Idiopathic urethritis in pediatric males: A 13-year experience with and without steroid injection

Abstract

OBJECTIVE: Idiopathic urethritis (IU) is among the causes of macroscopic hematuria in children and primarily affects males aged between 5 and 15 years. Common symptoms include dysuria and hematuria. The etiology remains incompletely understood. Untreated IU may progress to urethral stricture in the long term. Conventional treatments like prolonged antibiotic therapy and nonsteroidal anti-inflammatory drugs have limited success. Recent studies suggest favorable outcomes with associated dysfunctional elimination syndrome treatment or steroid instillation. This study aims to present a 13-year retrospective analysis of patients diagnosed with IU via cystourethroscopy, assess long-term outcomes with or without steroid injection and explore the relationship between IU and voiding dysfunction. METHODS: Patients who underwent cystoscopy due to unexplained hematuria and/or dysuria between 2010 and 2023 were retrospectively screened. Patients diagnosed with IU were included and those who underwent steroid instillation (Group S) or received no steroid treatment (Group NS) evaluated separately. Available uroflowmetry (UFM) results were assessed. RESULTS: Thirty male patients were diagnosed with IU, with a mean age of 11.1 (2-17) years and mean symptom duration of 9.3 (0.1-36.5) months. Steroid instillation was performed in 21 patients (Group S), yielding a 57% recovery rate. In Group NS, symptoms resolved without treatment in 66% of patients. UFM results showed obstructive patterns in patients with urethral strictures. CONCLUSION: Cystourethroscopy allows for accurate diagnosis of IU and targeted intervention. In our series, the promising steroid instillation therapy did not significantly alter long-term symptom-free survival compared to observation alone. Further research is warranted to elucidate IU's pathogenesis and establish standardized treatment approaches.