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A case of bullous cystitis with a right ureter stone seen in a 25-year-old male is described. Inflammatory tumorous cystitis was performed. One month after transurethral resection, there was inflammatory tumorous cystitis at the same position. Therefore, right ureterolithotomy and right ureterovesical neostomy were done. The patient is currently in good health 1 year and 5 months after the surgery.
Eubacterium suis was isolated from the bladders of 3 of 64 sows (4.7%) examined at slaughter. Two of the sows had cystitis similar to other descriptions of E suis infections in sows. There was no histologic evidence of cystitis in the third sow from which E suis was recovered. In all 3 instances, a mixed infection was present. Other bacteria present were predominantly gram-positive organisms. Eubacterium suis cystitis may be more prevalent than previously suspected. The special culture conditions required to grow this organism may account for the paucity of reports in the United States.
Fosfomycin (FOM) is an antibiotic which inhibits phospho(enol)pyruvic acid transferase. Fifty-five patients with cystitis were treated with the drug for 7 days, at oral doses of 1 g for 3 times a day. Adult females under 70 years of age, visiting the clinic within 2 weeks after the onset, were classified as cases with typical simple cystitis with confirming the bladder irritability, pyuria and bacteriuria. The treatment was effective for 95.0% of these cases. Two cases with atypical cystitis caused by Klebsiella pneumoniae poorly responded to the drug.
Chronic interstitial cystitis is a disease characterized by clinical recurring cystitis with histopathological aspects of a chronic aspecific inflammation of the bladder. Etiopathogenesis is still unknown, even if autoimmunity has been hypothesized in some cases. In this paper we report an immunopathologic and immunohistochemical study on a case of chronic interstitial cystitis. The inappropriate immunologic behaviour of the lymphocyte populations, the inhibition of leukocytes migration with bladder extracts and the immunofluorescent findings of IgG and C3 deposits in the mucosa support the hypothesis of an autoimmune pathogenesis of the disease.
Cinoxacin (CINX) was administered twice a day for 7 consecutive days (400 mg X 2/day) to 34 female patients suffering from acute simple cystitis. The overall clinical efficacy was excellent in 15 cases (94%) and moderate in one case (6%) according to the criteria for clinical evaluation by the UTI committee. The efficacy was not determined in 18 cases. Bacteriological examination revealed 11 cases of single infection by E. coli, 2 cases of single infection by P. cepacia and S. epidermidis and one case of single infection by S. sunguis. MIC of E. coli ranged from 3.13 to 6.25 micrograms/ml. MIC of P. cepacia was 3.13 micrograms/ml and MIC of S. epidermidis more than 100 micrograms/ml. All the strains were eradicated with the efficacy of 100%. There was no relapse of acute simple cystitis in 16 cases after 7 days treatment of CINX. No serious side effects were recognized except for slight general fatigue and heart burn in 2 cases. It was thus concluded that CINX is clinically effective and safe for acute simple cystitis caused by E. coli and P. cepacia.
UNLABELLED: The recurrence of female acute uncomplicated cystitis was investigated clinically. The criteria for the evaluation of recurrences were proposed, as follows; PATIENTS: Target infection is acute uncomplicated cystitis (AUC) which had satisfied the specifications of AUC Criteria by the UTI Committee of Japan and showed the excellent effects of an antimicrobial agent after a definite period of administration. Treatment period: Seven days; after 3 days' administration to evaluate the drug efficacy, patients shall take an additional 4 days' treatment. Interval of follow up proposed was 7 days. Evaluation of recurrence: Parameters of criteria are pyuria and bacteriuria. Recurrence: Pyuria greater than or equal to 10 WBCs/hpf and bacteriuria greater than or equal to 10(4)/ml. Evaluation of the day of recurrence: Evaluation should be made 14 days after the start of treatment. Urine sampling: After 7 days of treatment, midstream urine is collected and in cases with positive findings, catheterized urine should then be collected. Using these criteria it will be possible to evaluate and compare the ability of various antimicrobial agents to cure acute uncomplicated cystitis.
Histopathological examination of the urinary bladders of 63 patients dying in a geriatric clinic was performed. In 40 of 51 patients who had been treated with a urinary catheter, histological changes of polypoid cystitis were found. In 34 of the bladders the lesion engaged the posterior wall which corresponds to the localization of the tip of the catheter. The frequency of polypoid cystitis increased with increasing time of catheter treatment and reached its peak by three months. After that time the frequency was relatively constant. The frequency of polypoid cystitis seemed not to be influenced by bacterial urinary tract infection. Urothelial atypia was not seen after the catheter treatment.
