IndicationsRecurrent and postcoital cystitis in women may be caused by pathological or anatomical conditions of the terminal urethra, e.g. urethral stenosis, chronic skeneitis, a urethral diverticulum, retromeatal ring, mucosal hood, hypospadias, or urethrohymenal fusion. The last is a particularly common cause of postcoital cystitis and may be treated successfully by urethrolysis and hymenoplasty [1±8]. Hypospadias, i.e. the presence of the urethral meatus inside the vaginal cavity immediately below the vaginal vestibule (Fig. 1a), can also cause recurrent and postcoital cystitis, through the following two mechanisms: (i) aspiration of pathogenic microorganisms during sexual intercourse, as in the case of vaginohymenal fusion [7±10]; or (ii) the shorter hypospadiac urethra, which favours the passage of microorganisms from the vagina. Often both mechanisms are present. Hypospadias as a cause of recurrent cystitis has been reported and surgically treated [5,9±12]. In the present study, we report the results of treating recurrent cystitis in women with hypospadias by meatal transposition.
MethodsBetween 1987 and 1998, 32 patients (mean age 22 years, range 16±38) were included in the study; they had medium-grade hypospadias, i.e. with the meatus 1±2 cm below the vaginal vestibule, but no stress incontinence. All presented with recurrent bacterial cystitis (more than eight episodes per year) with signi®cant bacteriuria (>10 5 c.f.u./mL). All had been treated with antibiotic therapy, but had not undergone urethral dilatation. Escherichia coli (76%) was by far the most common infection, followed by Klebsiella (12%), Proteus (8%), Enterococcus (2%) and other species (2%). In 60% of the patients the recurrent cystitis was associated with sexual intercourse and recurrent episodes were more frequent during colder weather (October±March).All the patients used the usual techniques for maintaining perineal hygiene, but with little bene®t. Many (75%) followed a regimen of hyperdiuresis (drinking >2.5 L per day) which increased the interval between episodes of cystitis, while each acute episode tended to resolve more rapidly. All the patients who presented with a typical history of postcoital cystitis took antibiotics before and after sexual intercourse as antibacterial prophylaxis, but this affected the appearance and duration of episodes of cystitis in only 30%; 20% of the patients had sporadic vaginal infections and only 10% noted an association between vaginitis and cystitis. The patients complained of the classical symptoms of cystitis, i.e. diurnal and nocturnal frequency, dysuria, urgency, suprapubic pain and sometimes urge incontinence. None of the patients complained of urinary disturbances other than those associated with the episodes of cystitis. Finally, the only anomaly noted was hypospadias; radiological investigations (micturating cystography, IVU), ultrasonography, urodynamics and urethral calibration showed no other possible causes for the cystitis. In particular, incomplete bladder voiding, bladder neck obstr...