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[Treatment of cystitis in women].

Acute cystitis is a benign curable condition which affects at least one out of every two women at least once in their life. In uncomplicated cases, urinalysis is usually unnecessary as a simple dip stick test is sufficient for diagnosis and prescription of a short antibiotic regimen (a single dose or a 3 day treatment). Complicated acute cystitis requires a more precise diagnosis and justifies urinalysis and imaging. Antibiotics adapted to germ sensitivity is prescribed until bacteriologically sterile urine is obtained (3 to 10 days). Associated malformations of the urinary tract or obstruction must be managed together with careful control of aggravating factors (diabetes) and personal hygiene. Recurrent cystitis, defined as at least 4 episodes, raises a certain number of problems. The casual germ varies, although Escheria coli is found in approximately 70% of the cases. Several factors favour recurrent cystitis including malformations of the urinary tract, lithiasis, bladder reflux, cystocele or modification of the urethral meatus. Other circumstances such as sexual relations, excessive vaginal hygiene, vaginal tampons and clothing habits may play a role. Antibiotics generally solve the problem, but mechanisms which would improve the organism's specific response are currently under study.

Acute Disease↗

[A case of lupus cystitis successfully treated with corticosteroid accompanied by gastrointestinal symptoms].

A 34-years-old woman was admitted to our department in February, 1992, because of nausea, vomiting, abdominal pain and diarrhea. She had been diagnosed as systemic lupus erythematosus (SLE) in 1988 and treated with prednisolone at the dose of 5 mg a day. In December, 1991, gastrointestinal symptoms developed followed by anuria on March 3, 1992. The laboratory findings revealed no activities in SLE. Computed tomography (CT) showed bilateral hydroureteronephrosis, swelling of bladder and gastrointestinal wall, and ascites. Under the diagnosis of lupus cystitis, corticosteroid therapy was started with 125 mg of methylprednisolone. Her symptoms improved immediately. Abnormal findings shown in the previous CT disappeared concomitantly. Lupus cystitis was reported by Orth et al. 1983 as severe fetal syndrome. However, because early corticosteroid therapy appears to reverse acute manifestation of lupus cystitis without complications, attention should be paid on lupus cystitis in patients with SLE with gastrointestinal symptoms of unknown etiology and decreasing urinary volume.

Adult↗

Cyclosporine in severe interstitial cystitis.

PURPOSE: Cyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results. Because interstitial cystitis may have an autoimmune etiology, we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis. MATERIALS AND METHODS: A total of 11 patients, who fulfilled the criteria for interstitial cystitis according to an international accrual form, received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg. daily and a maintenance dose of 1.5 to 3 mg./kg. daily. Blood pressure, serum creatinine and cyclosporine concentrations were monitored regularly. The patients completed frequency-volume charts at 2-week intervals. RESULTS: The frequency-volume charts showed favorable effects. Micturition frequency decreased (p<0.01), and mean and maximum voided volumes increased significantly (p<0.001 and p<0.01, respectively). Bladder pain decreased or disappeared in 10 patients, allowing for storage of large urine volumes. Serum creatinine did not change with the dosages used. Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered. After cessation of treatment symptoms recurred in the majority of patients. CONCLUSIONS: The findings revive the concept of interstitial cystitis as an autoimmune disease.

Adult↗

Urinary epitectin (MUC-1 glycoprotein) in the menstrual cycle and interstitial cystitis.

PURPOSE: We compared interstitial cystitis and control urine specimens for epitectin (MUC-1 glycoprotein), an epithelial mucin. MATERIALS AND METHODS: Urinary epitectin was measured in 28 patients with interstitial cystitis and 26 healthy controls. Ten controls provided multiple urine samples to determine whether urinary epitectin changes with the menstrual cycle. RESULTS: Epitectin levels were stable throughout the menstrual cycle. Interstitial cystitis cases had decreased urinary epitectin-to-creatinine ratios (mean 3.89 versus 6.38 micrograms./mg. creatinine for controls, p = 0.0035) and epitectin concentrations (mean 1.96 versus 4.30 micrograms./ml., respectively, p = 0.0005). CONCLUSIONS: Decreased mean urinary epitectin levels may reflect a cause (epithelial mucin deficiency) or a consequence of interstitial cystitis.

Creatinine↗

[Emphysematous cystitis: a case report].

