CURRENT ICS DEFINITIONS

URETHRAL PAIN

Subject Author Replies Views Last Message
No Comments


Authors: Jane Meijlink, BA Hons, MCIJ and Sharon Eustice, RN, Bphil, MSc, ALNP

November 2017


CURRENT ICS DEFINITION

Doggweiler et al, 2017
TheICS Standard for Terminology in chronic pelvic pain syndromes working group identified nine domains, each of which were considered in terms of symptoms, signs, and further evaluation. Domain I (Lower Urinary Tract Domain) included the bladder and urethra with the following recommendations for urethral pain (1).

“B. Urethra
Urethral pain is perceived to be in the urethra, usually when voiding, with increased day- and night-time frequency. It may be combined with a feeling of dull pressure, and sometimes radiates toward the groin, sacrum and perineum.1,7 The terms ‘‘chronic urethritis’’ and ‘‘urethral syndrome’’ are no longer recommended.5,23
i. Persistent or recurrent pain.
ii. No history of current infection or other obvious pathology.
iii. May be subsequent to a previous urinary tract infection.”

PREVIOUS ICS DEFINITIONS
Abrams et al, 2002:
Urethral pain is felt in the urethra and the individual indicates the urethra as the site.
Taxonomy: 1. Lower Urinary Tract Symptoms (LUTS), 1.6 Genital and Lower Urinary Tract Pain
and
Urethral pain syndrome is the occurrence of recurrent episodic urethral pain usually on voiding, with daytime frequency and nocturia, in the absence of proven infection or other obvious pathology
Taxonomy: 1. Lower Urinary Tract Symptoms (LUTS), 1.7 Genito-Urinary Pain Syndromes and Symptom Syndromes Suggestive of LUTD.

OTHER DEFINITIONS
INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN (IASP)
GROUP XXIII: CHRONIC PELVIC PAIN SYNDROMES
Urethral Pain Syndrome (XXIII-8)
Urethral pain syndrome is the occurrence of chronic or recurrent episodic pain perceived in the urethra, in the absence of proven infection or other obvious local pathology. Urethral pain syndrome is often associated with negative cognitive, behavioral, sexual or emotional consequences as well as with symptoms suggestive of lower urinary tract, sexual, bowel or gynecological dysfunction. Urethral pain syndrome may occur in men and women (3).

EUROPEAN ASSOCIATION OF UROLOGY (EAU)
3.2.5.4 Urethral Pain Syndrome
Some mechanisms for the development of urethral pain syndrome have been proposed. The intimate relation of the urethra with the bladder (both covered with urothelium) suggests that urethral pain syndrome may be a form of bladder pain syndrome (BPS). Mechanisms thought to be basic for BPS may also apply to the urethra. This means that the specific testing with potassium is used to support the theory of epithelial leakage. Another possible mechanism is neuropathic hypersensitivity following urinary tract infection. The relationship with gynaecological and obstetric aspects is unclear. In a small group of patients with urethral pain, it has been found that grand multiparity and delivery without episiotomy were more often seen in patients with urethral syndrome, using univariate analysis (4).

PERSPECTIVES AND CONTROVERSIES
Urethral pain can be challenging to distinquish from other pain syndromes (5). Therefore obtaining a thorough clinical history is fundamental for targeted therapies. However, unravelling the constellation of symptoms can be subjective and nebulous. For those patients undergoing urodynamic investigations, pinpointing pain can be demonstrated (6).

REFERENCES

  1. 1. Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, Hanno P, Fraser MO, Homma Y, Garrido G, Gomes MJ, Elneil S, van de Merwe JP, Lin AT, Tomoe H. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. 2017 Apr;36(4):984-1008. doi: 10.1002/nau.23072. Epub 2016 Aug 26.
  2. 2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A. Standardisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167-78. (see Abrams et al. 2002).
  3. 3. IASP Classification of Chronic Pain, Second Edition (Revised). Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Available at: https://www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&navItemNumber=677
  4. 4. Engeler D, Baranowski AP, Borovicka J, et al. European Association of Urology Guidelines on Chronic Pelvic Pain. 2016. Page 22. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Chronic-Pelvic-Pain-2016-1.pdf
  5. 5. Cho ST. Is Urethral Pain Syndrome Really Part of Bladder Pain Syndrome?. Urogenit Tract Infect. 2017 Apr;12(1):22-27. https://doi.org/10.14777/uti.2017.12.1.22
  6. 6. Veit-Rubin, N., Cartwright, R., Esmail, A., Digesu, G. A., Fernando, R. and Khullar, V. (2017), The location of pain and urgency sensations during cystometry. Neurourol. Urodynam., 36: 620–625.

Add Discussion