Urethral and Vaginal Infections, Age of Patients and State of the Pelvic Floor in the Aetiology of the Irritative Symptoms of the Lower Urinary Tract

OBJECTIVES: The aim of this study was to evaluate the importance of a) urethral and/or vagi-nal infections caused by common germs or Mycoplas-mas, Chlamydia, Candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women. METHODS: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. A detailed micturition history and a genitourina-ry physical examination were performed. Urine samples as well as vaginal and urethral swabs were taken for cultures. RESULTS: No statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. Whereas a significant statistical difference was found in the age of the patients. In the symptomatic group the women were older than in the asymptomatic group. Both symptomatic and asymptomatic women filled out a questionnaire on previous urinary-tract symptoms. Prolapses were evaluated and graded according to the halfway system classification of Baden and Walker with the patients in the lithotomy position and under maximum straining effort. Urine samples as well as vaginal and urethral swabs were taken for cultures. The diagnosis of Candida was based on the presence of yeast cells and pseudohyphae in Gram stained vaginal smears. The vaginal secretions were cultured for 72 hours at 37° C on Sabouraud agar. In Chlamydial infection vaginal swabs were sent to the laboratory and processed using polymerase chain reaction (PCR). In Mycoplasmas infection vaginal swabs were sent to the laboratory and then inoculated into a broth containing urea (U. urealyticum), and into a broth containing arginine dihydrochloride (M. hominis). In bacterial vaginosis swabs were cultured aerobically and anaerobically on blood, chocolate, and MacConkey agars, and on Gardnerella selective medium. Gram stained smears were examined too. Patients with neurological disease, pregnant women, urinary tract tuberculosis, diabetes, bladder or pelvic tumors, pelvic radiotherapy, bladder stones and urinary tract infections were excluded.