Emphysematous cystitis is a rare condition in which gas-forming organisms produce gas in the bladder wall and lumen. We present a case of emphysematous cystitis with neurogenic bladder. The patient was a 78-year-old man who complained of dysuria and lower abdominal soft mass. Urine culture yielded Klebsiella pneumoniae and Enterococcus faecalis. A plain X-ray film of upright position showed a large air-fluid level. The gas was demonstrated in the bladder wall and lumen on CT scan. These findings were compatible with that of emphysematous cystitis. The symptoms were improved and the intraluminal gas had disappeared on radiography after treatment with antibiotics. We reviewed 20 cases of emphysematous cystitis reported in the Japanese literature and reported clinical characteristics of 21 patients including ours here.

Aged↗

[Hemorrhagic cystitis in pregnancy: report of a case and analysis of its treatment].

Hemorrhagic cystitis is generally a benign self-limited disorder, however there are some severe cases which are associated to a significant blood loss. The etiology may be either bacterial, viral or chemical in origin; though the cause is not identified in most of the cases. Immunocompromised patients or patients who have undergone chemotherapy or radiation constitute the highest risk group. There are only a few articles about hemorrhagic cystitis in pregnancy, that is the reason why the therapy for this disorder is not uniform. Hemorrhagic cystitis in pregnant women frequently is associated with preterm labor. We describe one patient with a clinical status of hematuria, dysuria, frequency, urgency and premature labor. The cystoscopic study showed data that suggest hemorrhagic cystitis. The various treatment used in this disorder are reviewed here.

Adult↗

Genetic evidence supporting the fecal-perineal-urethral hypothesis in cystitis caused by Escherichia coli.

PURPOSE: The fecal-perineal-urethral hypothesis to explain the cause of urinary tract infections (UTI) by enteric bacteria has been supported by longitudinal studies using methods of serotyping and detecting urovirulence factors such as P fimbriae. However, genetic techniques to more accurately characterize Escherichia coli strains have not been exploited. MATERIALS AND METHODS: A total of 2,700 E. coli colonies isolated from the urine and rectal swabs of 9 female subjects with acute uncomplicated cystitis and from the rectal swabs of 30 healthy women were serotyped and examined for genes encoding various urovirulence factors by colony hybridization test. The clonality of the urine and fecal isolates of E. coli from the cystitis subjects was further evaluated by pulsed-field gel electrophoresis (PFGE). RESULTS: E. coli strains causing cystitis dominated the rectal flora of 7 of 9 patients. In the remaining 2 patients, similar clones comprised at least 20% of the fecal flora. Carriage of E. coli strains with a variety of urovirulence factors was quite common among healthy women. PFGE demonstrated that most of the isolates sharing the same serotypic characteristics and virulence factors in the urine and rectal swab samples from each subject were identical. CONCLUSIONS: Based upon precise genetic techniques, our results clearly support the fecal-perineal-urethral hypothesis, indicating that E. coli strains residing in the rectal flora serve as a reservoir for urinary tract infections, e.g., cystitis.

Acute Disease↗

Treatment of cyclophosphamide induced hemorrhagic cystitis with neodymium:YAG laser in pediatric patients.

PURPOSE: Hemorrhagic cystitis is a significant and sometimes fatal complication of cyclophosphamide therapy. We report our recent experience using a neodymium (Nd):YAG laser to treat 3 pediatric patients with cyclophosphamide induced cystitis. MATERIALS AND METHODS: Between May 1994 and March 1995 we treated 3 pediatric patients 6 to 8 years old with an Nd:YAG laser for severe hemorrhagic cyclophosphamide induced cystitis. All patients presented with gross hematuria and conservative measures failed. The Nd:YAG laser (20 watts and 2-second pulse mode) was used to fulgurate bleeding endoscopically. All patients required 2 laser treatment sessions with a total energy range of 8,011 to 16,595 J. and strict parameters to avoid small bowel injury. RESULTS: All 3 patients had resolution of gross hematuria with Nd:YAG therapy. They were discharged home within 3 days after repeat laser treatment with grossly clear urine and stable hematocrit. At followup of 11 to 18 months the patients have grossly clear urine and they are free of symptoms. CONCLUSIONS: Our experience suggests that the Nd:YAG laser can be effective and safe for treating refractory cyclophosphamide induced hemorrhagic cystitis in pediatric patients.

