Cystitis

Cystitis: refers to inflammation (acute or chronic) of the bladder; very common in young females and older population. Cystitis can be asymptomatic or more usually presents with urinary symptoms…

• Frequency

• Dysuria

• Abdominal pain

Also, may be associated with hematuria and systemic symptoms (e.g. development of pyelonephritis and associated complications); though resolution is common (antibiotics, treatment of underlying causes etc.)

Aetiology: cystitis is most commonly due to infection…

• Bacterial infection (most common): e.g. E. coli, Proteus, S. Faecalis

[Most bacteria causing UTI originate in the bowel.]

• Viral infection: adenovirus may cause haemorrhagic cystitis in children

• Parasite: Schistosoma haematobium, which is common in Africa

• Fungi: Candida

Occasionally caused by physical agents e.g. radiation or mechanical irritants

Pathogenesis:

Risk factors:

• Urinary retention: due to obstruction e.g. prostatic enlargement, bladder paralysis, foreign body, calculi, and tumours.

• Infection of adjacent structure, e.g., prostatitis, urethritis.

• Diabetes mellitus

• Pregnancy

• Trauma e.g. catheterization

Also vesico-ureteric reflux predisposes to extension to kidney

Routes of infection:

• Ascending infection: (commonest) lower vagina and periurethral mucosa  distal urethra  ascend the urethra into the bladder (cystitis); may extend to the ureters and renal parenchyma (pyelonephritis).

Note: F>M incidence because females have a shorter urethra

Other less common routes:

• Descending infection: from the kidney e.g. renal tuberculosis

• Direct spread: from adjacent organs e.g. diverticulitis

• Haematogenous: from distant focus rare

• Lymphatic: extremely rare

Morphology:

• Non-specific acute or chronic inflammation

• Ulceration of bladder mucosa

• Epithelial metaplasia

• Fibrosis of wall

Special types of cystitis:

• Cystitis cystica and cystitis glandularis

• Granulomatous (TB, intravesical BCG, following instrumentation)

• Eosinophilic

• Interstitial (Hunner ulcer) – clinicopathological entity

• Iatrogenic (following radiation or chemotherapy)

• Malacoplakia (usually chronic E coli or Proteus infection)

Category: Medicine Notes