Cystitis overview
|
Cystitis Microchapters | |
|
Diagnosis | |
|
Treatment | |
|
Case Studies | |
|
Cystitis overview On the Web | |
|
American Roentgen Ray Society Images of Cystitis overview | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
Overview
Cystitis is defined as inflammation of the urinary bladder.[1] When caused by an infection, Cystitis is called a type of the Lower UTI. Cystitis results mostly from ascending infections from the urethra but can also result from descending infections from the blood or the lymphatic system. The condition more often affects women, but can affect either gender and all age groups. 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.[2][3]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. 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.[4] 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. 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.[5][6] Urinary tract infections are the most frequent bacterial infection in women.[7] The female to male ratio is 4 to 1.[7]
Acute uncomplicated cystitis commonly affects women ages 18-39 years.[8] Approximately 50% of patients with acute uncomplicated cystitis will recover without treatment within a few days or weeks.[7] 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.[9] A detailed and thorough medical history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include use of urinary catheters, pregnancy, sexual history, diabetes, recent antibiotic use, history of renal disease, urinary incontinence, and urinary retention. Symptoms of cystitis include abnormal urine color (cloudy), blood in the urine, frequent urination or urgent need to urinate, painful urination, pressure in the lower pelvis or back, flank pain, back pain, nausea, vomiting, and chills.[10] Patients with cystitis are usually well-appearing. Common physical examination findings of cystitis include fever and suprapubic tenderness.[11] Laboratory tests used in the diagnosis of cystitis include urinalysis and urine culture. Laboratory findings consistent with the diagnosis of cystitis include pyuria and either white blood cells (WBCs) or red blood cells (RBCs) on urinalysis and a positive urine culture. Antimicrobial therapy is indicated in cystitis. The treatment of cystitis depends on the disease course (acute uncomplicated vs. complicated) and the rates of resistance in the community. Due to the risk of the infection spreading to the kidneys (complicated UTI) and the high complication rate in diabetics and the elderly population, prompt treatment is almost always recommended. Preventative measures to avoid cystitis include abstinence from sexual activity, use of barrier contraception during sexual intercourse, increasing fluid intake and frequency of urination, and use of estrogen (among post-menopausal women). Single-dose prophylactic antimicrobial therapy prior to sexual intercourse may be administered to patients who have recurrent episodes of cystitis that are associated with sexual activity.
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.[12]
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.[3][13][14][15][16]
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.[4]
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.[5][6]
Epidemiology and Demographics
Urinary tract infections are the most frequent bacterial infection in women.[7] 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.[6] Females are more commonly affected with cystitis than males. The female to male ratio is 4 to 1.[7] Acute uncomplicated cystitis commonly affects women ages 18-39 years.[8]
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.[7] 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.[9]
Diagnosis
History and Symptoms
A detailed and thorough medical history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include use of urinary catheters, pregnancy, sexual history, diabetes, recent antibiotic use, history of renal disease, urinary incontinence, and urinary retention. Symptoms of cystitis include abnormal urine color (cloudy), blood in the urine, frequent urination or urgent need to urinate, painful urination, pressure in the lower pelvis or back, flank pain, back pain, nausea, vomiting, and chills.[10]
Physical Examination
Patients with cystitis are usually well-appearing. Common physical examination findings of cystitis include fever and suprapubic tenderness.[11]
Laboratory Findings
Laboratory tests used in the diagnosis of cystitis include urinalysis and urine culture. Laboratory findings consistent with the diagnosis of cystitis include pyuria and either white blood cells (WBCs) or red blood cells (RBCs) on urinalysis and a positive urine culture.
Treatment
Medical Therapy
Antimicrobial therapy is indicated in cystitis. The treatment of cystitis depends on the disease course (acute uncomplicated vs. complicated) and the rates of resistance in the community. Due to the risk of the infection spreading to the kidneys (complicated UTI) and the high complication rate in diabetics and the elderly population, prompt treatment is almost always recommended.
Prevention
Preventative measures to avoid cystitis include abstinence from sexual activity, use of barrier contraception during sexual intercourse, increasing fluid intake and frequency of urination, and use of estrogen (among post-menopausal women). Single-dose prophylactic antimicrobial therapy prior to sexual intercourse may be administered to patients who have recurrent episodes of cystitis that are associated with sexual activity.
References
- ↑ Interstitial Cystitis. Centers for Disease Control and Prevention (2016). http://www.cdc.gov/ic/index.html Accessed on July 28, 2016
- ↑ 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.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
- ↑ 5.0 5.1 Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
- ↑ 6.0 6.1 6.2 Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Urinary Tract Infections. Wikipedia 2016. https://en.wikipedia.org/wiki/Urinary_tract_infection. Accessed on February 9, 2016
- ↑ 8.0 8.1 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.
- ↑ 9.0 9.1 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
- ↑ 10.0 10.1 Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
- ↑ 11.0 11.1 Colgan R, Williams M (2011). "Diagnosis and treatment of acute uncomplicated cystitis". Am Fam Physician. 84 (7): 771–6. PMID 22010614.
- ↑ Interstitial Cystitis. Wikipedia.https://en.wikipedia.org/wiki/Interstitial_cystitis#History Accessed on February 8, 2016
- ↑ Watson NA, Notley RG (1973). "Urological complications of cyclophosphamide". Br J Urol. 45 (6): 606–9. PMID 4775738.
- ↑ 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.
- ↑ Hooton TM, Stamm WE (1997). "Diagnosis and treatment of uncomplicated urinary tract infection". Infect Dis Clin North Am. 11 (3): 551–81. PMID 9378923.
- ↑ 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.