We describe the histochemical properties of mucin in three cases of cystitis glandularis affecting the urinary bladder. Of particular importance is the positive staining reaction that was obtained with the periodate borohydride/potassium hydroxide/PAS (PB/KOH/PAS) technique, indicating the presence of O-acetylated sialic acids. This reaction has been regarded as unique to the epithelial mucins in the normal terminal ileum and large intestine. Therefore, cystitis glandularis represents a true mucous metaplasia of large intestinal type. A case of primary adenovillous carcinoma of the bladder associated with cystitis glandularis also produced O-acetylated sialomucin, whereas a primary adenocarcinoma of urachal origin did not. The demonstration of O-acetylated sialic acid producing glandular epithelium in the bladder cannot be assumed to represent a metastasis from a colorectal cancer. The PB/KOH/PAS staining technique may provide a means of distinguishing between primary adenovillous and primary urachal carcinoma of the bladder.
Clavulanic acid (CA) competitively inhibits beta-lactamase hydrolysis of penicillins in vitro. Treatment with amoxycillin combined with clavulanic acid (A-CA) was compared with placebo in a blind study in cats with experimental cystitis caused by Escherichia coli demonstrating in vitro resistance to amoxycillin. Bacterial cystitis was induced in 20 cats by bladder infusion of 5 ml of 0.05 per cent alcoholic salicylic acid followed after 24 hours by a brain-heart infusion broth of E coli (10(8) colony forming units ml-1) previously found to be resistant to amoxycillin in vitro (minimum inhibitory concentration over 512 micrograms ml-1). Four days after infection, cats were randomly divided into two groups of 10 and treated with amoxycillin combined with clavulanic acid or placebo for 10 days. When compared to the placebo-treated group, the A-CA treated group showed: reduced quantitative bacterial counts in urine on days 7 (P less than 0.001) and 14 (P less than 0.02); reduced culture positive urine on days 7 (P less than 0.001) and 14 (P less than 0.001); and less severe inflammation on histological examination of the bladder and urethra (P less than 0.01). It was concluded that A-CA was effective in reducing the bacterial count and reducing the histopathological changes in the bladder and urethra in an experimental model of acute bacterial cystitis in cats infected with an E coli demonstrating in vitro resistance to amoxycillin.
Two patients presented with macroscopic haematuria and dysuria. Cytoscopic examination showed haemorrhagic cystitis. The findings of casts in the urine and of impaired renal function led to renal biopsies. These showed glomerulonephritis with deposits of IgA in the mesangium. No evidence of viral infection was found. A third patient diagnosed on biopsy 9 years previously as having focal glomerulonephritis developed gross haematuria and dysuria. Cystoscopy revealed haemorrhagic cystitis, and deposits of immunoglobulins were present in the bladder wall. It is suggested that haemorrhagic cystitis may occur as part of a syndrome with glomerulonephritis and may be due to an immunological mechanism.
Eosinophilic cystitis, of which 35 cases have been published, is a recurrent cystitis remarkable for its chronicity and for the importance of haematuria; the urine is usually sterile and blood eosinophilia frequently present; at histology, infiltration of the vesical wall by eosinophils is pathognomonic. In view of the irregular results of cortico-steroid treatment, a search for causative factors is required. Parasitic infestation has been suspected but never actually proven, and an allergic origin probably is frequently missed. We report two cases of eosinophilic cystitis where allergy to penicillin and clometacin respectively could be demonstrated for the first time and in which the condition subsided after withdrawal of these drugs.
This article analyzes a series of 302 female patients prone to cystitis. The fact that these women were seen in a urological crenotherapy center highlights the very evolutive nature of the disease. The high rate of E coli present in the urine should be noted. Most of the women had a normal intravenous urogram and a normal endoscopy. The "classic" causes are rarely responsible for attacks of cystitis, but sexual intercourse and pregnancy seem to play a part. Several of the women took estroprogestative pills, or wore an intra-uterine device. The rate of bowel symptomatology-colopathy or constipation--should be noted. The article assesses the evolution of cystitis before and after crenotherapy at La Preste.
When adult male Wistar-Kyoto rats had been injected intra-peritoneally with a dose of 100 mg/kg of cyclophosphamide (CP), their urinary bladders showed changes of thickening and haemorrhage visible macroscopically, and oedema, necrosis and haemorrhage of the mucosa visible microscopically. There was an increase in bladder weight from an average of 60 mg in untreated control rats to an average of 125 mg in the CP-treated rats. When in addition they had been given 400 mg/kg of a thiol drug, namely either penicillamine or its disulphide, or N-acetylcysteine (NAC) or its S-carboxymethyl derivative carbocysteine, the increase in bladder weight and the histologic changes of haemorrhagic cystitis were found to be prevented by the co-administration of penicillamine or NAC but not by penicillamine disulphide or carbocysteine. The leucopenia caused by CP was not prevented by co-administration of these thiol drugs. It is concluded that penicillamine, like NAC, is effective in preventing CP-induced cystitis but not at the expense of reducing the cytotoxicity of CP. The inefficacy of penicillamine disulphide and carbocysteine suggests that significant dissociation of the disulphide does not occur in vivo and that the thiol moiety is important in preventing the cystitis. Penicillamine, a thiol compound with anti-rheumatic and possible anti-tumour effects, may thus prove to be a very useful adjunct to CP therapy.
