Cystitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]

Overview

Cystitis may be classified according to the etiology and therapeutic approach into various subtypes such as traumatic, interstitial, eosinophilic, hemorrhagic cystitis, foreign body, emphysematous, and cystitis cystica. Cystitis can also be classified as acute or chronic depending on the duration of the infection. For the purpose of treatment, cystitis may also be classified into acute uncomplicated, complicated, and recurrent cystitis. It can be classified as bacterial, viral, fungal or parasitic depending on the causative pathogen.

Classification

Cystitis may be classified into several subtypes based on:[1]

Classification according to etiology

There are several medically distinct types of cystitis, each having a unique etiology and therapeutic approach:

Traumatic Cystitis

It is probably the most common form of cystitis in the female, and is due to bruising of the bladder, usually by abnormally forceful sexual intercourse. This is often followed by bacterial cystitis, frequently by coliform bacteria being transferred from the bowel through the urethra into the bladder. Lack of circumcision and intercourse are important risk factors for traumatic cystitis.[1][2]

Interstitial Cystitis

Interstitial cystitis is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. Certain urinary metabolites are being associated with the diagnosis of interstitial cystitis. Chronic interstitial cystitis can lead to changes in the expression of the neuropeptides leading to defected visceral sensations and hyperreflexia of the urinary bladder. Several therapies are now available.[3][4][5]

Eosinophilic Cystitis

It is a rare form of cystitis that is diagnosed by biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC may be attributed to infection by Schistosoma haematobium or by certain medications in afflicted children. Some consider it a form of interstitial cystitis.[6][7][8]

Hemorrhagic Cystitis

Blood in the bladder due to rupture of vessels, trauma, or tumour can act as an irritant and cause cystitis. Hemorrhagic cystitis can occur as a side effect of cyclophosphamide, ifosfamide, exposure to environmental toxins like aniline dyes, pesticides, and radiation therapy.[9] Radiation cystitis, one form of hemorrhagic cystitis is a rare consequence of patients undergoing radiation therapy for the treatment of cancer.[10] Several adenovirus serotypes have been associated with an acute, self-limited hemorrhagic cystitis, which occurs primarily in boys. It is characterized by hematuria, and virus can usually be recovered from the urine.[11][12][13][14]

Foreign Body Cystitis

This is the kind of inflammation of the urinary bladder that can result from foreign bodies like a kidney stone, tumour, contraceptive device, foley catheter, or an infection associated with these foreign bodies. When caused by a benign lesion obstructing the bladder, foreign body cystitis is called papillary or polypoid cystitis.[15][16][17][18]

Cystitis Cystica

This is a chronic cystitis glandularis accompanied by the formation of cysts. This disease can cause chronic urinary tract infections. It appears as small cysts filled with fluid and lined by one or more layers of epithelial cells. These are due to hydropic degeneration in the center of Brunn's nests.[19][20]

Emphysematous Cystitis

Emphysematous cystitis is associated with production of gas and is mostly caused by E Coli and klebsiella pneumoniae.[21]

Cystitis Glandularis

This is a premalignant type of cystitis. It is considered to be a precursor of adenocarcinoma of the bladder.[22]

Ketamine Cystitis

This kind of cystitis is caused by the anaesthetic agent, ketamine, which causes urothelial dysfunction.[23]

Classification according to pathogen

Cystitis can be classified according to the causative organisms.[24][25][26][27][28]

Classification according to duration and treatment

Cystitis may be classified based on the duration of infection and the treatment:

Acute uncomplicated cystitis[36]

  • Patients with acute uncomplicated cystitis have an infection that is restricted to the lower urinary tract and is most commonly seen in women with normal structure and function of the genitourinary tract and children older than age 2 years. Acute Urinary infections in men are always managed as complicated infections.
  • Patients with acute uncomplicated cystitis may be treated using a single antimicrobial therapy using either a single dose or a 3-day regimen.

Complicated cystitis[37][38]

  • Complicated urinary tract infections occur irrespective of age and gender in people who have either functional or structural malformations. Urinary tract infection in elderly men is always considered complicated.
  • Patients with complicated cystitis generally require a longer duration of therapy compared with patients with uncomplicated cystitis.

