Download PDF
Aktuelle Urol 2016; 47(04): 315-320
DOI: 10.1055/s-0042-106662
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Das Urethralsyndrom und urethrale Schmerzen – behandeln wir den Menschen oder die Diagnose?

Urethral Syndrome and Urethral Pain: Do we Treat People or Diagnoses?
R. Doggweiler
1   KontinenzZentrum Hirslanden, Zürich, Schweiz
,
A. Reitz
1   KontinenzZentrum Hirslanden, Zürich, Schweiz
,
R. Kirschner-Hermanns
2   Zentrum für Kontinenz und Neuro-Urologie, Urologische Klinik, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms Universität und neurologisches Rehabilitationszentrum Godeshöhe
› Author Affiliations
Further Information

Publication History

Publication Date:
08 August 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Das Urethralsyndrom mit Schmerzen in der Harnröhre und Blasenentleerungsstörungen ist eine Ausschlussdiagnose. Das Krankheitsbild ist ein Sammelbegriff für organische, funktionelle und entzündliche Harnröhrenerkrankungen unterschiedlichster Ätiologien. Zu den möglichen Ursachen zählen unter anderem Infektionen, Entzündungen der paraurethralen Drüsen, Verspannungen der Sphinkteren und/oder der Beckenbodenmuskulatur, Östrogenmangelerscheinungen, Traumata, Neuropathien, Allergien und psychosomatische Störungen.

Patientinnen mit Urethralsyndrom müssen ganzheitlich betrachtet, abgeklärt und behandelt werden. Während der Abklärung und Behandlung benötigen diese Patientinnen viel Zeit und Aufmerksamkeit. Heute gilt als sicher, dass bei vielen somatischen Leiden psychosoziale Faktoren mitspielen, dass diese den Verlauf der Erkrankung entscheidend beeinflussen können und im Behandlungsprozess berücksichtigt werden müssen.

Abstract

The urethral syndrome with urethral pain and bladder voiding disorders is a diagnosis of exclusion. Possible aetiologies are diverse and include organic, functional and inflammatory pathologies of the urethra. Infections, inflammation of the paraurethral glands, spasms of the sphincter muscle and/or of the pelvic floor muscles, oestrogen deficiency, trauma, neuropathies, hypersensitivity and psychosomatic issues have been investigated as possible causes.

Patients with urethral syndrome must be viewed, evaluated and treated holistically. They need a lot of time and attention during their evaluation and treatment. It is now well known that psychosocial aspects are involved in the development of many somatic conditions and may have a crucial impact on the course of a disease. This needs to be taken into consideration during the treatment process.

