BLADDER

INFECTION

Clinical Presentation

Lim, Syndel Raina W.

Acute Cystitis

• Infection of the urinary bladder

• Women > men• Ascending mode of infection

– Periurethral– Vaginal– Fecal flora

• E coli – most common

Acute Cystitis• Findings

– Irritative voiding symptoms:• Dysuria• Frequency• Urgency

– Low back & suprapubic pain– Hematuria– Cloudy/foul smelling urine– Urinalysis: WBC & hematuria– Urine culture:

• Confirm diagnosis• Identify organism

• Radiographic Imaging– If uncomplicated:

• Radiologic evaluation is not necessary

Acute Cystitis

Management

• Short course of oral antibiotics– Trimethoprim – sulfamethoxazole (less expensive)– Nitrofurantoin (less expensive)– Fluoroquinolones

• Duration: 3-5 days• Longer therapy not indicated• Single dose: floroquinolones (long half-lives)• Not recommended: – penicillins; aminopenicillins (high resistance)

Recurrent Cystitis / UTI

• Bacterial persistence or reinfection w/ another organism

• Mx: Bacterial persistence ≠ reinfection

• Radiographic Imaging– Ultrasonography

• Screening evaluation of the GUT

– IV pyelogram– Cystoscopy– CT scan– Retrograde pyelogram

Recurrent Cystitis / UTI

Management

• Bacterial persistence - surgical removal of source (urinary calculi)

• Bacterial reinfection- surgically repair fistulas– 95% reduction – medical mx: low dose continuous

prophylactic antibiotic

• Alternatives:– Intravaginal estriol– Lactobacillus vaginal suppositories– cranberry juice

Malacoplakia

• Uncommon inflammatory disease of the bladder

• Can also affect the ureters & kidneys

• Plaques or nodules– Von Hansemann cells

• Large histiocytes– Micahelis-Gutmann bodies

• Laminar inclusion bodies

• Women > men

Malacoplakia

• Findings– Hx of UTI– Chronic illness or

immunosuppressed– Irritative voiding symptoms:

• Urgency• Frequency

– Hematuria

• Radiologic Imaging– Ultrasonography– CT scan

• Bladder mass• Ureter: obstruction• Kidney

– Focal or diffuse– Hypodense – Parenchymal masses

Malacoplakia

Management

• Antibiotic therapy– TMP-SMX– Fluoroquinolones (decreased mortality rate )

• Bethanecol & ascorbic acid – enhance phagolysosomal activity

According to site of involvement:• Lower urinary tract: antibiotic therapy• Ureter & kidney: surgical excision + antibiotic therapy

– Prognosis: poor; high mortality rate (bilateral renal involvement)