Recurrent/Chronic cystitis[5][39][40][41][42]

References

  1. ↑ 1.0 1.1 Hooton TM, Stamm WE (1997). "Diagnosis and treatment of uncomplicated urinary tract infection". Infect Dis Clin North Am. 11 (3): 551–81. PMID 9378923.
  2. ↑ Aydos MM, Memis A, Yakupoglu YK, Ozdal OL, Oztekin V (2001). "The use and efficacy of the American Urological Association Symptom Index in assessing the outcome of urethroplasty for post-traumatic complete posterior urethral strictures". BJU Int. 88 (4): 382–4. PMID 11564026.
  3. ↑ Kind T, Cho E, Park TD, Deng N, Liu Z, Lee T; et al. (2016). "Interstitial Cystitis-Associated Urinary Metabolites Identified by Mass-Spectrometry Based Metabolomics Analysis". Sci Rep. 6: 39227. doi:10.1038/srep39227. PMC 5156939. PMID 27976711.
  4. ↑ Friedlander JI, Shorter B, Moldwin RM (2012). "Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions". BJU Int. 109 (11): 1584–91. doi:10.1111/j.1464-410X.2011.10860.x. PMID 22233286.
  5. ↑ 5.0 5.1 Vizzard MA (2001). "Alterations in neuropeptide expression in lumbosacral bladder pathways following chronic cystitis". J Chem Neuroanat. 21 (2): 125–38. PMID 11312054.
  6. ↑ Kilic O, Akand M, Gul M, Karabagli P, Goktas S (2016). "Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children". Iran Red Crescent Med J. 18 (6): e24562. doi:10.5812/ircmj.24562. PMC 5002967. PMID 27621918.
  7. ↑ Okazaki S, Hori J, Kita M, Yamaguchi S, Kawakami N, Kakizaki H (2014). "[A case of eosinophilic cystitis mimicking an invasive bladder cancer]". Hinyokika Kiyo. 60 (12): 635–9. PMID 25602481.
  8. ↑ Leutscher PD, Pedersen M, Raharisolo C, Jensen JS, Hoffmann S, Lisse I; et al. (2005). "Increased prevalence of leukocytes and elevated cytokine levels in semen from Schistosoma haematobium-infected individuals". J Infect Dis. 191 (10): 1639–47. doi:10.1086/429334. PMID 15838790.
  9. ↑ Manikandan R, Kumar S, Dorairajan LN (2010). "Hemorrhagic cystitis: A challenge to the urologist". Indian J Urol. 26 (2): 159–66. doi:10.4103/0970-1591.65380. PMC 2938536. PMID 20877590.
  10. ↑ Wakamiya T, Kuramoto T, Inagaki T (2016). "[Two Cases of Spontaneous Rupture of the Urinary Bladder Associated with Radiation Cystitis, Repaired with Omentum Covering]". Hinyokika Kiyo. 62 (10): 545–548. doi:10.14989/ActaUrolJap_62_10_545. PMID 27919130.
  11. ↑ Russo P (2000). "Urologic emergencies in the cancer patient". Semin Oncol. 27 (3): 284–98. PMID 10864217.
  12. ↑ PHILIPS FS, STERNBERG SS, CRONIN AP, VIDAL PM (1961). "Cyclophosphamide and urinary bladder toxicity". Cancer Res. 21: 1577–89. PMID 14486208.
  13. ↑ Watson NA, Notley RG (1973). "Urological complications of cyclophosphamide". Br J Urol. 45 (6): 606–9. PMID 4775738.
  14. ↑ Cox PJ (1979). "Cyclophosphamide cystitis and bladder cancer. A hypothesis". Eur J Cancer. 15 (8): 1071–2. PMID 510344.
  15. ↑ Cunha BA, Lee P, Kaouris N, Raza M (2015). "The safety of nitrofurantoin for the treatment of nosocomial catheter-associated bacteriuria (CAB) and cystitis". J Chemother. 27 (2): 122–3. doi:10.1179/1973947814Y.0000000202. PMID 25004793.
  16. ↑ Teal SB, Craven WM (2006). "Inadvertent vesicular placement of a vaginal contraceptive ring presenting as persistent cystitis". Obstet Gynecol. 107 (2 Pt 2): 470–2. doi:10.1097/01.AOG.0000164072.91339.9e. PMID 16449153.
  17. ↑ Bilichenko SV, Maĭzel's IG, Golovina EI, Arkhipov VV (2001). "[Bladder foreign body in a 4-year-old girl]". Urologiia (3): 42–3. PMID 11505545.
  18. ↑ Stamatiou K (2013). "Urinary retention due to benign tumor of the bladder neck in a woman; a rare case of papillary cystitis". Urologia. 80 (1): 83–5. doi:10.5301/RU.2013.10716. PMID 23423685.
  19. ↑ Halder P, Mandal KC, Mukherjee S (2016). "Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication". Indian J Urol. 32 (4): 329–330. doi:10.4103/0970-1591.189718. PMC 5054670. PMID 27843222.
  20. ↑ Grimsby GM, Tyson MD, Salevitz B, Smith ML, Castle EP (2012). "Bladder Outlet Obstruction Secondary to a Brunn's Cyst". Curr Urol. 6 (1): 50–2. doi:10.1159/000338871. PMC 3783323. PMID 24917712.
