Protásio Alves, MD. Associate Professor, Surgery-Urology Department, Rio Grande do Sul State University (UFRGS).

Cláudio Lima, MD, M.A. in Surgery-Urology, Rio Grande do Sul State University (UFRGS).

What’s it and how is it acquired?

Cystitis is what the inflammatory and/or infectious diseases of the urinary bladder are called. The most frequent cystitis cases are caused by germs from our intestinal tract. One of these is the bacterium known as Escherichia coli. These bacteria are found in the feces. In special situations, these bacteria migrate, contaminating the region where the genital organs are located. After a period of multiplication, these bacteria may invade the urethra and settle down in the urinary bladder, causing infectious cystitis. This situation is easier to occur in women, especially due to anatomic causes.

Other types of infectious agents can also cause cystitis, e.g., Koch’s bacillus. In this case, we have a tuberculosis cystitis.

In immunodepressed patients (HIV-positive patients or HIV carriers), or those undergoing chemotherapy, fungal cystitis is common.

There are non-infectious cystitis cases of inflammatory origin. Patients undergoing radiotherapy to pelvic organs (womb, prostate) may acquire a vesical inflammation called radiation cystitis.

Another type of non-rare cystitis is interstitial cystitis of unknown cause. It’s an insidious, chronic inflammation, with a tendency to decreased urinary bladder capacity, bringing about pain and discomfort to the patient.

Infectious cystitis is caused by predisposing anatomic, constitutive and genetic factors, instrumentation of the urinary apparatus (use of urethral probes), surgeries in the urinary apparatus, urinary apparatus diseases (stones), sexual activity, and presence of vaginal discharge.

What does one feel and how does it manifest?

Cystitis patients complain about an increase in urinary frequency (pollakiuria), urinary urgency, pain in the urinary bladder (cystalgia), and painful and difficult urination (dysuria). The urine may present a characteristic odor, as well as blood. General discomfort, lower lumbar pains, and irritation may accompany the condition. Fever usually doesn’t accompany cystitis in adults. Mild or moderate hyperthermia may be present in children. There are situations in which the patient has germs in the urine without any symptom. It’s the so-called asymptomatic bacteriuria (bacteria in the urine).

In other types of non-infectious cystitis, symptoms are the same, but with one difference only: the absence of germs in urine tests. There are no symptoms differentiating between an infectious cystitis and a non-infectious one.

How is the diagnosis achieved?

Patient history is important for locating the involved organ. A qualitative urine test gives us a notion about counts of leukocytes, red blood cells and density. However, the most important exam is urine culture with antibiogram. This test is the only one that will differentiate between an infectious cystitis and a non-infectious one. It identifies the bacteria, and, by means of the antibiogram, guides the choice of the best antibiotics for the treatment. Should the urine culture point out to the absence of germs, the diagnosis of non-infectious cystitis is the most likely. There are conditions that mimic cystitis, as is the case of bladder carcinoma in situ and the diagnosis is achieved through biopsies of the vesical mucosa. Ureteral calculi may elicit symptoms similar to cystitis. Neurological diseases that affect the urinary bladder are another example.

Once infectious cystitis is diagnosed, we must look for its cause. Imaging exams (urinary apparatus radiographs, echography) and cystoscopy must be asked depending upon the case. The diagnostic approach varies according to patient age and gender. The same goes for non-infectious cystitis.

How is it treated?

Infectious cystitis is treated with antibiotics according to the urine culture result. If a cause is identified, this must be eliminated (e.g., renal calculus). Non-infectious cystitis is more complex when it comes to its treatment. Analgesics, anti-inflammatory, myorelaxant, anti-spasmodic drugs and local anesthetics are widely used resources. General measures also work, such as local heat, urine alkalisers, and teas.

In extreme situations, as in advanced interstitial cystitis, the bladder is removed from the patient.

What’s the prognosis?

Fortunately, infectious cystitis has a good prognosis. The problem is its recurrence, chiefly in women, with no clear cause being found most of the time.In many cases, the physician has to resort to a prolonged use of small daily doses of antibiotics to prevent recurrence.

Interstitial cystitis poses a challenge for urologists, since its cause is unknown, and, thus, its treatment is impaired. Every year new drugs are introduced without bringing, however, a significant benefit to patients.

Radiation cystitis is less frequent than years ago, owing to modern radiotherapeutic devices.

Questions you can ask your doctor

What causes cystitis?

Is it transmissible?

Can cystitis cause cancer?