| Cystitis cystica | |
|---|---|
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| Micrograph showing cystitis cystica. | |
| Specialty | Urology  |
Cystitis cystica is an uncommon chronic reactive inflammatory disease that is believed to be brought on by a tumor, calculi, infection, or obstruction of the urothelium. [1] Cystitis glandularis is a proliferative progression of cystitis cystica that is distinguished by urothelial glandular metaplasia. [2]
The symptoms of cystitis cystica and associated pathologies are not specific. They could exhibit vague symptoms akin to those of numerous other urinary illnesses and ailments. Symptoms include suprapubic or perianal pain, hematuria, urine retention, [3] lower urinary tract symptoms such as incomplete emptying, urgency, and frequency, [4] and obstructive urinary symptoms. [5]
Although many affected individuals share a common feature of chronic irritation, infection, or inflammation, the exact cause of cystitis cystica remains unknown. [6] Potential causes include chronic Urinary tract infections, in-dwelling catheters, mechanical irritation, [7] chronic bladder outlet obstruction, and neurogenic bladders. [8] Changes in the bladder mucosa caused by diffuse cystitis cystica are often linked to bladder exstrophy. [9]
A complete blood count, tests for inflammatory mediators, a urinalysis, and a kidney function test are commonly performed examinations. Specifically, a urinalysis is necessary to identify any urinary tract infection or the presence of hematuria, and it should be obtained before starting any antibiotic. [6]
Cystitis cystica cystoscopy features can range from a large bladder cyst or mass to an essentially unremarkable appearance. On the other hand, it usually manifests as several tiny translucent cysts under the mucosa, primarily located at the bladder neck and trigone. Congestion, thickening, irregularity, multiple nodules, or an exophytic polypoidal mass can all be seen in the bladder mucosa. [10] Since cystitis cystica usually has inconclusive cystoscopic and radiological features, a concurrent biopsy is usually done on both the lesion and the mucosal changes. [11]
One trustworthy and non-invasive method to help diagnose cystitis cystica is ultrasonography. [12] Because it measures the thickness of the bladder wall, it is useful in cases of recurrent Urinary tract infections. [13] One study found that, in contrast to simple recurrent UTIs, which typically have a bladder wall thickness of less than 3 mm, cystitis cystica is indicated by values of bladder wall thickness greater than 3 mm. [14]
For a comprehensive assessment of the genitourinary system, computerized tomography (CT) scanning of the urinary tract with and without contrast media (CT urogram) is used. It can detect lesions in the bladder that are large enough to be seen, gauge the thickness of the bladder wall, and look for additional lesions that might be the source of hematuria. Cystitis cystica can show up on a CT urogram as a number of small, rounded filling defects in the bladder wall that range in size from 2 to 5 mm. Lesions can also occasionally appear as a large, tumor-like mass. [15]
Since determining the precise cause of cystitis cystica can be difficult, treatment can be complicated. Following diagnosis confirmation, the mainstays of treatment are the elimination of aggravating factors, symptomatic management, antibiotics and chemoprophylaxis, and, in the event that non-pharmacological measures prove ineffective, surgical intervention. [6]
Although the exact clinical course of cystitis cystica is unknown, the inflammation associated with the cystitis may subside if the irritant source is eliminated. The mucosal alterations may go away if UTIs are treated effectively and prevented. [6]
Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right away, needing to urinate often, and pain with sex. IC/BPS is associated with depression and lower quality of life. Many of those affected also have irritable bowel syndrome and fibromyalgia.
A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.
The bladder is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans, the bladder is a distensible organ that sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra. The typical adult human bladder will hold between 300 and 500 ml before the urge to empty occurs, but can hold considerably more.
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.
A urethral stricture is a narrowing of the urethra, the tube connected to the bladder that allows the passing of urine. The narrowing reduces the flow of urine and makes it more difficult or even painful to empty the bladder.
Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.
Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).
