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A 66-year-old woman was admitted with asymptomatic macrohematuria. Cystoscopy revealed bladder tumor with a diameter of about 1.5 cm and smooth surface. Transurethral resection was performed and histological examination showed proliferative cystitis, mainly consisting of cystitis glandularis. Proliferative cystitis is not so rare, but tumorous formation of it seems to be unusual.
A 7-year-old castrated male Miniature Poodle had recurrent episodes of cystitis, perineal dermatitis, and urine leaking from the perineum during active micturition. Urethrorectal fistula, urethroperineal fistula, and urethral duplication were diagnosed by positive-contrast fluoroscopic retrograde cystography and voiding cystourethrography. The urethrorectal fistula was resected through an ischial-pubic flap osteotomy, and the urethroperineal fistula was resected by use of a perineal approach. The dog developed urinary incontinence that resolved by 48 hours after surgery. Cystitis and urine scald were not evident 6 months after surgery. Treatment of urethral duplication is not necessary, unless clinical signs of cystitis or urine leakage develop.
OBJECTIVE: To determine the efficacy, safety, and costs associated with four different 3-day regimens for the treatment of acute uncomplicated cystitis in women. DESIGN: A prospective randomized trial with a cost analysis. STUDY POPULATION: Women with acute cystitis attending a student health center. INTERVENTIONS: Treatment with 3-day oral regimens of trimethoprim-sulfamethoxazole, 160 mg/800 mg twice daily, macrocrystalline nitrofurantoin, 100 mg four times daily, cefadroxil, 500 mg twice daily, or amoxicillin, 500 mg three times daily. RESULTS: Six weeks after treatment, 32 (82%) of 39 women treated with trimethoprim-sulfamethoxazole were cured compared with 22 (61%) of 36 treated with nitrofurantoin (P = .04 vs trimethoprim-sulfamethoxazole), 21 (66%) of 32 treated with cefadroxil (P = .11 vs trimethoprim-sulfamethoxazole), and 28 (67%) of 42 treated with amoxicillin (P = .11 vs trimethoprim-sulfamethoxazole). Persistence of significant bacteriuria was less common with trimethoprim-sulfamethoxazole (3%) and cefadroxil (0%) compared with nitrofurantoin (16%; P = .05 vs trimethoprim-sulfamethoxazole) and amoxicillin (14%; P = .11 vs trimethoprim-sulfamethoxazole). Persistence of bacteriuria was associated with amoxicillin-resistant strains in the amoxicillin group but nitrofurantoin-susceptible strains in the nitrofurantoin group. Trimethoprim-sulfamethoxazole was more successful in eradicating Escherichia coli from rectal cultures soon after therapy and from urethral and vaginal cultures at all follow-up visits compared with the other treatment regimens. Adverse effects were reported by 16 (35%) of 46 patients receiving trimethoprim-sulfamethoxazole, 18 (43%) of 42 receiving nitrofurantoin, 12 (30%) of 40 receiving cefadroxil, and 13 (25%) of 52 receiving amoxicillin. The mean costs per patient were less with trimethoprim-sulfamethoxazole ($114) and amoxicillin ($131) compared with nitrofurantoin ($155) and cefadroxil ($155). CONCLUSIONS: A 3-day regimen of trimethoprim-sulfamethoxazole is more effective and less expensive than 3-day regimens of nitrofurantoin, cefadroxil, or amoxicillin for treatment of uncomplicated cystitis in women. The increased efficacy of trimethoprim-sulfamethoxazole is likely related to its antimicrobial effects against E coli in the rectum, urethra, and vagina.
The treatment of cyclophosphamide-induced hemorrhagic cystitis is difficult. We report a successful case of severe cyclophosphamide-induced hemorrhagic cystitis treated with intravesical instillation of prostaglandin F2 alpha. A 32-year-old woman underwent high-dose cyclophosphamide conditioning before the autologous bone marrow transplantation. She developed clot retention which required continuous irrigation with normal saline. The patient had failed to respond to continuous bladder irrigation with saline and intravesical administration of 1% alum. Fifty ml of prostaglandin F2 alpha solution (1 mg in 100 ml normal saline) was instilled into the bladder, with a dwelling time of 60 minutes, three times a day for 5 days. The hematuria cleared completely 3 days after therapy. The only adverse effect was bladder spasm which was controlled with oxybutynin chloride. The success of this therapy suggests that prostaglandin F2 alpha is a safe and useful therapy for hemorrhagic cystitis secondary to cyclophosphamide chemotherapy.