Schlüsselwörter

Urethral Schmerzen - Schmerzgedächtnis - Psychosomatisch

Key words

Urethral Pain - Pain Memory - Psychosomatic
 

  • Literatur

  • 1 Doggweiler R, Whitmore K, Nordling J et al. The Standard of Terminology in Chronic Pelvic Pain; Preliminary report from the working group on chronic pelvic pain of the standardization committee of the International Continence Society. 1s World Congress on Abdominal and Pelvic Pain 31.5.–1.6.2013; Amsterdam, NL2013
    PubMedGoogle Scholar
  • 2 Widmer R. Praxiserfahrung zum postkoitalen Urethralsyndrom. Gynäkologie 2005; 5: 18-21
    PubMedGoogle Scholar
  • 3 Dombo O, Otto U. Stress-Inkontinenz beim Mann: Anatomische und funktionelle Besonderheiten. Journal für Urologie und Urogynäkologie 2004; 11: 7-12
    PubMedGoogle Scholar
  • 4 Kim HK, Kang SY, Chung YJ et al. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med 2015; 21: 65-71
    CrossrefPubMedGoogle Scholar
  • 5 Frankl-Hochwart Lv, Zuckerkandl O. Nervöse Erkrankungen der Harnblase. In Nothnagel H. Spezielle Pathologie und Therapie. 2. Aufl Wien: Alfred Hölder; 1898.
    Google Scholar
  • 6 Gunthert EA. Psychosomatic problems in urology. Experiences of a practising urologist (author’s transl). Urologe A 1980; 19: 232-235
    PubMedGoogle Scholar
  • 7 Graziottin A, Gambini D, Bertolasi L. Genital and sexual pain in women. Handb Clin Neurol 2015; 130: 395-412
    PubMedGoogle Scholar
  • 8 Petri E. Erkrankung der weiblichen Harnröhre. 2. Aufl Stuttgart: Thieme; 1996
    Google Scholar
  • 9 Latthe P, Latthe M, Say L et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006; 6: 177
    CrossrefPubMedGoogle Scholar
  • 10 Wesselmann U. Klinik und Pathophysiologie der Schmerzen der Beckenorgane bei der Frau. Schmerz 2002; 16: 467-475
    CrossrefPubMedGoogle Scholar
  • 11 Elsenbruch S, Hauser W, Janig W et al. 2015; 29: 496-502
    PubMed
  • 12 Merskey H, Bogduk N. International Association for the Study of Pain. Task Force on Taxonomy. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2. Aufl Seattle: IASP Press; 1994
    Google Scholar
  • 13 Kürten L. Chronischer Schmerz. In: Froschung BfBu. (Hrsg.). Frechen: Ritterbach Medien GmbH; 2001
    Google Scholar
  • 14 Buddeberg C. Psychosoziale Medizin. 3. Aufl Berlin Heidelberg: Springer-Verlag; 2004
    CrossrefGoogle Scholar
  • 15 Gallagher DJ, Montgomerie JZ, North JD. Acute Infections of the Urinary Tract and the Urethral Syndrome in General Practice. Br med J 1965; 1: 622-626
    CrossrefPubMedGoogle Scholar
  • 16 Gittes RF, Nakamura RM. Female urethral syndrome. A female prostatitis?. West J Med 1996; 164: 435-438
    PubMedGoogle Scholar
  • 17 Bernstein AM, Philips HC, Linden W et al. A psychophysiological evaluation of female urethral syndrome: evidence for a muscular abnormality. J behav med 1992; 15: 299-312
    CrossrefPubMedGoogle Scholar
  • 18 Stamm WE, Wagner KF, Amsel R et al. Causes of the acute urethral syndrome in women. N Engl J Med 1980; 303: 409-415
    CrossrefPubMedGoogle Scholar
  • 19 Maskell R. Pathogenesis of urethral syndrome. J R Coll Gen Pract 1988; 38: 473-474
    PubMedGoogle Scholar
  • 20 Brumfitt W, Hamilton-Miller JM, Gillespie WA. The mysterious ‘urethral syndrome’. BMJ 1991; 303: 719-720
    PubMedGoogle Scholar
  • 21 Marovt M, Kese D, Kotar T et al. Ureaplasma parvum and Ureaplasma urealyticum detected with the same frequency among women with and without symptoms of urogenital tract infection. Eur J Clin Microbiol Infect Dis 2015; 34: 1237-1245
    CrossrefPubMedGoogle Scholar
  • 22 Nickel JC, Stephens A, Landis JR et al. Assessment of the Lower Urinary Tract Microbiota during Symptom Flare in Women with Urologic Chronic Pelvic Pain Syndrome: A MAPP Network Study. J Urol 2016; 195: 356-362
    CrossrefPubMedGoogle Scholar
  • 23 Baranowski A, Abrams P, Berger R et al. Classification of Chronic Pain, Second Edition (Revised). Im Internet: http://www.iasp-pain.org/PublicationsNews/Content.aspx?ItemNumber=1673&navItemNumber=677 Stand: 22.3.2016
