bubble_chart Overview

Acute bacterial cystitis is primarily caused by large intestinal bacilli (commonly Escherichia coli), while cases caused by gram-positive aerobic bacteria (such as Staphylococcus saprophyticus and Enterococcus) are rare. The infection often ascends from the urethra to the bladder. The pathogenesis and predisposing factors of cystitis have been discussed in detail in this chapter. Girls and women are more susceptible to cystitis than boys and adult men. In children, adenovirus infection can lead to hemorrhagic cystitis, but viral cystitis is uncommon in adults.

bubble_chart Pathological Changes

In the early stage of acute cystitis, the bladder mucosa is congested and edematous, with leukocyte infiltration. In the late stage (third stage), the mucosal fragility increases, making it prone to bleeding, and the surface becomes granular with localized superficial ulcers containing exudate, typically not involving the muscle layer.

bubble_chart Clinical Manifestations

Symptoms: Significant bladder irritation symptoms include frequent urination, urgency, increased nocturia, burning sensation during urination, or dysuria. Pain or discomfort in the lumbosacral or suprapubic region is common. Interrupted urination and hematuria are frequently observed, while fever is rare. In women, episodes are often triggered after intercourse (honeymoon cystitis).

Sign: Suprapubic tenderness may sometimes be present, but lacks specificity. Possible contributing factors should be examined, such as vaginal or urethral orifice abnormalities (e.g., urethral diverticulum), vaginal discharge, urethral discharge, or swollen and tender prostate or epididymis.

bubble_chart Auxiliary Examination

Laboratory tests: The blood picture is normal, or there may be grade I leukocytosis. Urinalysis often reveals pyuria or bacteriuria, and sometimes gross hematuria or microscopic hematuria can be detected. Pathogenic bacteria may be identified in urine culture. If there are no other urinary tract diseases, serum creatinine and blood urea nitrogen levels are normal.

X-ray examination: If kidney infection or other genitourinary abnormalities are suspected, X-ray examination is necessary. For patients infected with Proteus, X-ray examination should be performed if the treatment response is poor or ineffective to determine whether there is concurrent urinary tract calculi.

Instrumental examination: When bleeding is significant, cystoscopy is required, but it must be performed after the acute phase of infection or after the infection has been adequately treated.

bubble_chart Treatment Measures

(1) Special Treatment: The efficacy of short-term antibiotic therapy (1 to 3 days, or even a single dose) for male patients has not been confirmed. However, this therapy is effective for women with acute uncomplicated cystitis. The choice of antibiotics should preferably be based on bacterial culture and drug sensitivity tests. Since most uncomplicated infections occurring outside the hospital are caused by Escherichia coli strains sensitive to multiple antibiotics, sulfonamides, SMZCo, nitrofurantoin, and ampicillin are usually effective. If the treatment outcome is unsatisfactory, a comprehensive urological examination is necessary.

(2) General Treatment: Because acute uncomplicated cystitis responds quickly to appropriate antibiotic therapy, additional treatment is usually unnecessary. Occasionally, warm baths, anticholinergic drugs (such as propantheline), or analgesics may be needed to relieve symptoms.

bubble_chart Prognosis

Uncomplicated acute cystitis can recover quickly with appropriate antibiotic treatment. Severe bladder damage is uncommon.

bubble_chart Prevention

For patients with recurrent acute bladder infections, it is necessary to carefully examine various possible factors that may increase susceptibility to infection and promptly correct them. If no obvious causative factors are found, prophylactic antibiotic treatment must be administered.

bubble_chart Complications

The main complication of acute cystitis is the upward spread of infection to the kidneys, which is more likely to occur in children with vesicoureteral reflux or pregnant women.

bubble_chart Differentiation

Female patients with acute bacterial cystitis must be differentiated from other genitourinary infections. Vaginitis and cystitis have similar symptoms, but pelvic examination and detection of pathogenic bacteria in vaginal secretions can confirm the diagnosis. Acute urethral syndrome may cause urinary frequency and dysuria, but urine culture shows low colony counts or no bacterial growth. Acute pyelonephritis may present with bladder irritation symptoms but is accompanied by lumbago and fever.

In children, certain detergents or pinworms can cause vulvar and urethral irritation symptoms, which resemble those of cystitis.

In male patients, acute bacterial cystitis must be differentiated from urethral, prostatic, and renal infections, and appropriate physical and laboratory examinations can aid in differentiation.

Noninfectious cystitis has symptoms similar to bacterial cystitis, such as cystitis caused by antitumor therapy (radiotherapy, chemotherapy), interstitial cystitis, eosinophilic cystitis, and bladder tumors, all of which require differential diagnosis.