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.

1. Feofilov IV, Boboev MM, Shkuratov SS, Pochivalov AK, Plugin PS. Postcoital cystitis: results of surgical treatment. Siberian Medical Gazette. 2021;(3):19-23. (In Russ.). DOI: https://doi.org/10.31549/2541-8289-2021-3-19-23

2. Gadzhieva ZK, Kazilov YB. Features of the approach to prevention of recurrent infections of the lower urinary tract. Urologiia. 2016;(3):65-76.

3. Komyakov BK, Shevnin MV, Tarasov VA., Nazarov T.Kh., Shpilenya ES, et al. Surgical treatment of vestibulo-vaginal frictional dislocation of urethra in postcoital cystitis. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery. 2023;24(3):89-94. [date of access 2025 April 08]. Available from: https://cyberleninka.ru/article/n/operativnaya-korrektsiya-vestibulo-vaginalnoy-friktsionnoy-dislokatsii-uretry-pri-postkoitalnom-tsistite (In Russ.).

4. Komyakov BK, Tarasov VA, Ochelenko VA, Shpilenya ES, Shevnin MV. Pathogenesis and treatment of postcoital cystitis: are our approaches correct? Urologiia = Urology. 2022;(2):27-32. (In Russ.). DOI: https://dx.doi.org/10.18565/urology.2022.2.27-32

5. Teterina TA, Apolikhina IA, Ivanova EA. Anatomical and functional features of the female urethra: postcoital cystitis. Meditsinskiy opponent=Medical Opponent. 2021;3(15):35-42.

6. Kulchavenya EV, Shevchenko SYu. Peculiarities of treatment of patients with postcoital cystitis (preliminary results). Medicine and Education in Siberia. 2015;(2):23. [date of access 2025 April 08]. Available from: https://jsms.elpub.ru/jour/article/view/69/0 (In Russ.).

7. Silchuk NA, Nechiporenko AN, Korsak VE, Knyaziuk AS. Chronic recurrent postcoital cystitis: a modern view of the problem. Journal of Grodno State Medical University. 2022;20(4):374-379. [date of access 2025 April 08]. Available from: (https://cyberleninka.ru/article/n/hronicheskiy-retsidiviruyuschiy-postkoitalnyy-tsistit-sovremennyy-vzglyad-na-problemu (In Russ.).

8. Tsukanov AIu. Prevention of post coital cystitis: the role of D-mannose. Case report. Consilium Medicum. 2021;23 (7):590-593. DOI: https://doi.org/10.26442/20751753.2021.7.201149

9. Bergamin PA, Kiosoglous AJ. Non-surgical management of recurrent urinary tract infections in women. Transl Androl Urol. 2017;6(Suppl 2):S142-S152. DOI: https://doi.org/10.21037/tau.2017.06.09

10. Komiakov BK. Extravaginal urethral transposition in the treatment of postcoital cystitis. Urology. 2013;(5):12-15. [date of access 2025 April 08]. Available from: https://urologyjournal.ru/ru/archive/article/12177 (In Russ.).

11. Lemtygov MB. The role of vaginal ectopia of the external urethral orifice in the development of morphologic changes of the bladder mucosa in women. Health and Ecology Issues. 2024;21(2):46-53. DOI: https://doi.org/10.51523/2708-6011.2024-21-2-06

12. Eliseev DE, Kholodova JL, Abakumov RS, Dobrokhotova SE, Shaderkina VA Postcoital cystitis: surgical treatment. Experimental and Clinical Urology. 2021;14(1):130-134. (In Russ.). DOI: https://doi.org/10.29188/2222-8543-2021-14-1-130-134

13. Bonkat G, Bartoletti R, Bruyere F. et al. EAU Guideline of Urological Infections. European Association of Urology; 2021 [date of access 2025 April 08]. Available from: https://uroweb.org/guidelines/urological-infections

14. Anikiev AV, Okulov AB, Volodko EA, Brovin DN, Andreeva EN, Mokrysheva NG. New classification of hypospadias in girls according to modern concepts of disorders of sexual development and surgical management strategy. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2022;(7):88-95. (In Russ.). DOI: https://dx.doi.org/10.18565/aig.2022.7.88-95

15. O’ Donall R.P. Chronic honeymoon cystitis correction by surgery. Br J Sex Med. 1978;5(37):20.

16. Belova AN, Krupina VN. Chronic pelvic pain. Guide for doctors. Moscow: Antidor; 2007. (In Russ.).

17. Koss LG, Hoda RS. Koss’s Cytology of the Urinary Tract with Histopathologic Correlations. Springer; 2012. 125 p. [date of access 2025 April 08]. Available from: https://link.springer.com/book/10.1007/978-1-4614-2056-9

18. Kubin ND, Tsareva AV, Salnikov DYu. Leukoplakia of the bladder – does this diagnosis have a place in the era of evidencebased medicine? Experimental and Clinical Urology. 2023;16(3):94-104. DOI: https://doi.org/10.29188/2222-8543-2023-16-3-94-104

19. Tityaev II, Udalov KV, Aizikovich BI, Savchenko SV, Morozov DV. Morphological assessment of the mucous membranes of the bladder and vagina in chronic cystitis in women. Journal of Siberian Medical Sciences. 2021;(2):56-64. (In Russ.).

20. Zinovkin DA, Achinovich SL, Zubritskiy MG, Whatmore JL, Pranjol MZI. High Expression of Galectin-1, VEGF and Increased Microvessel Density Are Associated with MELF Pattern in Stage I-III Endometrioid Endometrial Adenocarcinoma. J Pathol Transl Med. 2019 Sep;53(5):280-288. DOI: https://doi.org/10.4132/jptm.2019.05.13. Epub 2019 Jun 27

21. Zinovkin DA, Kose SY, Nadyrov EA, Achinovich SL, Los’ DM, Gavrilenko TE, et al. Potential role of tumor-infiltrating T-, B-lymphocytes, tumor-associated macrophages and IgA-secreting plasma cells in long-term survival in the rectal adenocarcinoma patients. Life Sci. 2021 Dec 1;286:120052. DOI: https://doi.org/10.1016/j.lfs.2021.120052

22. Komyakov B, Ochelenko V, Tarasov V. Extravaginal transposition of urethra – the results of 412 operations. The Journal of Urology. 2020;203(Suppl.4):e430-e431. DOI: https://doi.org/10.1097/JU.0000000000000868.05