Child↗

An investigation of the nature of bladder mucosal glycoconjugates and their role in interstitial cystitis.

The long-term objective of this study is to elucidate the role of bladder mucosal glycosaminoglycans and mucin glycoproteins in the development of interstitial cystitis and other bladder diseases. Bladder biopsies and urine samples from patients and healthy controls were analyzed for glycoconjugates by biochemical and immunochemical methods. Due to the limited availability of human bladders for research purposes, detailed analysis of rabbit bladders glycoconjugates were also carried out. Biochemical analysis of rabbit bladders indicate that while the major portion of the glycoconjugates in the urothelium is sialoglycoprotein, low levels of heparan sulfate and chondroitin sulfate are also present. The correlating immunohistochemical data show very weak staining of the rabbit bladder epithelium by antiglycosaminoglycan antibodies. In contrast, the lamina propria and muscle layers stained intensely for chondroitin sulfate and hyaluronic acid. Thus, the quantity of glycosaminoglycans associated with the bladder epithelial layer, particularly as extracellular matrix components on the luminal surface of the bladder, appears insignificant. On the other hand, several lectins and anti-epitectin (a MUC1 sialoglycoprotein) antibodies showed strong staining of the luminal surface of rabbit and normal human bladders. Further, preliminary results with anti-epitectin antibodies reveal a weaker and patchy staining of biopsy specimens from interstitial cystitis patients compared to controls. The urinary levels of glycosaminoglycans and epitectin, in interstitial cystitis patients and healthy controls were determined by chemical or immunoassays. Urinary epitectin, but not glycosaminoglycans, was decreased in interstitial cystitis patients.

Animals↗

Interstitial cystitis.

Interstitial cystitis is a urologic disorder with protean pelvic manifestations (urologic, gynecologic, gastroenterologic) and variable prevalence. Although current research indicates a non-bacteriologic etiology, interstitial cystitis has features suggestive of autoimmunity, a deficient bladder wall lining, activated bladder sensory neuropeptides and bladder mastocytosis. Pentosan polysulfate sodium is a recently approved oral treatment for interstitial cystitis. Further research into the gynecologic and pain aspects of interstitial cystitis is clearly needed.

Anti-Inflammatory Agents, Non-Steroidal↗

[Lupus interstitial cystitis. Apropos of a case].

We report a case of lupus interstitial cystitis in 17 year-old female. The patient presented with suprapubic pain, urinary frequency, dysuria, nocturia and no bacterial growth. Intravenous pyelography showed a low capacity bladder with thickwall, and a bilateral ureterohydronephrosis. Interstitial cystitis was confirmed on bladder biopsy specimen. Clinical symptoms remained eventhough after steroid treatment. Clinical signs of cystitis occurring in a patient with systemic lupus erythematous could be a manifestation of a lupus cystitis.

Adolescent↗

Results of double-contrast cystography in cats with idiopathic cystitis: 45 cases (1993-1995).

OBJECTIVE: To determine results of double-contrast cystography in cats with idiopathic cystitis. DESIGN: Retrospective study. ANIMALS: 45 cats with clinical signs of nonobstructive lower urinary tract disease for which an underlying cause could not be determined. PROCEDURE: Medical records and double-contrast cystograms performed initially and during 6- and 12-month reevaluations were reviewed. RESULTS: 105 cystograms were reviewed. Fifteen (33%) cats had abnormalities evident on cystograms obtained at the time of initial examination. Of these, only 1 had abnormalities 6 and 12 months later. Thirty cats did not have abnormalities evident on cystograms obtained at the time of initial examination. Of these, 1 had abnormalities on a cystogram performed 6 months later and another had abnormalities on a cystogram performed 12 months later. Abnormalities evident on cystograms included focal thickening of the bladder wall (n = 11), diffuse thickening of the bladder wall (6), irregularities of the bladder mucosa (10), decreased opacity of the bladder wall (3), increased opacity of the bladder mucosa (3), filling defects (4), contrast medium in unexpected locations (3), and altered ureteral opacity (15). CLINICAL IMPLICATIONS: Results suggested that a large percentage of cats with idiopathic cystitis do not have cystographic abnormalities when initially examined but that abnormalities may be apparent during follow-up evaluations. In addition, a smaller percentage of cats with idiopathic cystitis may have nonspecific cystographic signs of cystitis or hemorrhage. Leakage of contrast medium into the peritoneal space during cystography does not necessarily require surgical management.