OBJECTIVES: A multicentric double-blind double-placebo randomized trial was conducted to compare the effectiveness and safety of ciprofloxacin versus pefloxacin given in a single oral dose in female out-patients with acute cystitis. METHODS: A series of 561 female patients (age range 18-65 years) with signs of uncomplicated community acquired acute cystitis were randomly assigned to parallel groups given a single oral dose of ciprofloxacin (500 mg + placebo) or pefloxacin (800 mg + placebo). Clinical and bacteriological effectiveness was evaluated 12 +/- 2 days after the treatment day. RESULTS: The clinical outcome was equivalent for the two groups (92 vs 88.9% clinical cure for ciprofloxacin and pefloxacin respectively). Mean time to clinical resolution was about 40 hours in both groups. Urine sterilization was comparable in the two groups (80.8 and 81.1% respectively). Undesirable side effects (mostly digestive tract disorders and neurosensorial complaints) were reported in 16.1% of the patients taking ciprofloxacin and 18.1% of those taking pefloxacin (NS). Single-dose treatment was well accepted by 82.3 and 84.8% of the women respectively. CONCLUSION: These findings demonstrate that ciprofloxacin and pefloxacin are equally effective and equally well tolerated as single-dose oral curative therapy for acute cystitis in women.
Radiation cystitis with macroscopic hematuria has been a frustrating clinical problem for urologists. Since 1985 hyperbaric oxygen (HBO) has been used to treat this disease, showing favorable results. Between November 1989 and October 1992, 20 female patients with hemorrhagic radiation cystitis were treated with HBO at a pressure of 2.5 atm abs, breathing 100% O2 for 100 min in our multiplace hyperbaric chamber. After an average of 44 HBO sessions, macroscopic hematuria was completely halted in 16 patients (80%) and markedly decreased in 2 patients (10%). Comparison of the cystoscopic findings before and after HBO showed a significant decrease in hemorrhagic sites and telangiectasis of the bladder mucosa. One patient had urinary frequency and urgency without hematuria during her hospital stay. After 30 sessions of HBO therapy, her symptoms subsided, and the cystoscopic findings were much improved. Only one patient failed to respond to HBO and underwent ileal conduit diversion. The mean follow-up period was 14 mo. (5-41 mo.). From our clinical results and cystoscopic findings, we suggest that HBO is an effective and safe treatment for hemorrhagic radiation cystitis.
Emphysematous cystitis in man and domestic animals is reviewed. A case of emphysematous cystitis occurring 5 d after standard therapy for urethral obstruction in a non-diabetic male Siamese-cross cat is described. Escherichia coli was isolated, and the cystitis resolved after antibiotic therapy.
Interstitial cystitis (IC) is a form of painful bladder disease, characterized by chronic urinary urgency, frequency, and pain without evidence of bacterial infection. Ninety percent of patients with IC are women. Somatization disorder is a psychiatric diagnosis, given most often to women who report a variety of symptoms, such as dysmenorrhea, burning in sex organs, dyspareunia, irregular menstrual periods, and painful urination. Because diagnosis of interstitial cystitis may take many years, health care providers must be alert to the risks of the overdiagnosis of psychiatric problems and the underdiagnosis of interstitial cystitis.
The existence of a reliable and valid measure of interstitial cystitis symptoms would assist with diagnosis and the evaluation of treatment effectiveness. The purpose of this article is to report development of a scale to measure symptoms of interstitial cystitis. Data concerning the evidence of content and construct validity, as well as reliability, is provided. The findings suggest that this scale accurately measures the symptoms of interstitial cystitis.
