Cystitis overview
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Steven C. Campbell, M.D., Ph.D.
Overview
Cystitis is inflammation of the urinary bladder. The condition more often affects women, but can affect either gender and all age groups.
Historical Perspective
Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC. In 1836, Philadelphia surgeon Joseph Parrish published the earliest record of interstitial cystitis by describing three cases of severe lower urinary tract symptoms without the presence of a bladder stone.The term "interstitial cystitis" was coined by Dr. Alexander Skene in 1887 to describe the disease.[1]
Classification
Cystitis may be classified according to the etiology and therapeutic approach into 5 subtypes: traumatic, interstitial, eosinophilic, hemorrhagic cystitis, and cystitis cystica. For the purpose of treatment, cystitis may also be classified into acute uncomplicated, complicated, and recurrent cystitis.
Pathophysiology
Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria, which leads to irritation and inflammation. Females are more prone to the development of cystitis because of their relatively shorter urethra. Bacteria does not have to travel as far to enter the bladder, which is in part due to the relatively short distance between the opening of the urethra and the anus. The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.[2]
Causes
More than 85% of cases of cystitis are caused by escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract. Other causes of cystitis include certain medications, diabetes, Crohn's disease, iatrogenic causes, endometriosis, pelvic inflammatory disease, urinary obstruction, and bladder incontinence.
Differential Diagnosis
Cystitis must be differentiated from other causes of dysuria such as acute pyelonephritis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis.[3][4]
Epidemiology and Demographics
Urinary tract infections are the most frequent bacterial infection in women.[5] It is estimated that more than 30% of women will experience at least one episode of cystitis. Of these 30%, 20% of these women will have recurrent cystitis.[4] Females are more commonly affected with cystitis than males. The female to male ratio is 4 to 1.[5] Acute uncomplicated cystitis commonly affects women ages 18-39 years.[6]
Risk Factors
Common risk factors in the development of cystitis include diabetes, pregnancy, catheterization, bowel incontinence, old age, and immobility.
Natural History, Complications, and Prognosis
Approximately 50% of patients with acute uncomplicated cystitis will recover without treatment within a few days or weeks.[5] If left untreated, some patients with cystitis may progress to develop recurrent infection, pyelonephritis, hematuria, and rarely renal failure. Prognosis is generally good. The majority of patients with cystitis do not have recurrence or complications after treatment.[7]
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Because of the risk of the infection spreading to the kidneys (complicated UTI) and due to the high complication rate in the elderly population and in diabetics, prompt treatment is almost always recommended.
Prevention
References
- ↑ Interstitial Cystitis. Wikipedia.https://en.wikipedia.org/wiki/Interstitial_cystitis#History Accessed on February 8, 2016
- ↑ Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
- ↑ Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
- ↑ 4.0 4.1 Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
- ↑ 5.0 5.1 5.2 Urinary Tract Infections. Wikipedia 2016. https://en.wikipedia.org/wiki/Urinary_tract_infection. Accessed on February 9, 2016
- ↑ Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE (2004). "Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy". Clin Infect Dis. 39 (1): 75–80. doi:10.1086/422145. PMID 15206056.
- ↑ Urinary Tract Infections in Adults. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/Pages/facts.aspx. Accessed on February 9, 2016