New Approaches in the Study of the Pathogenesis of Urethral Pain Syndrome

Abstract

Introduction: Urethral pain syndrome (UPS) is still a pathology in which the diagnosis is formulated as a “diagnosis of exclusion”. The exact pathogenetic mechanisms are not yet fully understood and clear recommendations for the prevention and treatment of UPS are absent. Methods and Participants: A clinical and laboratory evaluation of 55 patients with established UPS included history taking, basic laboratory tests (e.g., complete blood count and clinical urine test), physical examination, uroflowmetry, and cystourethroscopy. Additionally, transvaginal ultrasound (TVUS) with compression elastography and cross-polarization optical tomography (CP OCT) were performed in 24 and 33 patients with UPS, respectively. The control group consisted of 14 patients with no complaints from the urinary system. Results: TVUS showed an expansion in the diameter of the internal lumen of the urethra, especially in the proximal region compared with the norm. Compression elastography revealed areas with increased stiffness (presence of fibrosis) in urethral and surrounding tissues. The performed CP OCT study showed that in UPS, the structure of the tissues in most cases was changed: trophic alterations in the epithelium (hypertrophy or atrophy) and fibrosis of underlying connective tissue were observed. The proximal fragment of the urethra with UPS underwent changes identical to those of the bladder neck. Conclusion: This paper showed that the introduction of new technology—CP OCT—in conjunction with TVUS will allow verification of structural changes in tissues of the lower urinary tract at the level of their architectonics and will help doctors understand better the basics of the UPS pathogenesis.

Optical Diagnostics in Human Diseases

“…The article by Streltsova and colleagues is dedicated to the targeted study of female urethral tissues (their elasticity and the condition of the epithelial and connective tissue layers) in urethral pain syndrome (UPS). The results showed that the introduction of new CP OCT technology in conjunction with transvaginal compression ultrasound will allow for in vivo verification of structural changes in lower urinary tract tissues at their architectonics level and will provide more information about basic elements of the UPS pathogenesis [ 5 ].…”

Features of blood supply of urethral tissues in women with primary urethral pain syndrome

“…Вторым фактором, влияющим на тонус сосудов и на состояние слизистой оболочки уретры, является гуморальный [20,21]. Ранее методом КП ОКТ в нашей работе [22] было показано, что изменения эпителия в шейке МП и уретре (гиперплазия или атрофия) зависят от гормонального фона женщин: у женщин репродуктивного возраста встречаются в 44,4% случаев, в постменопаузальном периоде -в 93,3% наблюдений.…”

Urethral Pain Syndrome: Treatment with Oxygen and Hyaluronic Acid

“…The rational of UPS treatment hypothesis with Caressflow® (Caress Flow Srl, Bologna, Italy) is substantiated by the clinical study of Streltsova et al [26]: Accordingly with her observation, the urethra and the bladder are embryologically and physiologically joined in "the painful bladder syndrome" [27] and the common connective tissue matrix of both the structures with its protective and trophic functions, displays a mechanosensitive signalling system [28], [29] and might be responsible of the disease. The authors in their utmost interesting paper describe also the routinary diagnostic methods, such as ultrasound (US) and uroflowmetry, but also US elastography and cross-polarization optical tomography (CP OCT); the last one seems be the most appealing method to detect UPS, on an investigational basis, being able to explain the fine neurovascular disorder of urethra [30], [31], [32], [33], [34].…”

“…The authors in their utmost interesting paper describe also the routinary diagnostic methods, such as ultrasound (US) and uroflowmetry, but also US elastography and cross-polarization optical tomography (CP OCT); the last one seems be the most appealing method to detect UPS, on an investigational basis, being able to explain the fine neurovascular disorder of urethra [30], [31], [32], [33], [34]. Streltsova et al compared transvaginal US (TVUS) with compression elastography and CP OCT in 55 patients with UPS against 14 control healthy patients [26]. TVUS showed enlargement of the internal lumen of the upper third of the urethra.…”

“…The proximal urethra of UPS and the bladder neck above showed overlapping pathological changes. Oxygen together with HA is supposed to relieve the UPS symptoms acting specifically on the soft-tissue matrix, and carefully also stimulating the urethra channel with the gas flow, to help it to increase the tone and reduce its enlarged diameter [26].…”