Features of treatment of chronic recurrent postcoital cystitis in women

Objective . To assess the efficacy and safety of the main treatment methods of chronic recurrent postcoital cystitis due to vaginal ectopia of the external urethral opening and/or urethral hypermobility in women. Materials and methods . The study group included 42 female patients with chronic recurrent postcoital cystitis. The study included 3 stages. Patients used behavioral treatment and non-antibacterial drugs administration at stage 1. In case of ineffectiveness of the stage 1 they moved on to stage 2: patients received antibacterial drugs according to the prescribed regimen — drugs from the nitrofuran group at a single dosage of 100 mg after each sexual contact, or according to bacteriological urine culture. Stage 3 included surgical treatment — transposition of the external opening of the urethra with excision of urethrohymenal adhesions, if any. This stage was used if stages 1 and 2 were ineffective. No relapses of postcoital cystitis were detected after surgical treatment in 94.7% of patients. All patients underwent cystoscopy with a biopsy of the bladder mucosa before surgery and 3–6 months after it. The observation period was at least 12 months after surgery. Results. Behavioral treatment and non-antibacterial drugs administration were effective in 4/42 (9.6%) patients. Effectiveness of antibacterial therapy according to the prescribed regimen after each sexual contact was 14/42 (33.3%). Surgical treatment was performed in 38/42 (90.5%) patients. Effectiveness of surgical treatment of eliminating recurrent postcoital cystitis was 36/38 (94.7%). Conclusion. If surgical intervention is clinically indicated, and with a technically correct surgical technique, the risk of complications is minimal, and cystoscopy with bladder biopsy is an objective method for diagnosing morphological changes in the mucosa. Persistence of relapses of chronic recurrent cystitis against the background of morphological changes in the bladder mucosa after surgical correction of pathogenetic factors (vaginal ectopia of the external urethral opening and/or urethral hypermobility) indicates other pathogenetic mechanisms for the development of the disease.