Cystitis

Cystitis — Is inflammation of the bladder mucosa.

Cystitis can be acute and recurrent, infectious and noninfectious, complicated and uncomplicated. The most common form of the disease — Acute uncomplicated cystitis. Uncomplicated cystitis refers to cystitis in non-pregnant women without anatomical and functional abnormalities of the urinary system, without serious concomitant diseases.

Acute cystitis — one of the most common diseases in women. More than 50% of women have been diagnosed with this condition at least once in their lives.

Anatomy

Anatomically, the female urethra is much shorter and wider than the male urethra, is 2-4 cm long and is located close to natural possible sources of infection, such as the vagina and anus. In men, the length of the urethra is about 20 cm and is anatomically divided into several sections. Before entering the bladder, the urethra passes through the prostate gland, which is a natural barrier that prevents the entry of infection into the bladder.

Predisposing factors

Predisposing factors for the development of cystitis are:

• Anatomo-physiological features of the female body, a change in the location of the urethra;
• Excessive sexual activity;
• A new sexual partner, frequent change of sexual partners;
• Use of spermicides;
• An episode of urinary tract infection (UTI) in childhood;
• A history of urinary tract infections in the mother.

The causative agent of acute cystitis in 70-95% of cases is E.coli — Escherichia coli. Other pathogens, such as staphylococcus, Klebsiella, protei, are much less common.

Symptoms of acute cystitis

Symptoms of cystitis most commonly include:

• frequent painful urination (dysuria); ;
• Unpleasant urine odor.

These complaints alone or in combination occur in 90% of women with acute cystitis. Body temperature over 37.3°C is not characteristic of cystitis and may indicate a more serious inflammatory process in the kidneys — acute pyelonephritis.

Blood in the urine — hematuria — Usually causes panic fear in women, but is most often a sign of common cystitis.

The combination of pain during urination and an admixture of blood in the urine suggested acute bladder inflammation (hemorrhagic cystitis) rather than other, more serious urologic pathology — For example, a tumor of the urinary tract, in the presence of which dysuria is uncharacteristic.

Blood in the urine may also appear due to chronic cystitis, leading to an increase in the number of blood vessels (hypervascularization) in the submucosal layer of the bladder, their fragility and tendency to hemorrhage.

Other possible causes of hemorrhagic cystitis: radiation therapy, chemotherapy, use of certain medications.

Cystitis accompanied by blood in the urine may occur acutely, without signs of chronic inflammation and the preceding factors. The treatment algorithm is usually limited to the same measures as in acute cystitis without hematuria.

Diagnosis

The diagnosis of acute cystitis is established on the basis of the patient’s complaints. To clarify the diagnosis, a general urinalysis is used, ideally — urinalysis with test strips.

The prescription of treatment for acute cystitis is also possible only on the basis of the patient’s complaints (so-called empirical therapy), without obtaining the results of urinalysis. Urine sampling for culture (bacteriological study) is not obligatory for patients with uncomplicated cystitis. Urine culture is only necessary in a number of cases, such as: the presence of pregnancy, suspected acute pyelonephritis, a prolonged course of cystitis (more than 2 weeks), atypical course of the disease. In the presence of bacteria in the urine culture — more than 10? — The diagnosis of acute cystitis may be confirmed microbiologically.

The ultrasound or other imaging techniques are not included in the algorithm for diagnosing acute cystitis. There may be no specific findings on ultrasound of the bladder. Ultrasound signs such as «Thickening of the bladder wall» и «The presence of bladder suspension», Do not talk about the mandatory inflammation of its mucosa. The purpose of ultrasound most often is to rule out bladder tumors and ureteric stones.

Cystoscopy is contraindicated in acute cystitis.

Differential diagnosis

Vaginitis. Characterized by frequent urination associated with vaginal irritation. A mild, sluggish course. Predisposing factors may be excessive sexual activity, frequent changes in sexual partners (new sex partner). Blood in the urine, pain during urination, pain in the lower abdomen is usually absent. Examination may reveal a vaginal discharge that reveals an inflammatory process.

Urethritis. This disease is also characterized by frequent, painful urination, but the severity of symptoms is usually weaker than in acute cystitis. The most common causes of urethritis are gonorrhea, trichomoniasis, chlamydia and herpes simplex virus. The disease may also occur due to a change in sexual partner. urethral discharge is more common in men.

Treatment of cystitis

The basis of treatment of acute cystitis is antibacterial therapy.

It has been proven that 90% of women have symptoms of acute cystitis within 72 hours after starting antibiotic therapy.

First-line drugs for acute cystitis are those that create a high concentration of the active substance in the urine and a low concentration in the blood, that is, drugs that act primarily in the urinary tract.

Fosfomycin. A broad-spectrum antibacterial drug (granules for oral administration) with a high concentration of the active substance. In acute cystitis, its peculiarity is a single dose — One dose of the drug is enough (3 g for adults). Used for initial manifestations of cystitis. If there are signs of bladder inflammation within a few days, another dose may be used (24 hours after the first dose).

