Cystitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Cystitis may be classified according to the etiology and therapeutic approach into 5 subtypes: traumatic, interstitial, eosinophilic, hemorrhagic cystitis, and cystitis cystica.
Classification
Classification due to etiology
There are several medically distinct types of cystitis, each having a unique etiology and therapeutic approach:
Traumatic Cystitis
It is probably the most common form of cystitis in the female, and is due to bruising of the bladder, usually by abnormally forceful sexual intercourse. This is often followed by bacterial cystitis, frequently by coliform bacteria being transferred from the bowel through the urethra into the bladder.
Interstitial Cystitis
It is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. Several therapies are now available.
Eosinophilic Cystitis
It is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC may be attributed to infection by Schistosoma haematobium or by certain medications in afflicted children. Some consider it a form of interstitial cystitis.
Hemorrhagic Cystitis
It can occur as a side effect of cyclophosphamide, ifosfamide, and radiation therapy. Radiation cystitis, one form of hemorrhagic cystitis is a rare consequence of patients undergoing radiation therapy for the treatment of cancer. Several adenovirus serotypes have been associated with an acute, self-limited hemorrhagic cystitis, which occurs primarily in boys. It is characterized by hematuria, and virus can usually be recovered from the urine.
Cystitis Cystica
This is a chronic cystitis glandularis accompanied by the formation of cysts. This disease can cause chronic urinary tract infections. It appears as small cysts filled with fluid and lined by one or more layers of epithelial cells. These are due to hydropic degeneration in the center of Brunn's nests.
Classification according to duration and treatment
For the purpose of treatment, cystitis may be classified into:
- Acute uncomplicated cystitis
- Patients with acute uncomplicated cystitis may be treated using a single antimicrobial therapy using either a single dose or a 3-day regimen
- Complicated cystitis
- Patients with complicated cystitis generally require a longer duration of therapy compared with patients with uncomplicated cystitis.
- Recurrent cystitis
- Patients with recurrent cystitis may require prolonged prophylactic antimicrobial therapy for 6-12 months