Hemorrhagic cystitis or haemorrhagic cystitis is an inflammation of the bladder defined by lower urinary tract symptoms that include dysuria, hematuria, and hemorrhage. The disease can occur as a complication of cyclophosphamide, ifosfamide and radiation therapy. In addition to hemorrhagic cystitis, temporary hematuria can also be seen in bladder infection or in children as a result of viral infection.
Prostatic congestion is a medical condition of the prostate gland that happens when the prostate becomes swollen by excess fluid and can be caused by prostatosis. The condition often results in a person with prostatic congestion feeling the urge to urinate frequently. Prostatic congestion has been associated with prostate disease, which can progress due to age. Oftentimes, the prostate will grow in size which can lead to further problems, such as prostatitis, enlarged prostate, or prostate cancer.
Gerald Domingue is an American medical researcher and academic who served as Professor of Urology, Microbiology and Immunology in the Tulane University School of Medicine and Graduate School for thirty years and also as Director of Research in Urology. He is currently retired and resides in Zürich, Switzerland, where he is engaged in painting and creative writing. At retirement he was honored with the title of Professor Emeritus at Tulane (1967–1997). Prior to Tulane, he was faculty of Saint Louis University School of Medicine); was a lecturer at Washington University School of Dentistry and director of clinical microbiology in St. Louis City Hospital, St. Louis, Missouri.
Urachal cancer is a very rare type of cancer arising from the urachus or its remnants. The disease might arise from metaplastic glandular epithelium or embryonic epithelial remnants originating from the cloaca region.
Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are affected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred.
Chronic bacterial prostatitis is a bacterial infection of the prostate gland. It should be distinguished from other forms of prostatitis such as acute bacterial prostatitis and chronic pelvic pain syndrome (CPPS).
Urinary bladder disease includes urinary bladder inflammation such as cystitis, bladder rupture and bladder obstruction (tamponade). Cystitis is common, sometimes referred to as urinary tract infection (UTI) caused by bacteria, bladder rupture occurs when the bladder is overfilled and not emptied while bladder tamponade is a result of blood clot formation near the bladder outlet.
Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.
Cystitis glandularis is the transformation of mucosal cells lining the urinary bladder. They undergo glandular metaplasia, a process in which irritated tissues take on a different form, in this case that of a gland. The main importance is in the findings of test results, in this case histopathology. They must distinguish a benign metaplastic change from the cancerous condition urothelial cell carcinoma. It is a very common finding in bladder biopsies and cystectomies, and most often found in the trigone area. Cystitis glandularis lesions are usually present as small microscopic foci; however, occasionally it can form raised intramucosal or polypoid lesions. The cystitis glandularis lesions are within the submucosa.
Eosinophilic cystitis is a rare type of interstitial cystitis first reported in 1960 by Edwin Brown. Eosinophilic cystitis has been linked to a number of etiological factors, including allergies, bladder tumors, trauma to the bladder, parasitic infections, and chemotherapy drugs, though the exact cause of the condition is still unknown. The antigen-antibody response is most likely the cause of eosinophilic cystitis. This results in the generation of different immunoglobulins, which activate eosinophils and start the inflammatory process.
Emphysematous cystitis is a rare type of infection of the bladder wall by gas-forming bacteria or fungi. The most frequent offending organism is E. coli. Other gram negative bacteria, including Klebsiella and Proteus are also commonly isolated. Fungi, such as Candida, have also been reported as causative organisms. Citrobacter and Enterococci have also been found to cause emphysematous cystitis. Although it is a rare type of bladder infection, it is the most common type of all gas-forming bladder infections. The condition is characterized by the formation of air bubbles in and around the bladder wall. The gas found in the bladder consists of nitrogen, hydrogen, oxygen, and carbon dioxide. The disease most commonly affects elderly diabetic and immunocompromised patients. The first case was identified in a post-mortem examination in 1888.
A urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers (fascia) that surround it.