Animals↗

Activation of CNS circuits producing a neurogenic cystitis: evidence for centrally induced peripheral inflammation.

We present a model of neurogenic cystitis induced by viral infection of specific neuronal circuits of the rat CNS. Retrograde infection by pseudorabies virus (PRV) of neuronal populations neighboring those that innervate the bladder consistently led to a localized immune response in the CNS and bladder inflammation. Infection of bladder circuits themselves or of circuits distant from these rarely produced cystitis. Absence of virus in bladder and urine ruled out an infectious cystitis. Total denervation of the bladder, selective C-fiber deafferentation, or bladder sympathectomy prevented cystitis without affecting the CNS disease, indicating a neurogenic component to the inflammation. The integrity of central bladder-related circuits is necessary for the appearance of bladder inflammation, because only CNS lesions affecting bladder circuits, i.e., bilateral dorsolateral or ventrolateral funiculectomy, as well as bilateral lesions of Barrington's nucleus/locus coeruleus area, prevented bladder inflammation. The close proximity in the CNS of noninfected visceral circuits to infected somatic neurons would thus permit a bystander effect, leading to activation of the sensory and autonomic circuits innervating the bladder and resulting in a neurogenic inflammation localized to the bladder. The present study indicates that CNS dysfunction can bring about a peripheral inflammation.

Animals↗

[Long-term monitoring of female acute uncomplicated cystitis cases after lomefloxacin single-dose therapy].

Female acute uncomplicated cystitis responds relatively well to antimicrobial chemotherapy, but this is also a disease which shows a high frequency of recurrence. However, there have been no published reports regarding long-term monitoring of the course of this disease after therapy has been administered. Accordingly, using primarily a questionnaire, the authors carried out long-term monitoring (for a mean of 242 days) of the natural course of cases of female acute uncomplicated cystitis after single-dose therapy with lomefloxacin (LFLX), a new quinolone antimicrobial agent. The subjects of this study were female patients diagnosed as having acute uncomplicated cystitis with pain upon urination, pyuria (> or = 10 WBCs/hpf) and bacteriuria (> or = 10(4) cfu/ml). LFLX was orally administered as a single dose of 100 mg or 300 mg, and the therapeutic efficacy was evaluated on the 3rd and 7th days thereafter. In principle, the evaluation of cure was performed on the 7th day after LFLX administration, and monitoring was conducted to detect early recurrence during the next 7 days (i.e., through the 14th day after treatment). Then the subjects were monitored for late recurrence during a mean follow-up period of 242 days by means of a questionnaire. Confirmation of recurrence was carried out to the greatest extent possible. It was possible to carry out long-term monitoring of the natural course of 101 cases of female acute uncomplicated cystitis in which the clinical efficacy on the 3rd day after LFLX treatment had been evaluated as good or excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

Discovery of morphological subgroups that correlate with severity of symptoms in interstitial cystitis: a proposed biopsy classification system.

PURPOSE: We identified morphologically distinct subgroups in interstitial cystitis using cluster analysis and investigated the associations between cluster membership and urinary symptoms. MATERIALS AND METHODS: Of 637 patients enrolled in the Interstitial Cystitis Data Base Study 203 (32%) provided bladder biopsies at baseline screening, representing the focus of this analysis. A cluster analysis algorithm implemented in SAS PROC CLUSTER using standardized distances to measure the dissimilarity of each pair of patients with respect to select histopathological features was used to construct subgroups of these patients. Multivariate regression models for baseline nighttime and 24-hour voiding frequency, urinary urgency and pain were developed, incorporating indicator variables for cluster membership as predictors. Longitudinal urinary symptom profiles during 3 years of followup were also compared among the morphology clusters. RESULTS: Three morphology clusters were identified, corresponding to unique pathological groupings. In cluster C2 7 patients showed multiple pathological features of parenchymal damage, including several inflammatory features. In cluster C1 17 patients was characterized by complete denudation of the urothelium and variable edema. In cluster C0 in 179 patients none of the pathological features were present above the specified thresholds for C2. Cluster membership was significantly associated with baseline nighttime and 24-hour frequency (p <0.001, and with urinary urgency (p = 0.03). These significant increases in baseline symptom severity among clusters from C0 to C1 to C2 persisted throughout the 3 years of followup. CONCLUSIONS: These results suggest an important role for histopathological features in the predictive modeling of interstitial cystitis symptoms.

