Treatment of Urethral Pain Syndrome (UPS) in Sweden

Autoři: Lina Birgitta Ivarsson aff001;  Björn Erik Lindström aff001;  Matts Olovsson aff001;  Annika Kristina Lindström aff001
Působiště autorů: Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden aff001;  Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden aff002;  Clinical Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225404



Urethral Pain Syndrome (UPS) in women is a recurrent urethral pain without any proven infection or other obvious pathology. There are few studies on UPS, and evidence-based treatment is lacking. The primary aim was to study what treatments are used, and to compare the treatment tradition of UPS in Sweden in 2018, with what was used in 2006.


A questionnaire on the treatment of women with UPS was sent to all public gynecology, urology, gynecologic oncology and venereology clinics, and one public general practice in each county in Sweden in 2018. Private practice clinics in gynecology responded to the survey in 2017. Comparisons were made with the same survey sent to gynecology and urology clinics in 2006.


Of 137 invited clinics in 2018, 99 (72.3%) responded to the survey. Seventy-seven (77.8%) of them saw women with UPS and 79.2% (61/77) of these clinics treated the patients using 19 different treatment methods. Local corticosteroids and local estrogens were the methods most used. Treatments were similar in gynecology and urology clinics in 2006 and 2018, although strong corticosteroids had increased in use in the treatment regimens of 2018. More than half of the clinics used antibiotics.


Since there is no evidence-based treatment of UPS, a wide spectrum of treatments is used, and different specialties use different treatment strategies. Despite the lack of proven infection, a large number of clinics also treated the syndrome with antibiotics. There is thus a need for well-designed randomized controlled clinical trials to find evidence-based treatments of UPS.

Klíčová slova:

Antibiotics – Cancer treatment – Estrogens – Obstetrics and gynecology – Oncology – Silver – Sweden – Urology


1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol. 2002;187(1):116–26. Epub 2002/07/13. doi: 10.1067/mob.2002.125704 12114899.

2. Gallagher DJ, Montgomerie JZ, North JD. Acute Infections of the Urinary Tract and the Urethral Syndrome in General Practice. Br Med J. 1965;1(5435):622–6. Epub 1965/03/06. Gallagher DJ, Montgomerie JZ, North JD,

3. Youngblood VH, Tomlin EM, Davis JB. Senile urethritis in women. J Urol. 1957;78(2):150–2. Epub 1957/08/01. Youngblood VH, Tomlin EM, Davis JB,


5. Phillip H, Okewole I, Chilaka V. Enigma of urethral pain syndrome: why are there so many ascribed etiologies and therapeutic approaches? Int J Urol. 2014;21(6):544–8. doi: 10.1111/iju.12396 24447292.

6. Chowdhury ML J N, Ghoniem Gamal M. Urethral Pain Syndrome: A Systematic Review. Current Bladder Dysfunction Reports. 2019. Epub 16 April 2019. doi: 10.1007/s11884-019-00509-8

7. Baldoni F, Baldaro B, Ercolani M, Emili E, Trombini G. Urethral syndrome: a study in psychosomatic urology. Psychother Psychosom. 1989;52(1–3):114–8. Epub 1989/01/01. Baldoni F, Baldaro B, Ercolani M, Emili E, Trombini G,

8. Baldoni F, Ercolani M, Baldaro B, Trombini G. Stressful events and psychological symptoms in patients with functional urinary disorders. Percept Mot Skills. 1995;80(2):605–6. Epub 1995/04/01. Baldoni F, Ercolani M, Baldaro B, Trombini G,

9. Hamilton-Miller JM. The urethral syndrome and its management. J Antimicrob Chemother. 1994;33 Suppl A:63–73. Hamilton-Miller JM,

10. Dreger NM, Degener S, Roth S, Brandt AS, Lazica DA. [Urethral pain syndrome: fact or fiction—an update]. Urologe A. 2015;54(9):1248–55. doi: 10.1007/s00120-015-3926-9 26337167.

11. Gittes RF, Nakamura RM. Female urethral syndrome. A female prostatitis? West J Med. 1996;164(5):435–8. Epub 1996/05/01. Gittes RF, Nakamura RM, 8686301

12. Parsons CL. The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain. BJU Int. 107(3):370–5. Epub 2010/12/24. doi: 10.1111/j.1464-410X.2010.09843.x 21176078.

13. Kaur H, Arunkalaivanan AS. Urethral pain syndrome and its management. Obstet Gynecol Surv. 2007;62(5):348–51; quiz 53–4. Epub 2007/04/12. doi: 10.1097/01.ogx.0000261645.12099.2a 17425813.

