Acute cystitis is an inflammation of the inner lining of the bladder of infectious origin, usually not complicated by structural and functional changes on the part of the urinary system. It is manifested by frequent painful urination, the presence of pus and blood in the urine, subfebrility. It is diagnosed by clinical manifestations, general urine analysis and ultrasound. In the course of therapy, compliance with the protective regime, the use of antibacterial and painkillers, herbal medicine, local thermal effects, physiotherapy is shown.
ICD 10
N30.0 Acute cystitis
Meaning
Acute cystitis is a common manifestation of urinary tract infection in practical urology, occurring in childhood and adulthood, mainly in female patients. Infectious agents most often enter the bladder from the urethra (ascending), from the kidneys and ureters (descending), as well as other foci of inflammation: through the bladder wall (contact), through lymph or blood. The disease can be primary (without previous pathology of the bladder) or secondary; focal (cervical cystitis, trigonitis) or diffuse (total).
Causes
For the development of acute cystitis, the presence of pathogenic microflora in the bladder and the presence of certain factors is necessary. In most cases, inflammation is caused by gram-negative pathogens (in 80% of cases – E. coli, as well as proteus, klebsiella), gram-positive (enterococci, staphylococci), as well as microbial associations.
The role of a predisposing factor is played by adenovirus, herpetic, parainfluenza infections, which cause a violation of microcirculation and innervation of the bladder with the further development of bacterial inflammation. In some cases, the disease is caused by a combination of chlamydia, mycoplasma or ureaplasma infection and bacterial microflora. There are specific acute cystitis of gonorrhea, trichomonas, tuberculosis etiology.
In a healthy person, the urinary tract is cleared due to the regular outflow of urine, in addition, the inner lining of the bladder is very resistant to infection due to the development of a special mucopolysaccharide secret. Forming a thin protective layer (glycocalyx) on the surface of the bladder, it prevents adhesion and penetration of pathogenic microorganisms into the bladder wall, promotes inactivation and elimination of them during urination. The hormones estrogen and progesterone are involved in the regulation of the production of the protective layer.
Various changes in the mucin layer of the bladder lead to the loss of its protective function, against which the development of acute cystitis is possible. Thus, a violation of urodynamics in neurogenic bladder contributes to its insufficient purification and stagnation of urine. The disease may be associated with injuries to the inner lining of the bladder during instrumental and surgical interventions (catheterization of the bladder, cystoscopy, ureteroscopy); a decrease in local immune protection in beriberi, frequent acute respiratory infections; exposure to radiation, toxic and chemical substances.
In girls, primary acute cystitis is usually caused by insufficient compliance with hygiene rules, vaginal dysbiosis. Secondary inflammation often develops in boys against the background of anatomical and functional pathology of the vesicourethral segment (urethral stenosis, cervical sclerosis or diverticula of the bladder, phimosis, neurogenic dysfunction). Of no small importance in the occurrence of pathology is the stagnation of blood in the pelvis, leading to a violation of blood circulation in the bladder wall; metabolic disorders (crystalluria).
A relatively high percentage of cases of cystitis in women is associated with the structural features of the female urethra, hormonal disorders, frequent genital inflammations (vulvitis, vulvovaginitis), contributing to the entry of microflora into the lumen of the urethra and bladder. Acute cystitis in men almost always occurs against the background of prostatitis, urethritis and orchiepididymitis. An active sex life provides a high probability of infection in the bladder.
Pathanatomy
Pathology can be manifested by catarrhal and hemorrhagic changes in the inner lining of the bladder. In the catarrhal process, the urothelium is swollen and hyperemic, the blood vessels of the bladder wall are dilated. Increased vascular permeability leads to sweating in the focus of inflammation of a large number of red blood cells and the development of hemorrhagic cystitis. The severe form of the disease is characterized by the spread of inflammation to the submucosal layer.
Symptoms
Characteristic signs are frequent imperative urge to urinate, small portions with pain and pain at the end, the appearance of terminal hematuria; pain syndrome in the bladder, perineum and anus; changes in the transparency and color of urine (cloudy or the color of “meat slops”). Strong and frequent urge to urinate occur even with the accumulation of a small volume of urine, which is caused by increased reflex excitability of the bladder, provoking contractions of detrusor. The frequency of infections depends on the severity of the pathology (sometimes they occur every 20-30 minutes).