    PubMedGoogle Scholar
  • 24 Smith PJ, Roberts JB, Ball AJ. “Honeymoon” cystitis: a simple surgical cure. BJU 1982; 54: 708-710
    CrossrefPubMedGoogle Scholar
  • 25 Moldwin RM, Fariello JY. Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Current urology reports 2013; 14: 409-417
    CrossrefPubMedGoogle Scholar
  • 26 Travell J, Rinzler SH. The myofascial genesis of pain. Postgrad Med 1952; 11: 425-434
    CrossrefPubMedGoogle Scholar
  • 27 Schmidt RA. The urethral syndrome. The Urologic clinics of North America 1985; 12: 349-354
    PubMedGoogle Scholar
  • 28 Ghazwani YQ, Elkelini MS, Hassouna MM. Efficacy of sacral neuromodulation in treatment of bladder pain syndrome: long-term follow-up. Neurourol urodynam 2011; 30: 1271-1275
    PubMedGoogle Scholar
  • 29 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 2011; 107: 370-375
    CrossrefPubMedGoogle Scholar
  • 30 Fan YT, Chen C, Cheng Y. The Neural Mechanisms of Social Learning from Fleeting Experience with Pain. Front Behav Neurosci 2016; 10: 11
    PubMedGoogle Scholar
  • 31 Huber M. Reizdarmsyndrom – Stress durch Catastrophizing. Österreichische Ärztezeitung 2013; 23/24
    PubMedGoogle Scholar
  • 32 Guenthert E-A. Psychosomatische Urologie – Leitfaden für die Praxis. 2. Aufl Stuttgart: Schattauer; 2013
    Google Scholar
  • 33 Zermann DH, Ishigooka M, Doggweiler-Wiygul R et al. The male chronic pelvic pain syndrome. World J Urol 2001; 19: 173-179
    CrossrefPubMedGoogle Scholar
  • 34 Engeler DS, Baranowski AP, Dinis-Oliveira P et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur urol 2013; 64: 431-439
    CrossrefPubMedGoogle Scholar
  • 35 FitzGerald MP, Payne CK, Lukacz ES et al. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol 2012; 187: 2113-2118
    CrossrefPubMedGoogle Scholar
  • 36 Doggweiler-Wiygul R. Urologic myofascial pain syndromes. Curr Pain Headache Rep 2004; 8: 445-451
    CrossrefPubMedGoogle Scholar
  • 37 Carrico DJ, Peters KM. Vaginal diazepam use with urogenital pain/pelvic floor dysfunction: serum diazepam levels and efficacy data. Urologic nursing 2011; 31: 279-284 99
    PubMedGoogle Scholar
  • 38 Rogalski MJ, Kellogg-Spadt S, Hoffmann AR et al. Retrospective chart review of vaginal diazepam suppository use in high-tone pelvic floor dysfunction. Int Urogynecol J 2010; 21: 895-899
    CrossrefPubMedGoogle Scholar
  • 39 Banakhar M, Hassouna M. Sacral Neuromodulation for Genitourinary Problems. Prog Neurol Surg 2015; 29: 192-199
    PubMedGoogle Scholar
  • 40 Banakhar M, Gazwani Y, Kelini ME et al. Effect of sacral neuromodulation on female sexual function and quality of life: Are they correlated?. Can Urol Assoc J 2014; 8: E762-E767
    CrossrefPubMedGoogle Scholar
  • 41 Morrissey D, El-Khawand D, Ginzburg N et al. Botulinum Toxin A Injections Into Pelvic Floor Muscles Under Electromyographic Guidance for Women With Refractory High-Tone Pelvic Floor Dysfunction: A 6-Month Prospective Pilot Study. Female Pelvic Med Reconstr Surg 2015; 21: 277-282
    CrossrefPubMedGoogle Scholar
  • 42 Atchley MD, Shah NM, Whitmore KE. Complementary and alternative medical therapies for interstitial cystitis: an update from the United States. Transl Androl Urol 2015; 4: 662-667
    PubMedGoogle Scholar
  • 43 Chao MT, Abercrombie PD, Nakagawa S et al. Prevalence and use of complementary health approaches among women with chronic pelvic pain in a prospective cohort study. Pain medicine 2015; 16: 328-340
    CrossrefPubMedGoogle Scholar
  • 44 Landis JR, Williams DA, Lucia MS et al. The MAPP research network: design, patient characterization and operations. BMC urology 2014; 14: 58
    CrossrefPubMedGoogle Scholar
  • 45 Schneider-Weber M, Ackermann D. Der psychosomatische Patient zwischen Hausarzt und Psychiater – ein Netz mit (zu) vielen Lücken?. In: Medizin IfH. (Hrsg.) Zürich: 2011
    Google Scholar