Treatments of Female Urethral Syndrome Refractory to Antibiotics

Lee, Sang Bong; Lee, Tack; Ryu, Ji Kan

Abstract

PURPOSE: The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback with electrical stimulation therapy (EST) in patients who did not respond well to antibiotics.
MATERIALS AND METHODS
One hundred-five patients with a diagnosis of female urethral syndrome were entered in this study. Antibiotics were given as first-line therapy for about 3 months. In cases of recurrent or persistent urethral syndrome, antibiotic therapy combined with external sphincter relaxant or biofeedback with EST were performed. According to video-urodynamic analysis, 31 patients (29.5%) were external sphincter relaxant group who showed functional urethral obstruction and 41 patients (39.5%) were biofeedback with EST group who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire.
RESULTS
Thirty-three patients (31.4%) of all patients (n=105) were terminated with antibiotic therapy alone and 7 (21.2%) patients were recurred. The symptom score changed 10.51 to 2.85. In antibiotics with external sphincter relaxant, the symptom score changed 12.39 to 3.96. In five (16.1%) of them symptoms were recurred and 3 of 5 patients underwent urethral dilatation. In antibiotics with biofeedback, average frequency changed from 12.2 to 7.7 times a day and nocturia changed 2.4 to 0.6 time a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response).
CONCLUSIONS
Biofeedback and external sphincter relaxant therapy as an alternative therapeutic option are effective and appropriate for the treatment of female urethral syndrome especially in patients who did not respond well to antibiotics. For the better outcomes, selection of the most appropriate therapeutic modality with the diagnostic work up is warranted.