Evaluation of chronic urethritis. Defining the role for endoscopic procedures.

We determined the prevalence of structural and functional abnormalities of the lower urinary tract in a carefully defined population of 36 men with chronic urethritis who were attending a sexually transmitted disease clinic. They had experienced symptoms for an average of 12.1 months and had been treated with an average of 5.1 courses of antimicrobial drugs. All had objective evidence of urethral inflammation and negative cultures for both Neisseria gonorrhoeae and Chlamydia trachomatis. Structural abnormalities were documented in nine (25%) of 36 patients but were considered clinically significant in only four. Physical examination and uroflow testing led to clinical suspicion of anatomic abnormalities in all four patients with significant lesions, which included urethral strictures in three patients and benign prostatic hypertrophy in one patient. Additional abnormal findings included wide-bore strictures in three patients and developmental abnormalities of doubtful significance in two patients. Increased numbers of inflammatory cells in expressed prostatic secretions were associated with the presence of structural abnormalities. We conclude that among men with chronic urethritis, careful physical examination and uroflow studies can be used to screen for evidence of structural abnormalities that merit endoscopic evaluation.