Cystitis

Cystitis:
symptomatic disease of the bladder
common in women
most of the time, the inflammation is caused by
a bacterial infection:
Escherichia coli accounts for 7590% of cystitis
isolates; Staphylococcus saprophyticus for 5
15%; and Klebsiella spp., Proteus spp.,
Enterococcus spp., Citrobacter spp., and other
organisms for 510%.
 Pathophysiology:
in general, there are 3 main mechanisms
responsible for UTIs:
colonization with ascending spread
hematogenous spread
periurogenital spread
in the majority of UTIs, bacteria establish
infection by ascending from the urethra to the
bladder:
because sexual intercourse may promote this
migration, cystitis is common in otherwise healthy
young women
cystitis represents bladder mucosal invasion
 Clinical Manifestations:
symptoms and signs of UTI in the adult are as
follows:
dysuria
urinary urgency and frequency
a sensation of bladder fullness or lower abdominal
discomfort
suprapubic tenderness
flank pain and costovertebral angle tenderness (may
be present in cystitis but suggest upper UTI)
bloody urine
fevers, chills, and malaise (may be noted in patients
with cystitis, but more frequently associated with
upper UTI)
 Diagnosis:
the clinical history itself has a high predictive
value in diagnosing uncomplicated cystitis
a urine dipstick test positive for nitrite or
leukocyte esterase can confirm the diagnosis of
uncomplicated cystitis in pts with a high pretest
probability of disease.
the detection of bacteria in a urine culture is the
diagnostic gold standard for UTI.
Urine dipstick:
Treatment:
 Prevention of Recurrent UTI and
Prognosis:
women experiencing symptomatic UTIs 2 times
a year are candidates for prophylaxis:
continuous prophylaxis and postcoital prophylaxis
usually entail low doses of TMP-SMX, a
fluoroquinolone, or nitrofurantoin
in the absence of anatomic abnormalities,
recurrent infection in children and adults does
not lead to chronic pyelonephritis or to renal
failure.
 Interstial cystitis:
interstitial cystitis (painful bladder syndrome) is a
chronic condition
characterized by:
pain perceived to be from the urinary bladder
urinary urgency and frequency
and nocturia
 Epidemiology and Etiology
in the United States, 36% of women and 24%
of men have interstitial cystitis
the etiology remains unknown:
theoretical possibilities include chronic bladder
infection, inflammatory factors such as mast cells,
autoimmunity, increased permeability of the
bladder mucosa, and unusual pain sensitivity
 Clinical Manifestations:
the cardinal symptoms of pain (often at 2 sites),
urinary urgency and frequency, and nocturia
occur in no consistent order. Symptoms can
begin acutely or gradually:
pain caused by interstitial cystitis is exacerbated by
bladder filling and relieved by bladder emptying
85% of pts void >10 times per day; some do so
as often as 60 times per day
 Diagnosis:
the diagnosis is based on the presence of
appropriate symptoms and the exclusion of
diseases with a similar presentation
physical exam and laboratory findings are
insensitive and/or nonspecific
 Treatment:
the goal of therapy is the relief of symptoms
often requires a multifaceted approach:
stress reduction
dietary changes
medications such as nonsteroidal anti-inflammatory
drugs or amitriptyline