This article concerns a survey conducted to determine the origin and history of interstitial cystitis. Information was elicited from 565 patients on demographics, risk factors symptoms, pain, and psychological factors. All those surveyed satisfied the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases (NIDDK) criteria for interstitial cystitis and have been diagnosed as having the disorder. Comparison of risk factors was made with a control group of 171 individuals, consisting of healthy individuals over 18 years old and of adults attending urology clinics for bladder disorders unrelated to interstitial cystitis.
BACKGROUND: Vulvar vestibulitis and interstitial cystitis are enigmatic and controversial conditions. They are increasingly recognized as important causes of genitourinary pain in young women. This report proposes an etiologic association between the two conditions. CASES: We report three patients with both vulvar vestibulitis and interstitial cystitis. Although an association between these conditions has previously been proposed, these are the first case reports of the coexistence of these conditions in the same patient. CONCLUSION: Because both the vestibule of the vulva and the bladder are derived from the urogenital sinus, we propose that the coexistence of vulvar vestibulitis and interstitial cystitis in some patients represents a generalized disorder of urogenital sinus-derived epithelium.
Interstitial cystitis is a common disease with non objective diagnostic criteria. In 1989 the National Institute of Health (NIH) defined symptoms and cystocopic findings in order to select patients to include in research programs on pathophysiology of interstitial cystitis. While there is no lack of theories, the etiology of interstitial cystitis remains obscure. Today, the general opinion is that the etiology is multifactorial and that we may be dealing with a syndrome rather than with a specific disease.
Interstitial cystitis is fairly common in primary care practices and very common in urology practices. Still, it is probably underdiagnosed. Because symptoms can be confusing, patients are sometimes thought to have psychogenic problems or are treated repeatedly with antibiotics, despite the absence of evidence of bacterial infection. The key to correct diagnosis is awareness of the condition and its characteristics. In patients who have symptoms that resemble routine cystitis but normal results on urinalysis, interstitial cystitis should be considered as the working diagnosis. This is especially applicable in women, who are affected far wore often than men. Various therapies have been tried, but the cure, like the cause, remains unknown. Many patients respond to some form of therapy and may even have long-term remissions. However, arriving at the form of therapy that relieves symptoms in a given patient is often a trial-and-error process. A short-term trial of various methods is warranted initially. Ultimately, however, referral to a urologist may be necessary for definite diagnostic testing and additional therapy.
PURPOSE: Although bacterial infection has been long considered a possible cause of interstitial cystitis (IC), no definitive proof for or against this hypothesis has been presented so far. We have used 16S rDNA bacterial polymerase chain reaction to study bladder biopsies and sterile urine samples from patients suffering from IC. This method is sensitive and detects all known eubacteria. MATERIALS AND METHODS: Bladder biopsies and sterile urine samples obtained by transabdominal puncture were studied from 11 patients with IC. As controls we studied 4 patients with other urological problems leading to partly similar symptoms and 5 healthy individuals. RESULTS: All samples from the IC patients were negative. One positive sample was obtained from a woman with a history of urinary tract infections who suffered from nonIC ulcerative cystitis. Her sterile urine sample yielded Lactobacillus acidophilus. CONCLUSION: These results indicate that an ongoing bacterial infection is not the cause of interstitial cystitis.