Involvement in the inflammatory process of the neck of the bladder is accompanied by constant intense pain, giving into the perineum, anus and head of the penis in men. There may be a reflex delay in urination due to sharp pain and spasm of the external sphincter of the urethra and pelvic floor muscles. The cervical form of the disease involving the sphincter of the bladder may be accompanied by episodes of urinary incontinence. With the spread of the infectious process into the upper urinary tract, subfebrile temperature and malaise are added to dysuric disorders, which indicates the development of acute ascending pyelonephritis.
Diagnostics
Diagnosis of acute cystitis is carried out by a specialist urologist, it is quite simple due to the specific symptoms of the disease. The diagnosis is confirmed by the results of a general urinalysis, in which leukocyturia of a neutrophilic nature, erythrocyturia, bacteriuria, a large number of squamous epithelial cells and mucus are observed. Macrohematuria indicates a severe hemorrhagic process and is an unfavorable prognostic sign for further relapses.
To identify the causative agent of inflammation and its sensitivity to antibiotics, a urine culture study is performed. In a clinical blood test with an uncomplicated form, the criteria of the island-inflammatory process are rarely revealed. According to ultrasound of the bladder, conducted against the background of its “physiological filling”, a thickening of the inner wall of the bladder and the presence of a sufficient amount of “echonegative” suspension in its cavity are revealed. Cystoscopy and cystography during acute inflammation are not indicated, they can be performed after the inflammation subsides.
In patients with a complicated course, further examination is advisable to detect neurogenic dysfunction of the bladder (urodynamic examination), gynecological problems in women (smear microscopy, seeding for STIs, PCR studies), prostate diseases in men (back-seeding of a smear from the urethra, examination of prostate secretions). Differential diagnosis is carried out with acute pyelonephritis, acute appendicitis and paraproctitis, with sudden macrohematuria – with a tumor and bladder stones.
Treatment
Rest is indicated (if necessary, bed rest), copious drinking (up to 2.5 liters of liquid per day) and a gentle dairy-vegetable diet. It is necessary to monitor regular bowel movements, exclude sexual activity and avoid hypothermia. The patient’s condition is facilitated by general and local thermal procedures (warming, dry heat on the bladder area, herbal sedentary baths t = +37.5 ° C). Bladder instillations and hot baths are contraindicated.
Drug therapy of acute cystitis consists in taking painkillers, antispasmodics, antihistamines, uroseptic and antibacterial drugs. With severe pain syndrome, papaverine, drotaverine, metamizole sodium, ibuprofen, diclofenac, paracetamol (orally or rectally) are indicated. Antimicrobial therapy is carried out taking into account an antibioticogram, before the results of which nitrofurans, broad-spectrum antibiotics are used (with oral administration and preferential urinary excretion).
In acute uncomplicated cystitis in adults, treatment with fluoroquinolones (norfloxacin, ciprofloxacin) or monural is preferable. In the treatment of acute uncomplicated cystitis in children, amoxicillin, cephalosporins (cefuroxime axetil, cefaclor, ceftibutene), nalidixic acid are mainly used. The course is at least 7 days. The treatment is supplemented with phytotherapy with the use of herbal collections with diuretic, antimicrobial, anti-inflammatory and tanning effects (bearberry, lingonberry leaf, kidney tea, knotweed). After the acute stage of cystitis subsides, physiotherapy is prescribed (magnetotherapy, magnetolaser therapy, electrophoresis, UHF, inductothermy, etc.).
Prognosis and prevention
The prognosis for acute cystitis is usually favorable, in the case of a complicated form, the disease can acquire a chronic course. For prevention, it is important to urinate regularly and completely empty the bladder, observe personal hygiene, timely treatment of acute respiratory infections and sexual infections, increase the immune defense of the body, preserve the anatomical and functional integrity of the urothelium and detrusor during urological manipulations and operations.