The author reports a case of severe disturbance of micturition due to a cystitis in a 17 years old adolescent. As no cause was found, a biopsy was taken by endoscopy which revealed an inflammatory process involving the full thickness of the bladder wall with a great many eosinophils. The particular interest of this case presentation resides in the effectiveness of the immuno-suppressive treatment. Three tablets of Imuran for six weeks led to the cure of this patient. The authors review the literature of this rarely published condition. They classify it into the broader group of interstitial cystitis. The authors cite their case as an argument in favour of the auto-immune origin of these interstitial cystitis. The effectiveness of immuno-suppressive therapy is the best proof.
This paper describes a study of patients with cystitis treated with 1 gm/day of cinoxacin or four tablets/day of co-trimoxazole (trimethoprim, 80 mg, and sulfamethoxazole, 400 mg), both drugs given twice a day for 14 days. Of the 64 patients with cystitis, complete bacteriological data were available for 27 patients in the cinoxacin group and 23 patients in the co-trimoxazole group. In most instances, the infecting organism was Escherichia coli. Twenty-six (96%) patients who received cinoxacin and 22 (96%) patients who received co-trimoxazole had a satisfactory clinical response. Two patients on cinoxacin became reinfected with a new pathogen, and one had a recurrence of infection with the same pathogen; on patient on co-trimoxazole became reinfected with a new pathogen. Adverse reactions were reported by six (19%) of the 32 patients in the cinoxacin group, none of whom discontinued therapy, and by 18 (56%) of the 32 patients in the co-trimoxazole group, five of whom withdrew from the study. These differences between the groups were significant (P less than 0.05). It is concluded that cinoxacin is an effective, well-tolerated agent for use in cystitis caused by the common pathogens.
The authors emphasise the importance of radiological investigation of all children with urological infections. The key studies are complete intravenous urography and retrograde cystography. A broad sub-division of situations may be used to draw a distinction between recurrent cystitis in the young girl with an organic cause (urethral stenosis) and recurrent cystitis of functional origin. Organic urethral stenosis may be diagnosed immediately on the basis of radiological findings of an association of vesical hypertrophy and a permanent narrowing of the distal urethra with proximal dilatation, persisting during the different phases of micturition. This possibility is rare. By contrast, functional causes are much more common: spasm of the striate sphincter, absence of inhibition of the bladder, neurological dysfunction resulting in a non-neurogenic neurogenic bladder. There remains recurrent cystitis due to insufficiently frequent micturition. Analysis of the factors actually responsible for recurrent infections in any given child may be made difficult when they are present in association.
A morphological analysis of biopsy specimens from 32 patients with chronic cystitis allowed proliferative and nonproliferative forms of the disease to be distinguished. Chronic cystitis with von Brunn cell nests, cystic and glandular cystitis comprise different stages of the same pathological process which shows no trend for malignization. They may be considered to be the background diseases in the development of the bladder cancer. Vesical leukoplakia tends to malignancy and should be considered as a facultative precancer. Structural-metabolic reorganization in the connective tissue of the submucous layer with impairment of the vessel wall permeability regularly precedes the development of proliferative changes in the epithelial layer of the bladder wall.
OBJECTIVE: To determine the kinds of self-care used by women with interstitial cystitis and to find effective ways to manage symptoms of acute attack. STUDY DESIGN: One hundred thirty-eight women with interstitial cystitis completed a survey indicating how often they used and how effective they found strategies in four physical self-care subdomains (medication, treatment, diet, and body comfort) and three psychologic self-care subdomains (cognitive/stress reduction, distraction, and help-seeking). RESULTS: Descriptions of symptoms during an "acute attack" are more consistent with symptoms described "at onset" than symptoms experienced "currently." Physical strategies most used for acute attack included use of narcotics, antidepressants, and bladder analgesics, in addition to limiting the diet to bland or starchy foods, wearing loose clothing, taking hot baths, and using a heating pad over the pubis. Psychologic strategies most used included watching television, prayer, and seeking support from a significant other, family members, friends, and other patients with interstitial cystitis. CONCLUSIONS: Some psychologic and physical strategies found to be effective for other chronic pain conditions, such as biofeedback, alternating use of heat/cold, self-hypnosis, and redefining pain sensations were seldom used. Other nonmedical interventions such as massage and imagery, when used, were found to be more moderately to highly effective. Information about self-care and access to support groups may increase exposure to multiple ways of handling acute attacks.