  21. ↑ Tzou KY, Chiang YT (2016). "Emphysematous Cystitis". N Engl J Med. 375 (18): 1779. doi:10.1056/NEJMicm1509543. PMID 27806219.
  22. ↑ IMMERGUT S, COTTLER ZR (1950). "Mucin producing adenocarcinoma of the bladder associated with cystitis follicularis and glandularis". Urol Cutaneous Rev. 54 (9): 531–4. PMID 15443228.
  23. ↑ Tsai YC, Birder L, Kuo HC (2016). "Abnormal Sensory Protein Expression and Urothelial Dysfunction in Ketamine-Related Cystitis in Humans". Int Neurourol J. 20 (3): 197–202. doi:10.5213/inj.1632634.317. PMC 5083834. PMID 27706016.
  24. ↑ 24.0 24.1 Fihn SD (2003). "Clinical practice. Acute uncomplicated urinary tract infection in women". N Engl J Med. 349 (3): 259–66. doi:10.1056/NEJMcp030027. PMID 12867610.
  25. ↑ 25.0 25.1 Hooton TM (2003). "The current management strategies for community-acquired urinary tract infection". Infect Dis Clin North Am. 17 (2): 303–32. PMID 12848472.
  26. ↑ Czaja CA, Scholes D, Hooton TM, Stamm WE (2007). "Population-based epidemiologic analysis of acute pyelonephritis". Clin Infect Dis. 45 (3): 273–80. doi:10.1086/519268. PMID 17599303.
  27. ↑ Echols RM, Tosiello RL, Haverstock DC, Tice AD (1999). "Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis". Clin Infect Dis. 29 (1): 113–9. doi:10.1086/520138. PMID 10433573.
  28. ↑ de Cueto M, Aliaga L, Alós JI, Canut A, Los-Arcos I, Martínez JA; et al. (2016). "Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)". Enferm Infecc Microbiol Clin. doi:10.1016/j.eimc.2016.11.005. PMID 28017477.
  29. ↑ Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A; et al. (2013). "Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010". Infect Control Hosp Epidemiol. 34 (1): 1–14. doi:10.1086/668770. PMID 23221186.
  30. ↑ Zhanel GG, Walkty AJ, Karlowsky JA (2016). "Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis". Can J Infect Dis Med Microbiol. 2016: 2082693. doi:10.1155/2016/2082693. PMC 4904571. PMID 27366158.
  31. ↑ Kahlmeter G, ECO.SENS (2003). "An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project". J Antimicrob Chemother. 51 (1): 69–76. PMID 12493789.
  32. ↑ Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
  33. ↑ 33.0 33.1 Ples R, Méchaï F, Champiat B, Droupy S, Huerre M, Guettier C; et al. (2011). "[Pseudotumoral toxoplasmic cystitis revealing acquired immunodeficiency syndrome]". Ann Pathol. 31 (1): 46–9. doi:10.1016/j.annpat.2010.11.001. PMID 21349389.
  34. ↑ Ronald A (2002). "The etiology of urinary tract infection: traditional and emerging pathogens". Am J Med. 113 Suppl 1A: 14S–19S. PMID 12113867.
  35. ↑ Hemorrhagic cystitis. Pathology Outlines.http://www.pathologyoutlines.com/topic/bladderhemorrhagiccystitis.html Accessed on February 17, 2016
  36. ↑ Nicolle LE (2008). "Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis". Urol Clin North Am. 35 (1): 1–12, v. doi:10.1016/j.ucl.2007.09.004. PMID 18061019.
  37. ↑ Pallett A, Hand K (2010). "Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria". J Antimicrob Chemother. 65 Suppl 3: iii25–33. doi:10.1093/jac/dkq298. PMID 20876625.
  38. ↑ Nicolle LE (2001). "A practical guide to antimicrobial management of complicated urinary tract infection". Drugs Aging. 18 (4): 243–54. PMID 11341472.
  39. ↑ Wada K, Uehara S, Ishii A, Sadahira T, Yamamoto M, Mitsuhata R; et al. (2016). "A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis". Acta Med Okayama. 70 (4): 299–302. PMID 27549677.
  40. ↑ Holland SM, Gallin JI (1998). "Evaluation of the patient with recurrent bacterial infections". Annu Rev Med. 49: 185–99. doi:10.1146/annurev.med.49.1.185. PMID 9509258.
  41. ↑ Arbiser JL (1995). "Genetic immunodeficiencies: cutaneous manifestations and recent progress". J Am Acad Dermatol. 33 (1): 82–9. PMID 7601952.
  42. ↑ Franco AV (2005). "Recurrent urinary tract infections". Best Pract Res Clin Obstet Gynaecol. 19 (6): 861–73. doi:10.1016/j.bpobgyn.2005.08.003. PMID 16298166.

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