Adult↗

Responsiveness of symptom scales for interstitial cystitis.

OBJECTIVES: To evaluate the responsiveness of composite scales to change over time in a clinical trial of patients with interstitial cystitis (IC). The measurement of symptoms in IC includes the O'Leary-Sant Symptom and Problem Indexes and the University of Wisconsin Interstitial Cystitis Inventory and scales that measure the individual symptom domains of pain/discomfort, urgency, and voiding frequency. METHODS: The data were derived from a randomized clinical trial conducted by the Interstitial Cystitis Clinical Trials Group. Participants met the National Institutes of Health-National Institute for Diabetes, and Digestive and Kidney Diseases criteria for IC and reported at least moderate pain and frequency. The primary endpoint was a patient-reported global response assessment (GRA) at 24 weeks. Secondary endpoints included the three composite indexes, pain/discomfort and urgency, and 24-hour frequency. Responsiveness was assessed by comparing symptom score changes against response categories defined by the GRA. RESULTS: Of the 121 subjects in the original trial, 94 with complete data were included. All three composite indexes were sensitive to subject improvement over time as measured by the GRA. A 1.2-point change in the O'Leary-Sant indexes and a 3.1-point change in the Wisconsin IC inventory corresponded to a one-category change in the GRA. Individual symptoms were also responsive. The correlation was high among the changes in the six outcome measures. CONCLUSIONS: The three composite symptom scales are responsive to change over time in patients with IC. These indexes provide important insight into symptom changes and are recommended as secondary endpoints in future clinical trials of IC. Additional endpoints addressing individual symptom domains should also be considered to aid in the evaluation of effect mechanisms.

Adolescent↗

A diagnostic in vitro urine assay for interstitial cystitis.

OBJECTIVES: A low molecular weight urine factor that inhibits the proliferation of normal bladder epithelial cells in vitro was previously shown to be present significantly more often in the urine of patients with interstitial cystitis (IC) than in the urine of asymptomatic age-, race-, and sex-matched control subjects. We sought to determine the specificity of this finding for IC by determining whether the urine of patients with other urogenital inflammatory disorders also contains a factor that inhibits bladder epithelial cell proliferation. METHODS: Urine was collected from women with IC, acute bacterial cystitis, or vulvovaginitis, as well as from asymptomatic control women. The proliferation of primary normal adult bladder epithelial cells was determined by measuring 3H-thymidine incorporation in vitro. RESULTS: Osmolality- and pH-corrected urine specimens from 50 (86%) of 58 women with IC significantly inhibited human bladder epithelial cell proliferation compared with 3 (8%) of 36 asymptomatic control women, 7 (12%) of 58 women with bacterial cystitis, and 0 (0%) of 12 women with vulvovaginitis (P < 0.001 for the comparison of mean percent change in 3H-thymidine incorporation with IC urine versus urine from each of the control groups). Optimal sensitivity and specificity values of 91.4% and 90.6%, respectively, were achievable at a cutoff of 25% inhibition of 3H-thymidine incorporation, using all three control groups. CONCLUSIONS: The measurement of urine antiproliferative activity may be a useful noninvasive means for diagnosing IC in women.

Adult↗

Ticarcillin-induced cystitis. Cross-reactivity with related penicillins.

Two children had dysuria, sterile pyuria, and microscopic hematuria develop during treatment with ticarcillin disodium. With the exception of a predominance of pyuria over hematuria, the clinical course and laboratory findings in this disorder were similar to those observed in hemorrhagic cystitis, a potential complication of the use of several semisynthetic penicillins and penicillin G potassium. One patient had urinary abnormalities develop during two courses of ticarcillin therapy and subsequently after initiation of piperacillin sodium therapy. A second patient in whom hemorrhagic cystitis due to carbenicillin disodium developed experienced this related disorder four years later when first exposed to ticarcillin. Neither reduction of the dose nor substitution of one semisynthetic penicillin for another (piperacillin for ticarcillin, ticarcillin for carbenicillin) prevented recurrence of the disorder. The clinical importance of either form of cystitis induced by semisynthetic penicillins is uncertain, as is the risk for progression to interstitial nephritis.

Carbenicillin↗