Cystitis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
Overview
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.
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. Lack of circumcision and intercourse are important risk factors for Traumatic Cystitis. [1]
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.[2][3]
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.[4]
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.[5][6][7][8]
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.[9]
Classification according to duration and treatment
Cystitis may be classified based on the duration of infection and the treatment:
Acute uncomplicated cystitis[10]
- Patients with acute uncomplicated cystitis have an infection that is restricted to the lower urinary tract and is most commonly seen in women with normal structure and function of the genitourinary tract and children older than age 2 years. Acute Urinary infections in men are always managed as complicated infections.
- 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[11][12]
- Complicated urinary tract infections occur irrespective of age and gender in people who have either functional or structural malformations. Urinary tract infection in elderly men is always considered complicated.
- Patients with complicated cystitis generally require a longer duration of therapy compared with patients with uncomplicated cystitis.
Recurrent cystitis[13][14][15]
- Repeated urinary tract infections are commonly seen in children and the elderly. Immunodeficiency is suspected in any patient with recurrent Urinary Tract Infection.
- Patients with recurrent cystitis may require prolonged prophylactic antimicrobial therapy for 6-12 months
References
- ↑ Hooton TM, Stamm WE (1997). "Diagnosis and treatment of uncomplicated urinary tract infection". Infect Dis Clin North Am. 11 (3): 551–81. PMID 9378923.
- ↑ Kind T, Cho E, Park TD, Deng N, Liu Z, Lee T; et al. (2016). "Interstitial Cystitis-Associated Urinary Metabolites Identified by Mass-Spectrometry Based Metabolomics Analysis". Sci Rep. 6: 39227. doi:10.1038/srep39227. PMC 5156939. PMID 27976711.
- ↑ Friedlander JI, Shorter B, Moldwin RM (2012). "Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions". BJU Int. 109 (11): 1584–91. doi:10.1111/j.1464-410X.2011.10860.x. PMID 22233286.
- ↑ Kilic O, Akand M, Gul M, Karabagli P, Goktas S (2016). "Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children". Iran Red Crescent Med J. 18 (6): e24562. doi:10.5812/ircmj.24562. PMC 5002967. PMID 27621918.
- ↑ Russo P (2000). "Urologic emergencies in the cancer patient". Semin Oncol. 27 (3): 284–98. PMID 10864217.
- ↑ PHILIPS FS, STERNBERG SS, CRONIN AP, VIDAL PM (1961). "Cyclophosphamide and urinary bladder toxicity". Cancer Res. 21: 1577–89. PMID 14486208.
- ↑ Watson NA, Notley RG (1973). "Urological complications of cyclophosphamide". Br J Urol. 45 (6): 606–9. PMID 4775738.
- ↑ Cox PJ (1979). "Cyclophosphamide cystitis and bladder cancer. A hypothesis". Eur J Cancer. 15 (8): 1071–2. PMID 510344.
- ↑ Halder P, Mandal KC, Mukherjee S (2016). "Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication". Indian J Urol. 32 (4): 329–330. doi:10.4103/0970-1591.189718. PMC 5054670. PMID 27843222.
- ↑ Nicolle LE (2008). "Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis". Urol Clin North Am. 35 (1): 1–12, v. doi:10.1016/j.ucl.2007.09.004. PMID 18061019.
- ↑ Pallett A, Hand K (2010). "Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria". J Antimicrob Chemother. 65 Suppl 3: iii25–33. doi:10.1093/jac/dkq298. PMID 20876625.
- ↑ Nicolle LE (2001). "A practical guide to antimicrobial management of complicated urinary tract infection". Drugs Aging. 18 (4): 243–54. PMID 11341472.
- ↑ Wada K, Uehara S, Ishii A, Sadahira T, Yamamoto M, Mitsuhata R; et al. (2016). "A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis". Acta Med Okayama. 70 (4): 299–302. PMID 27549677.
- ↑ Holland SM, Gallin JI (1998). "Evaluation of the patient with recurrent bacterial infections". Annu Rev Med. 49: 185–99. doi:10.1146/annurev.med.49.1.185. PMID 9509258.
- ↑ Arbiser JL (1995). "Genetic immunodeficiencies: cutaneous manifestations and recent progress". J Am Acad Dermatol. 33 (1): 82–9. PMID 7601952.