The urethral syndrome.

The urethral syndrome remains a diagnosis of exclusion. The obvious difficulty is the lack of overall significance of this problem: patients with urethral syndrome do not die of their disease. More serious causes of urinary frequency, dysuria, and suprapubic discomfort must be excluded. A combination of a careful history, physical examination, inspection of the urine, urine culture, urine cytology, and cystourethroscopy with biopsy will make the diagnosis. One's personal bias about the etiology will often direct the evaluation. Selective usage of suppressive antibiotics along with reassurance and careful follow-up will prove effective in treating these patients. With greater understanding of lower urinary tract infections and the neurologic innervation of the bladder and urethra, it would seem appropriate for us to continue to develop a better understanding of the urethral syndrome, its etiology, and a more effective treatment rationale. A systematic approach must be maintained in the evaluation of these patients so that an appropriate treatment can be devised.