Nitrofurantoin macrocrystalline. Nitrofurantoin is one of the oldest antimicrobial drugs, but, nevertheless, the level of resistance to it has remained low for several decades. However, it should be remembered that the overly broad use of nitrofurantoin in the treatment of acute cystitis is unwarranted due to the relatively high frequency of adverse drug reactions to this drug, primarily acute and chronic pulmonary syndromes, which are often seen in the elderly. The recommended dose and duration of treatment of uncomplicated acute cystitis with nitrofurantoin is 50-100 mg x 4 times daily, 5-7 days for acute infection, 50-100 mg at night for prevention of recurrence.

Antibacterial drugs that act systemically, Are not recommended for the treatment of acute uncomplicated cystitis as first-line drugs, and can only be used as Possible alternative.

Cephalosporins. A group of broad-spectrum antibiotics. Produce high concentrations of the active substance not only in the urine but also in the blood. There are 4 generations of cephalosporins. Used for a variety of conditions: from sinusitis to peritonitis. In the treatment of acute cystitis, tablet forms of the antibiotic are most commonly used. Dosage: 400 mg (1 tablet).) x 1 time a day for 3-5 days.

Alternative antibacterial drugs:

Fluoroquinolones. A highly effective group of antibiotics, widely used in urological practice. Most commonly prescribed Ciprofloxacin, Levofloxacin. Used in the treatment of acute cystitis, but not currently recommended for empirical therapy due to increasing resistance in patients. Prescribed according to the results of bacteriological urine culture in the presence of sensitivity to them, more often used in the treatment of pyelonephritis, prostatitis. Contraindicated in pregnant women and patients under 18 years of age. Regimen: Ciprofloxacin (Ciprobacin, Ciprolet) — 250 mg x 2 times a day for 3-5 days.

Penicillins. The very first, artificially synthesized group of antibiotics. Representative: Amoxicillin. Not recommended for empirical therapy of acute cystitis due to increased E. coli resistance worldwide. However, the combination of Amoxicillin and clavulanic acid can be used in some cases, for example, in the presence of inflammation of the bladder mucosa in pregnant women. Regimen: Amoxicillin + clavulanic acid (Amoxiclav, Augmentin) 625 mg x 3 times a day for 7 days.

The basis of treatment cystitis in pregnant women is also the prescription of antibiotic therapy, but not all drugs are approved for use. Monural, Furamag and a penicillin antibiotic or cephalosporin group is acceptable.

The use of other drugs, herbal remedies, dietary supplements in the treatment of acute cystitis is ineffective, because there is a high probability of preservation of the pathogen and the occurrence of relapse of the disease.

Earlier recommendations to use a natural uroantiseptic have been encountered — Cranberries (plenty of cranberry juice). There is evidence in several studies of the effectiveness of cranberry in reducing the incidence of urinary tract infections in women. However, in a meta-analysis involving 24 studies and 4,473 patients, it was shown that foods containing cranberries, Do not statistically significantly reduce Frequency of urinary system infections, including acute cystitis in women.

If the patient for some reason demonstrates reluctance to drink antibiotics, it is allowed to prescribe anti-inflammatory drugs and analgesics to reduce the severity of dysuria and discomfort in the lower abdomen.

Phenazopyridine — Refers to analgesics for pain relief in inflammatory diseases of the bladder and urinary tract. Excreted with urine, providing local analgesic effect on urinary tract mucosa. Does not, by itself, get rid of bacteria or damage to the mucosa, is used only for symptom reduction. Can be used in conjunction with antibiotics to reduce discomfort. It is recommended to use no more than 2 days, as a longer treatment may mask the symptoms of the disease. Also used for elimination of discomfort, cutting during urination after bladder catheterization, endoscopic interventions, urethral surgeries.

Nonsteroidal anti-inflammatory drugs — Have a pronounced anti-inflammatory, analgesic, and moderate antipyretic effect. Widely used in urological practice, often in the form of rectal suppositories. The most popular: Diclofenac, Indomethacin, Ketoprofen. In special cases, in the absence of the possibility of taking an antibiotic and the presence of recurrent cystitis, can serve as the main medication for a short time.

Cystitis in men

Extremely rare. This is due to the longer urethra than in women, the smaller number of bacteria in the periurethral zone, the presence of antibacterial components in the prostate secretion. Factors contributing to cystitis in men include diagnostic manipulations and surgical procedures on the urinary tract, radiation therapy, chemotherapy, unprotected anal intercourse. Treatment is carried out with antibacterial drugs that are also used in the treatment of prostate inflammation: Ciprofloxacin 500 mg x 2 times a day, for at least 7 days.

After an episode of acute cystitis. Preventive measures

After adequate treatment of acute cystitis there is no need for additional examinations. Adequate fluid intake, avoidance of hypothermia, personal hygiene, hygiene of sexual life, timely treatment of gynecological diseases, sexually transmitted infections are recommended. Prophylactic use of any drugs after a single episode of acute cystitis is not indicated.

If the symptoms of cystitis occur within two weeks after treatment and the therapeutic effect is absent, the urine should be examined for culture and the sensitivity of the isolated pathogens to antibiotics should be determined (take a urine culture). According to the results of the bacteriological culture is recommended the appointment of an antibacterial drug according to the sensitivity to it of the pathogen.