Chronic cystitis is a long–term inflammation of the bladder, leading to structural and functional changes in the walls of the organ. Pathology can occur latently, with alternating exacerbations and remissions, or with constant symptoms. Diagnosis is carried out based on the results of urine tests, vaginal microflora in women, STD tests, ultrasound of the urinary organs, cystography, cystoscopy, endovesical biopsy. Antibacterial treatment, correction of hormonal and immune status, microcirculation processes, local therapy and prevention of exacerbations, according to indications – surgical interventions are recommended.
ICD 10
N30.1 N30.2
Meaning
The fairly wide prevalence of chronic cystitis in practical urology and the frequent resistance of the disease to etiotropic treatment makes it a serious medical problem. The transition of acute cystitis to a chronic form is observed in about a third of all cases. In a chronic process, inflammation occurs for a long time (more than 2 months), while not only the mucous membrane is affected, but also the deeper layers of the bladder wall. Prolonged inflammation in the bladder wall can lead to sclerotic changes in the connective tissue elements of the muscle layer and shrinkage of the bladder.
Causes
Etiological agents
The disease is more often of an infectious nature, can be caused by bacterial agents (gram-negative enterobacteria, staphylococci, specific pathogens of gonorrhea, tuberculosis, chlamydia, mycoplasmosis), viruses (herpes, adenoviruses), candida fungi, protozoa. Exacerbations of chronic cystitis in most cases are provoked by reinfection with another pathogen or persistent infection of the same species or strain.
Background diseases
Chronic cystitis develops against the background of existing diseases of the genitourinary system or with serious concomitant pathology that contributes to infection of the bladder and the formation of the inflammatory process. Prolonged violation of the outflow of urine, rare urination with incomplete emptying of the bladder, a decrease in the protective properties of its mucous membrane in the presence of foci of chronic infection (pyelonephritis, vulvovaginitis, prostatitis, urethritis, STDs, tuberculosis, tonsillitis, caries) create favorable conditions for the occurrence of inflammation. Tumor formations, polypous growths, diverticula, stones can provoke pathology.
Anatomical features of the urethra cause a high prevalence of cystitis in women, since they contribute to the entry of microflora from the vagina and anus into the bladder, in particular after sexual intercourse or in violation of hygiene rules. Chronic cystitis in men often occurs against the background of urethral strictures in its various departments, prostate adenoma. The incompleteness of the process of regeneration of the urothelium after acute cystitis against the background of impaired tissue homeostasis contributes to the chronization of inflammation.
Risk factors
Risk factors may be:
- diabetes mellitus
- hormonal changes (pregnancy, menopause)
- hypothermia
- non-compliance with personal hygiene
- active sex life
- spicy food, stress.
Pathanatomy
Morphological changes in chronic cystitis are characterized by metaplasia of the transitional epithelium – the formation of foci of keratinization, mucous cysts, sometimes polypous growths and leukocyte infiltrates in the subepithelial layer. With interstitial cystitis, ulceration of the mucous membrane, signs of hyalinosis and multiple glomerulations are observed, with allergic cystitis – eosinophilic infiltrates in the subepithelial and muscular layers.
Classification
Depending on the morphological picture, chronic cystitis can be catarrhal, ulcerative, cystic, polypous, encrusting or necrotic. By the nature of the course, chronic cystitis is divided into:
- latent;
- actually chronic (persistent);
- interstitial (bladder syndrome).
Symptoms
The disease can be asymptomatic, with rare (1 time a year) or frequent (2 or more times a year) exacerbations, in the form of a continuous sluggish process or with sufficiently pronounced symptoms. With a stable latent course, there are no complaints, and inflammatory changes in the bladder are detected only during endoscopic examination.
Exacerbation of chronic cystitis can develop by the type of acute or subacute inflammation. With the catarrhal nature of the pathology, frequent urination is observed, accompanied by sharp pain, painful sensations in the lower abdomen. The presence of an impurity of blood in the urine indicates a hemorrhagic or ulcerative lesion of the mucous membrane of the bladder. The persistent form is characterized by less pronounced symptoms with undisturbed reservoir function of the organ.