14. Lindstrom BE, Hellberg D, Lindstrom AK. Urethral instillations of clobetasol propionate and lidocaine: a promising treatment of urethral pain syndrome. Clin Exp Obstet Gynecol. 2016;43(6):803–7. Epub 2016/01/01. Lindstrom BE, Hellberg D, Lindstrom AK, 29944227

15. Yoon SM, Jung JK, Lee SB, Lee T. Treatment of female urethral syndrome refractory to antibiotics. Yonsei Med J. 2002;43(5):644–51. Epub 2002/10/29. doi: 10.3349/ymj.2002.43.5.644 12402379.

16. Bazi T, Abou-Ghannam G, Khauli R. Female urethral dilation. Int Urogynecol J. 2013;24(9):1435–44. Epub 2013/02/15. doi: 10.1007/s00192-013-2055-5 23408001.

17. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229–41. Epub 2014/12/02. doi: 10.1177/2042098614554919 25436105.

18. Nilsson S. [Local treatment of female urethritis]. Lakartidningen. 1971;68(6):581–4. Epub 1971/02/03. Nilsson S, 5101471

19. Nilsson K, Heimer G. Low-dose oestradiol in the treatment of urogenital oestrogen deficiency—a pharmacokinetic and pharmacodynamic study. Maturitas. 1992;15(2):121–7. Epub 1992/10/01. Nilsson K, Heimer G,

20. Robinson D, Cardozo L. Estrogens and the lower urinary tract. Neurourol Urodyn. 2011;30(5):754–7. Epub 2011/06/11. doi: 10.1002/nau.21106 21661025.

21. Parziani S, Costantini E, Petroni PA, Ursini M, Porena M. Urethral syndrome: clinical results with antibiotics alone or combined with estrogen. Eur Urol. 1994;26(2):115–9. Epub 1994/01/01. Parziani S, Costantini E, Petroni PA, Ursini M, Porena M,

22. Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10:CD001405. Epub 2012/10/19. doi: 10.1002/14651858.CD001405.pub3 23076892.

23. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008;(2):CD005131. Epub 2008/04/22. doi: 10.1002/14651858.CD005131.pub2 18425910.

24. Scotti RJ, Ostergard DR. The urethral syndrome. Clin Obstet Gynecol. 1984;27(2):515–29. Epub 1984/06/01. Scotti RJ, Ostergard DR,

25. Bergman A, Karram M, Bhatia NN. Urethral syndrome. A comparison of different treatment modalities. J Reprod Med. 1989;34(2):157–60. Epub 1989/02/01. Bergman A, Karram M, Bhatia NN, 2926732

26. Parsons CL. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology. 2005;65(1):45–8. Epub 2005/01/26. doi: 10.1016/j.urology.2004.08.056 15667861.

27. Parsons CL, Koziol JA, Proctor JG, Zupkas P, Argade S. Heparin and alkalinized lidocaine versus alkalinized lidocaine for treatment of interstitial cystitis symptoms. Can J Urol. 2015;22(2):7739–44. Epub 2015/04/22. Parsons CL, Koziol JA, Proctor JG, Zupkas P, Argade S, 25891339

28. Burkhard FC, Blick N, Hochreiter WW, Studer UE. Urinary urgency and frequency, and chronic urethral and/or pelvic pain in females. Can doxycycline help? J Urol. 2004;172(1):232–5. Epub 2004/06/18. doi: 10.1097/01.ju.0000128698.93305.2e 15201781.

29. Kyndel A, Elmer C, Kallman O, Altman D. Mycoplasmataceae Colonizations in Women With Urethral Pain Syndrome: A Case-Control Study. J Low Genit Tract Dis. 2016;20(3):272–4. Epub 2016/05/14. doi: 10.1097/LGT.0000000000000216 27172116.

30. Leite LM, Carvalho AG, Ferreira PL, Pessoa IX, Goncalves DO, Lopes Ade A, et al. Anti-inflammatory properties of doxycycline and minocycline in experimental models: an in vivo and in vitro comparative study. Inflammopharmacology. 2011;19(2):99–110. Epub 2011/02/26. doi: 10.1007/s10787-011-0077-5 21350981.

31. Swamy S, Kupelian AS, Khasriya R, Dharmasena D, Toteva H, Dehpour T, et al. Cross-over data supporting long-term antibiotic treatment in patients with painful lower urinary tract symptoms, pyuria and negative urinalysis. Int Urogynecol J. 2018. Epub 2018/12/20. doi: 10.1007/s00192-018-3846-5 30564872.

