (P > 0.002), the presence of discharge and/or dysuria (P < 0.001), and detection of Chlamydia trachomatis (P < 0.001) and Neisseria gonorrhoeae (P < 0.001). In men with urethritis, higher leukocyte counts were also observed in the above groups (P = 0.07, 0.03 and P < 0.0001, respectively). As leukocyte number increased, the likelihood of detecting either pathogen increased. This study suggests that symptoms and signs are a surrogate marker for the degree of inflammation present, and that as urethral inflammation increases, the likelihood of detecting a sexually transmitted pathogen also increases. This would explain why men with asymptomatic urethritis are less likely to have a sexually transmitted infection detected than those with discharge and/or dysuria.

Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study.

We examine whether leukocytes and bacteria correlate with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome. All 488 men screened into the National Institutes of Health Chronic Prostatitis Cohort Study before close of recruitment on August 22, 2001 were selected for analysis. The National Institutes of Health Chronic Prostatitis Symptom Index, including subscores, were used to measure symptoms. Urethral inflammation was defined as white blood cell (WBC) counts of 1 or more (1+) in the first voided urine. Participants were classified as category IIIa based on WBC counts of 5 or more, or 10 or more (5+, 10+) in the expressed prostatic secretion, or 1+ or 5+ either in the post-expressed prostatic secretion urine (voided urine 3) or semen. Uropathogens were classified as localizing if the designated bacterial species were absent in voided urine 1 and voided urine 2 but present in expressed prostatic secretion, voided urine 3 or semen, or present in expressed prostatic secretion, voided urine 3 or semen at 2 log concentrations higher than at voided urine 1 or 2. Associations between symptoms, and inflammation and infection were investigated using generalized Mantel-Haenszel methods. Of all participants 50% had urethral leukocytes and of 397 with expressed prostatic secretion samples 194 (49%) and 122 (31%) had 5+ or 10+ WBCs in expressed prostatic secretion, respectively. The prevalence of category IIIa ranged from 90% to 54%, depending on the composite set of cut points. None of the index measures were statistically different (p >0.10) for selected leukocytosis subgroups. Based on prostate and semen cultures, 37 of 488 men (8%) had at least 1 localizing uropathogen. None of the index measures were statistically different (p >0.10) for selected bacterial culture subgroups. Although men with chronic prostatitis routinely receive anti-inflammatory and antimicrobial therapy, we found that leukocytes and bacterial counts as we defined them do not correlate with severity of symptoms. These findings suggest that factors other than leukocytes and bacteria also contribute to symptoms associated with chronic pelvic pain syndrome.