The involvement of nitric oxide (NO) and the potential modulation of NO synthase (NOS) activity by platelet-activating factor were investigated in a rat model of cyclophosphamide-induced hemorrhagic cystitis. Male Wistar rats received a single intraperitoneal injection of cyclophosphamide, and cystitis was evaluated 6, 12, 24, 48, and 72 hours later by determining the changes in bladder wet weight and plasma protein extravasation and the macro- and microscopic morphological alterations. In addition, NOS activity and NADPH-diaphorase histochemistry were studied in bladder tissues. Normal bladders showed extensive NADPH-diaphorase staining and a high level of constitutive NOS whereas the activity of inducible NOS was almost undetectable. Cyclophosphamide dose- and time-dependently increased the bladder wet weight and bladder plasma protein extravasation. These events were accompanied at a microscopic level by urothelial necrosis, sloughing, ulceration, hemorrhage, and leukocyte infiltration. Cyclophosphamide also increased the levels of inducible NOS but reduced those of constitutive NOS. The NOS inhibitors L-NG-nitroarginine methyl ester and L-NG-nitroarginine significantly reduced the cyclophosphamide-induced plasma protein extravasation and urothelial damage. This reduction was completely reversed by L-arginine but not by D-arginine. The administration of the platelet-activating factor antagonist BN 52021 decreased the cyclophosphamide-induced plasma protein extravasation as well as the rise in inducible NOS activity but had no effect on the fall in constitutive NOS activity. These results suggest that endogenous NO participates in the urothelial damage and in the inflammatory events leading to cyclophosphamide-induced hemorrhagic cystitis. Platelet-activating factor also seems to be involved in the pathogenesis of this condition, possibly by inducing NOS.
The cytologic findings of cystitis cystica glandularis--a form of proliferative cystitis which can be mistaken for a tumor clinically and radiologically have hardly been recorded. We describe a case of cystitis cystica where the bladder washings showed a spectrum of findings which were later corroborated on biopsy.
To determine whether keratinocyte growth factor (KGF), an epithelial and urothelial growth factor, ameliorates cyclophosphamide (CP)-induced cystitis in rats, KGF (5 mg/kg) was injected in rats as a single i.v. injection 24 h prior to i.p. injection of CP (200 mg/kg). Bladders were evaluated histologically 48 h after CP injection, and KGF pretreatment was found to almost completely prevent CP-induced ulcerative hemorrhagic cystitis. Urinary KGF levels were measured by ELISA, and KGF was found to be undetectable in control urine, but it was found to appear in the urine of KGF-treated rats at 8 h, with a peak concentration of approximately 10 ng/ml. Bilateral nephrectomy did not diminish the proliferative effect of KGF on urothelium, suggesting that the contribution of urinary KGF to urothelial proliferation is insignificant. In conclusion, systemic administration of KGF is protective against CP-induced cystitis. Although KGF appears in the urine, urinary KGF is not necessary for the proliferative action of KGF on urothelium.
PURPOSE: Hemorrhagic cystitis is a therapy-limiting side effect of cyclophosphamide (CP) treatment for cancer. The purpose of this study was to investigate the potential protective effect of L-2-oxothiazolidine-4-carboxylate (OTZ; Procysteine) on CP-induced cystitis in the rat. MATERIALS AND METHODS: Thirty-six rats were divided into 6 groups: Group 1--Untreated controls, Group 2--OTZ alone (100 mg./kg., p.o.), Group 3--CP alone (68 mg./kg., i.v.), Group 4--CP + OTZ (68 mg./kg., i.v. + 100 mg.,/kg., p.o.), Group 5--CP + OTZ (68 mg./kg., i.v. + 1.0 g./kg., i.v.), and Group 6--CP + OTZ (68 mg./kg.,i.v. + 1.0 gm./kg., i.p.). OTZ was given once a day to groups 2 and 4 on the day prior to and on the day of CP administration. OTZ was given twice a day to groups 5 and 6 on the day prior to, the day of, and the day after CP administration. On the day of CP administration, CP was given 30 minutes prior to OTZ. Blood and bladder samples were taken for evaluation two days after CP administration. RESULTS: Expected depression in blood cell parameters were identified in all groups receiving CP with no differences noted between the CP-treated groups. Histologic changes (cystitis) were identified in the bladders of all CP treated groups. The lesions in the CP + OTZ groups were found to be less severe than the groups that received CP alone, with higher dosages of OTZ resulting in a significant (p < 0.05) decrease in lesion incidence and severity. CONCLUSIONS: Under the conditions of this study, L-2-oxothiazolidine-4 carboxylate caused a reduction in the incidence and severity of cyclophosphamide-induced lesions in the urinary bladder of rats. Further studies are needed to investigate optimal dosage scheme, mechanism of action, and interference with anti-tumor activity and prevention of long-term side effects of cyclophosphamide.