32. Sinha S. Commentary on "Cross-over data supporting long-term antibiotic treatment in patients with painful lower urinary tract symptoms, pyuria, and negative urinalysis". Int Urogynecol J. 2019. Epub 2019/02/02. doi: 10.1007/s00192-019-03875-3 30707258.

33. Tuovinen PI, Paalanen A. A colloidal silver chloride solution for bladder instillation. Urol Int. 1961;11:23–32. Epub 1961/01/01. doi: 10.1159/000277529 13778629.

34. Sumners D, Kelsey M, Chait I. Psychological aspects of lower urinary tract infections in women. BMJ. 1992;304(6818):17–9. Epub 1992/01/04. doi: 10.1136/bmj.304.6818.17 1734984.

35. Bernstein AM, Philips HC, Linden W, Fenster H. A psychophysiological evaluation of female urethral syndrome: evidence for a muscular abnormality. J Behav Med. 1992;15(3):299–312. Epub 1992/06/01. Bernstein AM, Philips HC, Linden W, Fenster H,

36. Oyama IA, Rejba A, Lukban JC, Fletcher E, Kellogg-Spadt S, Holzberg AS, et al. Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology. 2004;64(5):862–5. Epub 2004/11/10. doi: 10.1016/j.urology.2004.06.065 15533464.

37. Worz R, Berlin J. [Treatment of chronic pain syndromes with antidepressants.]. Schmerz. 1989;3(1):1–7. Epub 1989/03/01. doi: 10.1007/BF02527466 18415335.

38. van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol. 2004;172(2):533–6. Epub 2004/07/13. doi: 10.1097/01.ju.0000132388.54703.4d 15247722.

39. Haxthausen H. ON THE PENETRATION OF SILVER NITRATE AND OTHER ANTI-GONORRHOEICS: Some Experimental and Clinical Observations on the Value of the Injection Therapy in Gonorrhoeal Urethritis. Br J Vener Dis. 1925;1(4):245–67. Epub 1925/10/01. Haxthausen H,

40. Ingelman-Sundberg A. Urge incontinence in women. Acta Obstet Gynecol Scand. 1975;54(2):153–6. Epub 1975/01/01. Ingelman-Sundberg A,

41. Liu L, Wang X. Electric acupuncture in the treatment of 36 cases of female urethral syndrome. J Tradit Chin Med. 2003;23(4):284–5. Epub 2004/01/15. Liu L, Wang X, 14719301

42. Zheng H, Wang S, Shang J, Chen G, Huang C, Hong H, et al. Study on acupuncture and moxibustion therapy for female urethral syndrome. J Tradit Chin Med. 1998;18(2):122–7. Epub 1999/08/07. Zheng H, Wang S, Shang J, Chen G, Huang C, Hong H, et al., 10437230

43. King A, Quirouet A, Moore CK. Urologic applications of botulinum toxin. Cleve Clin J Med. 2015;82(7):456–64. Epub 2015/07/18. doi: 10.3949/ccjm.82a.13166 26185945.

44. Kuo YC, Kuo HC. Botulinum toxin injection for lower urinary tract dysfunction. Int J Urol. 2013;20(1):40–55. Epub 2012/05/11. doi: 10.1111/j.1442-2042.2012.03035.x 22571329.

45. Sinha D, Arunkalaivanan A. Urethral syndrome: response to alpha-adrenergic blocking agents. International urogynecology journal and pelvic floor dysfunction. 2006;17(6):659–60. Sinha D, Arunkalaivanan A,

46. Parkes AC, Boreham P. Cryosurgery for the urethral syndrome: preliminary communication. J R Soc Med. 1980;73(6):428–30. Epub 1980/06/01. Parkes AC, Boreham P, 7194918

47. Splatt AJ, Weedon D. The urethral syndrome: experience with the Richardson urethroplasty. Br J Urol. 1977;49(2):173–6. Epub 1977/04/01. doi: 10.1111/j.1464-410x.1977.tb04095.x 870138.

48. Costantini E, Zucchi A, Del Zingaro M, Mearini L. Treatment of urethral syndrome: a prospective randomized study with Nd:YAG laser. Urol Int. 2006;76(2):134–8. Epub 2006/02/24. doi: 10.1159/000090876 16493214.

49. Palleschi G, Carbone A, Ripoli A, Silvestri L, Petrozza V, Zanello PP, et al. A prospective study to evaluate the efficacy of Cistiquer in improving lower urinary tract symptoms in females with urethral syndrome. Minerva Urol Nefrol. 2014;66(4):225–32. Epub 2014/07/19. Palleschi G, Carbone A, Ripoli A, Silvestri L, Petrozza V, Zanello PP, et al., 25034330

Článek vyšel v časopise


2019 Číslo 11