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Non-specific urethritis
is an abacterial cystitis seen in females and young male patients,
who often fail to demonstrate other associated urinary abnormalities
by conventional investigative set-up. Repeated long-term use of antibiotics
does not improve the condition and nephrotoxic antibiotics like tetracyclines,
aminoglycosides, cephaloridine and long-acting sulphas if used for
a prolonged period, may further deteriorate the renal function. An
indigenous drug Cystone has been used in this study in such patients
and found satisfactory as a urinary analgesic and antispasmodic without
toxic symptoms.
Twenty five selected
patients attending the out-patient department of Division of Nephrology
between 1980-83 form the subject matter of the present study. All
the patients were initially screened for the presence of secondary
organisms by repeated cultures, usually 3 times, after stopping
antibiotics for 1 week. The urine culture was evaluated for aerobic,
non-aerobic as well as fungus and in case of males, prostatic fluid
for the purpose of culture. All the urine samples were also subjected
to acid-fast bacilli culture for 8-week evaluation. Those who did
not grow any organism with persistent dysuria, frequency and burning
syndrome were included for the study. All the 10 male patients were
previously treated for chronic prostatitis with metronidazole, co-trimoxazole
and tetracycline combination without much relief. No placebo study
was conducted.
The vaginal smears
in female patients did not grow any significant colony, hence we
do not mention it as a causative or associated factor of urethritis.
Crystalluria was present
in four patients of oxalate group. However, none of them had colicky
pain or anuria/oliguria syndrome.
Females out-numbered the males in the
ratio 3:2. The majority of the patients belonged to the second and
third decades of life (80%). The incidence of extramarital or pre-marital
relation was obtained in 40% of the males and no such history was
asked from females.
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Table 1: Age and sex group
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Age group
|
Male
|
Female
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Total
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20-30
|
5
|
8
|
13
|
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31-40
|
1
|
6
|
7
|
|
41-50
|
4
|
1
|
5
|
|
Total
|
10
|
15
|
25
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88% patients had chronicity of symptoms for more
than one year. None of the patients had significant pyuria (pus
cells < 5) or nocturia.
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Table
2: Duration of symptoms
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Duration
|
Male
|
Female
|
Total
|
|
< 1
year
|
2
|
1
|
3
|
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1-2 years
|
6
|
10
|
16
|
|
2-3 years
|
2
|
4
|
6
|
|
Total
|
10
|
15
|
25
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The initial dose of
Cystone was two tablets b.i.d. 32% of the patients improved within
a fortnight, whereas the remaining 68% required a prolonged therapy
of one month. Almost all the patients reduced the frequency from
4 to 2 by the end of the 4th week, when a maintenance
dose of 1 tablet, 2 to 3 times a day was given for 2 months. Symptoms
recurred in 24% of the patients after 3 months and they had to be
restarted on the same dose for another 2 months with improvement.
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Table
3: Duration of improvement in symptoms
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Duration
(in week)
|
Male
|
Female
|
Total
|
|
1
|
1
|
2
|
3
|
|
2
|
2
|
2
|
4
|
|
3
|
4
|
6
|
10
|
|
4
|
3
|
5
|
8
|
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Total
|
10
|
15
|
25
|
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Table 4: Recurrence of symptoms
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| |
Male
|
Female
|
Total
|
|
8 weeks
|
–
|
–
|
–
|
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10 weeks
|
–
|
–
|
–
|
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3 months
|
2
|
6
|
6
|
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6 months
|
2
|
3
|
5
|
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No recurrence
|
6
|
6
|
12
|
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Total
|
10
|
15
|
25
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Urethral syndrome in abacterial cystitis may account
for 27% to 41% of all cases of female dysuria (Gallagher et al.,
1965, Kraft and Stamey, 1977). Most of the time these patients
do not show presence of known aerobic or anaerobic organisms; however,
a meticulous culture facility for viruses and chlamydia may demonstrate
its presence. These uncommon organisms have clinical significance,
as they are not easily amenable to antibacterial treatment (Markell
et al., 1979).
This embarrassing clinical problem leads to repeated
institution of antibiotics, urinary analgesics and anti-spasmodics
without much improvement. We used an indigenous preparation Cystone
in order to get rid of the persistence of these lower urinary tract
problems. All these patients were screened thoroughly before by
I.V.P. and cystoscopy so that no major underlying problems remained
undetected. A frequent review of the cases showed significant improvement
in their clinical picture.
In male patients chronic prostatitis is a well
documented and established factor and those drugs which have a higher
secretory property in racemose type of gland like prostate, exhibit
better results, e.g. co-trimoxazole, tetracycline and metronidazole.
However, persistence of these symptoms becomes difficult to deal
with. Prostatic fluid culture for acid-fast bacilli may some times
clinch the diagnosis.
Chatterjee et al., (1982) reported that
Cystone has a property of relaxing smooth muscle and a diuretic
property, which may act as an antispasmodic in chronic irritation
of the urethra leading to spasm of the external sphincter. The diuretic
property may reduce the contact of organisms with the bladder mucosa
and improve the hydrokinetic natural killing property of commensal
bacteria, which become opportunistic during convalescence. There
have been other reports on Cystone and its use in various renal
disorders (Sharma et al., 1983); however its exact scientific
role is yet to be evaluated. In our patients the average improvement
of symptoms was noticed after 3 weeks of therapy, but recurrence
of symptoms occurred in 13 patients after 3-6 months. Therefore
its role as placebo needs also further evaluation. However, Cystone
may be used as an urinary analgesic in such patients where assessment
of the exact aetiology of non-specific urethritis has been a failure
with conventional methods and repeated use of antibiotics has become
ineffective.
- Non-specific urethritis is a syndrome
due to abacterial cystitis of obscure origin often associated
with viruses, chlamydia and L-form protoplast bacteria, which
do not respond to antimicrobial therapy.
- These patients need a joint work
up with the help of a nephrologist and urologist and study of
lower urinary tract with cystoscopy, I.V.P., prostatic massage
and culture for aerobic, anaerobic, viruses, fungi and acid-fast
bacilli.
-
In those conditions
where no organisms have been demonstrated patients may be kept
on Cystone for 2-3 months to allay the persistence of symptoms.
-
In 50% of patients
symptoms may tend to recur after 6 months.
We are thankful to
The Himalaya Drug Company for supply of samples.
- Chatterjee, B.N., Role of Cystone in various urinary disorders.
Probe (1982): 1, 27.
- Maskell, R., Pead, L. and Allen, J., The puzzle of urethral
syndrome, a possible answer. The Lancet (1979): 1, 1088.
- Gallagher, D.J.A., Montgomery, J.Z. and North, J.D.K., Acute
infection in the urinary tract and the urethral syndrome in general
practice. Brit. med. J. (1965): 1, 622.
- Kaft, J.K. and Staney, J.A., the natural history of symptomatic
bacteriuria in women. Medicine (Baltimore) (1977): 55,
56.
- Sharma, B.M., Panagariya, Ashok and Jain, Kamal, Clinical trial
of Cystone in various renal disorders. Probe (1983): 2,
113.
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