A rather severe interstitial form is manifested by constant frequent urge to urinate, pain in the pelvis and lower abdomen, dysuria, a feeling of incomplete emptying of the bladder, nocturia, dyspareunia. Pain, insignificant at the beginning of the disease, eventually becomes the leading symptom, weakens after the injection and increases as the bladder fills due to a decrease in its size and a persistent decrease in reservoir function. The course of interstitial cystitis is chronic, progressive, with alternating remissions and exacerbations. The disease may also manifest symptoms of the main background pathology (urolithiasis, hydronephrosis, etc.).
Diagnostics
It is often difficult to establish a diagnosis of chronic cystitis due to erased, poorly expressed symptoms. The initial stage of diagnosis includes a thorough collection of anamnesis (taking into account the existing diseases of the genitourinary sphere, as well as the connection of manifestations of cystitis with sexual life), in women – gynecological examination with examination in mirrors; in men – rectal examination of the prostate. The next stage is to perform laboratory tests: urine tests – general, according to Zimnitsky, Nechiporenko, urine sampling with an antibioticogram, a smear from the urethra for STIs, in women – a vaginal smear for microflora and STIs.
Functional examination of the urinary tract includes bladder ultrasound, cystoscopy (in remission), uroflowmetry, cystography. Against the background of chronic inflammation, precancerous changes may develop in the epithelium of the bladder, such as hyperplasia, dysplasia, metaplasia, therefore, if necessary, endovesical biopsy and morphological analysis of biopsies are performed. Differential diagnosis is carried out with bladder and prostate cancer, simple ulcer, tuberculosis, schistosomiasis.
Treatment
In each case, a differentiated approach is needed to choose a treatment method that is adequate to the causes and mechanism of the development of the inflammatory process, the specifics of the course of the disease in this patient. Etiological, pathogenetic and prophylactic agents are used in complex treatment.
- Etiotropic treatment. It includes antibacterial therapy lasting at least 7-10 days (sometimes up to 2-4 weeks) with a drug to which this pathogen is sensitive (or a broad-spectrum antibiotic), followed by courses of nitrofurans or bactrim for 3-6 months.
- Pathogenetic therapy. It consists in normalization of immune and hormonal disorders, structural pathology of the urinary organs, improvement of blood supply to the bladder, correction of hygiene skills and sexual contacts. Immunotherapeutic and immunomodulatory drugs are indicated to stimulate the immune defense of the body. Be sure to prescribe antihypoxants, venotonics, antiplatelet agents, antihistamines. Severe pain syndrome is stopped with the help of nonsteroidal anti-inflammatory drugs.
- Physical therapy. As a local anti-inflammatory treatment, instillations of drugs (silver nitrate, colloidal silver, heparin) into the bladder are carried out with sufficient indications. Physical therapy and physiotherapy help strengthen the pelvic muscles and normalize pelvic blood circulation.
- Treatment of concomitant pathology. To eliminate chronic inflammation, appropriate treatment of the underlying disease is carried out, including surgical (removal of stones, bladder polyps, resection of the bladder neck, adenomectomy, etc.). When foci of chronic infection are detected, they are sanitized, in women – treatment of inflammatory gynecological diseases and genital dysbiosis.
With interstitial cystitis, which is quite difficult to treat, medication and local therapy, physiotherapy (ultrasound, diathermy, medicinal electrophoresis, electrical stimulation of the bladder, laser therapy, magnetotherapy) are used. Perform pre-bubble, intravesical and presacral novocaine blockades; in the case of cicatricial wrinkling of the bladder, surgical interventions are indicated: ureterosigmo- and ureteroureteroanastomosis, unilateral nephrostomy, ileocystoplasty.
Prognosis and prevention
The prognosis is usually quite favorable. Prevent exacerbations of chronic cystitis can be prescribed by a urologist preventive courses of therapy (antibiotic therapy, including postkital; herbal diuretics; postmenopausal – RRT estriol). An important role in the prevention of chronic cystitis is played by the observance of intimate hygiene and hygiene of sexual life, the timely elimination of urogenital pathology, concomitant purulent processes in the body, hormonal disorders.