Bladder infection (bacterial cystitis)
Review literature: (Fihn, 2003) (Krieger, 2003).
Bacterial cystitis is a common infection of the urinary bladder. Bladder infection is considered uncomplicated in the absence of anatomical abnormalities, bladder catheters or other urological implants or urological procedures have not been performed. The diagnostic work-up and treatment differs between uncomplicated and complicated bladder infection.
Epidemiology of Bladder Infection
20–30% of adult women have one or more times per year an episode of dysuria, bacterial bladder infection accounts for half of the cases. The prevalence rate of asymptomatic bacteriuria in sexually active women (20–45 years) lies around 5%, of which 8% develop a symptomatic urinary tract infection (compared to 1% without preexisting asymptomatic bacteriuria).
Etiology (Causes) of Bladder Infection
Principles, pathogenesis and causes of UTI see section urinary tract infection.
E. coli, Klebsiella, Enterobacter, Serratia, Pseudomonas, Proteus mirabilis and other gram-negative coliform bacteria in 80%.
Staphylococcus aureus, Staph. saprophyticus, Enterococci.
Pathology of Bacterial Cystitis
In the early stages of acute cystitis the bladder wall shows hyperemia, edema and infiltration by neutrophil granulocytes. In later stages, the mucosa is replaced by easily vulnerable granulation tissue. Small ulcers may develop. The lamina muscularis is usually not involved by the inflammation. Without treatment, hemorrhage and necrosis are possible.
Signs and Symptoms
Diagnosis of Bladder Infection
Diagnostic Work-up of Uncomplicated Cystitis in Premenopausal Women
Premenopausal women with typical symptoms for bacterial cystitis (dysuria and urinary frequency without vaginal discharge) may be treated with antibiotics with no further diagnostic work-up. Urinalysis, urine culture or imaging are not absolutely necessary, since the probability for bacterial cystitis is over 70%, and the diagnostic accuracy will not improve with further work-up [DGU (2009) S3-guideline for UTI].
Diagnostic Work-up of Bladder Infections
Urinalysis is performed with a dip stick and/or microscopic examination of the urine. Signs of a bladder infection are pyuria, bacteriuria, hematuria or a positive nitrite test.
A urine culture is recommended in complicated UTI, for cystitis in men, pregnant women or postmenopausal women after unsuccessful treatment or with diabetes mellitus.
Ultrasound imaging of bladder and kidneys:
Renal ultrasound: Obstructive uropathy? Anatomical variants? Bladder ultrasound: Postvoid residual volume? Diverticula of the bladder? Bladder stones?
Vaginal discharge should initiate a vaginal examination to diagnose vaginitis or pelvic inflammatory disease, and swabs for microbiological diagnosis obtained.
IVU is an option in recurrent cystitis to diagnose e.g. infection stones, obstructive uropathy, diverticula or ureterocele of the bladder.
Cystoscopy should be considered in recurrent cystitis and for differential diagnosis of hematuria (after treated acute bladder infection).
In recurrent cystitis or pyelonephritis MCUG should exclude vesicoureteral reflux.
Differential Diagnosis of Bladder Infection
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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Fihn 2003 FIHN, S. D.:
- Clinical practice. Acute uncomplicated urinary tract infection in
In: N Engl J Med
349 (2003), Nr. 3, S. 259–66
Krieger 2003 KRIEGER, J. N.:
- Urinary tract infections: what’s new?
In: J Urol
168 (2003), S. 2351–58.