Clinical implications of the anatomical position of the urethra meatus in women with recurrent post-coital cystitis: a case-control study - International Urogynecology Journal

Introduction and hypothesis

Recurrent post-coital urinary infection (rUTI)—usually cystitis—is a common entity among otherwise healthy young women. However, little is known about the possible influence of genital anatomical variations. Only a shorter urethral meatus-anus distance has been described as a risk factor. The aim of this study was to evaluate our hypothesis that a shorter urethra-vagina distance is involved in the etiology of post-coital urinary infection.

Methods

In this prospective case-control study, 61 young women aged between 18 and 40 years with an acute post-coital UTI and a history of intercourse-related rUTI were consecutively recruited between January 2013 and February 2018. Fifty-six age-matched, sexually active women with no history of UTI served as controls. Perineal measurements included the distances between the clitoris-urethra (C-U), urethra-vagina (U-V), urethra-anus (U-A) and perineum. Demographic and sexual behavior characteristics and the morphology of the urethral meatus were also noted. Univariate analysis compared variables between groups. ROC analysis was used to define the efficiency of perineal measurements in predicting outcome. Odds ratios and 95% confidence intervals for UTI-predisposing variables were estimated using logistic regression analysis.

Results

The U-V and U-A distance was shorter in patients compared with controls [median (interquatile range): 16 mm (14–18) vs. 21 mm (19–23) and 51 mm (47–53) vs. 59 mm (55–62), respectively, p < 0.001]. The U-V performed better in ROC analysis than the U-A distance (AUC 0.952 vs. 0.875, p = 0.023). The only statistically significant parameters in multivariate analysis influencing UTI were BMI (OR: 0.702; 0.510–0.967, p = 0.030) and U-V (OR: 0.297; 0.161–0.549, p < 0.001).

Conclusions

Our results indicate an association between shorter urethra-vagina distance and post-coital rUTIs.

1. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Recurrent urinary tract infections in women. Int Urogynecol J. 2015;26(6):795–804.

   Article  PubMed  Google Scholar 

2. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177–82.

   Article  CAS  PubMed  Google Scholar 

3. Griebling TL. Urologic diseases in America project: trends in resource use for urinary tract infections in women. J Urol. 2005;173(4):1281–7.

   Article  PubMed  Google Scholar 

4. Arnold JJ, Hehn LE, Klein DA. Common questions about recurrent urinary tract infections in women. Am Fam Physician. 2016;93(7):560–9.

   PubMed  Google Scholar 

5. Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia coli (UPEC) infections: virulence factors, bladder responses, antibiotic, and non-antibiotic antimicrobial strategies. Front Microbiol. 2017;8:1566. eCollection 2017

   Article  PubMed  PubMed Central  Google Scholar 

6. Foxman B, Gillespie B, Koopman J, Zhang L, Palin K, Tallman P, et al. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000;151(12):1194–205.

   Article  CAS  PubMed  Google Scholar 

7. Ishitoya S, Yamamoto S, Mitsumori K, Ogawa O, Terai A. Non-secretor status is associated with female acute uncomplicated pyelonephritis. BJU Int. 2002;89:851–4.

   Article  CAS  PubMed  Google Scholar 

8. Nseir W, Taha M, Nemarny H, Mograbi J. The association between serum levels of vitamin D and recurrent urinary tract infections in premenopausal women. Int J Infect Dis. 2013;17(12):e1121–4.

   Article  CAS  PubMed  Google Scholar 

9. Hooton TM, Stapleton AE, Roberts PL, et al. Perineal anatomy and urine-voiding characteristics of young women with and without recurrent urinary tract infections. Clin Infect Dis. 1999;29(6):1600–1.

   Article  CAS  PubMed  Google Scholar 

10. Gyftopoulos K. The aberrant urethral meatus as a possible aetiological factor of recurrent post-coital urinary infections in young women. Med Hypotheses. 2018;113:6–8.

    Article  PubMed  Google Scholar 

11. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An international urogynecological association (IUGA) / international continence society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn. 2016;35(2):137–68.

    Article  PubMed  Google Scholar 

12. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.

    Article  CAS  PubMed  Google Scholar 

13. Cao Y, Li Q, Zhou C, Li F, Li S, Zhou Y. Measurements of female genital appearance in Chinese adults seeking genital cosmetic surgery: a preliminary report from a gynecological center. Int Urogynecol J. 2015;26(5):729–35.

    Article  PubMed  Google Scholar 

14. Basaran M, Kosif R, Bayar U, Civelek B. Characteristics of external genitalia in pre- and postmenopausal women. Climacteric. 2008;11(5):416–21.

    Article  CAS  PubMed  Google Scholar 

15. Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM. Female genital appearance: "normality" unfolds. BJOG. 2005;112(5):643–6.

    Article  PubMed  Google Scholar 

16. Mira-Escolano MP, Mendiola J, Mínguez-Alarcón L, et al. Longer anogenital distance is associated with higher testosterone levels in women: a cross-sectional study. BJOG. 2014;121(11):1359–64.

    Article  CAS  PubMed  Google Scholar 

17. Alexander AR, Morrisseau PM, Leadbetter GW. Urethral hymeneal adhesions and recurrent post coital cystitis. Treatment by hymeneoplasty. J Urol. 1972;107:597–8.

    Article  CAS  PubMed  Google Scholar 

18. Reed JF. Urethral-hymeneal fusion: a cause of chronic adult female cystitis. J Urol. 1970;103:441–6.

    Article  PubMed  Google Scholar 

19. Ronzoni G, De Giovanni L, Weir JM, Pasqui F, Menchinelli P. Transposing the urethral meatus in the treatment of recurrent and postcoital cystitis in women with hypospadias. BJU Int. 2001;87(9):894–6.

    Article  CAS  PubMed  Google Scholar 

20. Nseir W, Farah R, Mahamid M, Sayed-Ahmad H, Mograbi J, Taha M, et al. Obesity and recurrent urinary tract infections in premenopausal women: a retrospective study. Int J Infect Dis. 2015;41:32–5.

    Article  PubMed  Google Scholar 

21. Sever N, Oskay U. An investigation of lower urinary tract symptoms in women aged 40 and over. Low Urin Tract Symptoms. 2017;9(1):21–6.

    Article  PubMed  Google Scholar 

Download references

Authors and Affiliations

1. Department of Anatomy, University of Patras Medical School, Patras, Greece

   Kostis Gyftopoulos

2. Olympion Hospital, Patras, Greece

   Kostis Gyftopoulos & Miltos Matkaris

3. Department of Microbiology, University of Patras Medical School, Patras, Greece

   Aikaterini Vourda

4. Department of Medical Physics, University of Patras Medical School, Patras, Greece

   George Sakellaropoulos

Corresponding author

Correspondence to Kostis Gyftopoulos.

Conflicts of interest

None.