Urinary Tract Ulcers in Women: Causes, Symptoms & Evaluation

Ulcers in the female urinary tract (urethra, bladder) are uncommon but significant. Causes include:

Etiologies

• UTI (especially recurrent/severe): Bacterial (E. coli) inflammation → ulceration; "cystitis cystica/glandularis" metaplastic changes.
• Bladder stones: Mechanical irritation → ulceration; more common in women with stasis/foreign bodies.
• Interstitial cystitis/bladder pain syndrome (IC/BPS): Hunner's lesions (ulcerative subtype) — glomerulations, mucosal cracks; autoimmune/neurogenic/epithelial defect theories.
• Trauma: Catheterization, radiation, surgery, foreign body.
• Radiation cystitis: Pelvic radiotherapy → ischemic, fibrotic ulceration (delayed onset).
• Systemic diseases: Behçet's (oral/genital/urogenital ulcers), Crohn's, lupus, sickle cell.
• Postmenopausal atrophy: Estrogen loss → thinning, friable urothelium → ulceration risk.

Symptoms

• Dysuria, urgency, frequency
• Suprapubic/pelvic pain
• Hematuria (visible or microscopic)
• Recurrent UTIs

Evaluation

• Urinalysis, culture
• Cystoscopy (gold standard for visualization, biopsy)
• Urodynamics (if voiding dysfunction)
• Imaging (CT/MRI) for extent

Treatment targets etiology: antibiotics, stone removal, IC/BPS multimodal therapy (instillations, oral meds, neuromodulation), estrogen (vaginal), immunosuppression (autoimmune).