Cystitis

Classification according to ICD-10
N30	Cystitis
ICD-10 online (WHO version 2019)

As cystitis , cystitis (Latin; plural: cystitides , cystitides ) (Greek κυστίτις from κύστις kýstis "bladder", "urinary bladder"), urinary bladder inflammation or bladder catarrh , an inflammation of the urinary bladder is called. It is one of the urinary tract infections . Inflammation of the gallbladder is known as cholecystitis .

Children and sexually active women are particularly affected. At an advanced age, men are also affected, often in connection with a benign prostate enlargement . In most cases, it is an ascending , i.e. ascending infection , the most common cause of which is gram-negative rods from the intestinal flora ( Escherichia coli in 77% of cases), but also gram-positive cocci, mycoplasmas, ureaplasma, yeasts, chlamydia, viruses and chemical or are mechanical stimuli. Cystitis is favored by disorders of the outflow of urine from the bladder, age, female gender and medical interventions. Therapy is usually antibiotic ; for uncomplicated cystitis in women, 1–3 days are usually sufficient. A dreaded complication is inflammation of the renal pelvis , which can be accompanied by a high fever up to blood poisoning and abscess formation .

There are also the rarer, abacterial forms of chemically or physically induced urinary bladder inflammation. An example of the latter form is what is known as radiation cystitis after radiation therapy in the pelvic area .

The symptom-free bacteriuria must be differentiated from cystitis .

Epidemiology

It is estimated that approximately seven million acute bladder infections are diagnosed in the United States each year, costing more than one billion dollars.

causes

Intestinal bacteria are the most common cause of acute, uncomplicated bladder infections, with Escherichia coli responsible for 70 to 95 percent of bladder infections. Staphylococcus saprophyticus is the responsible germ in about five to ten percent, Proteus mirabilis and Klebsiella are less common .

Favoring factors

Favoring (predisposing) factors for the development of cystitis are:

• Female sex : Due to the anatomical conditions (short female urethra, proximity of the outer urethral opening to the vagina and anal region ), germ ascension is favored in women. In the postmenopause, the epithelium sealing the urethra atrophies, which is why cystitis is more common here too. Overall, however, there is an increasing convergence of gender-specific prevalence with age . The reason is the increased incidence of prostatic hyperplasia in older men, with the resulting obstructive micturition problems . In female infants there is “diaper cystitis” due to the spread of germs through the short urethra. Malformations of the urogenital tract should be considered in young children of the male sex and in cystitis .
• Frequent sexual intercourse in women: Mechanical irritation due to the close proximity of the vagina to the urethral opening ("honeymoon cystitis", "honeymoon disease", "honeymoon cystitis", "holiday cystitis", "defloration cystitis"); The role of sexual and anal hygiene with possible germ transfer.
• Disturbances in the outflow of urine due to a narrowing ( obstruction ) in the area of ​​the urethra with residual urine formation , e.g. due to a urethral stricture , prostatic hyperplasia or tumors, pelvic floor subsidence, bladder diverticula and vesicoureteral reflux .
• Metabolic diseases , especially diabetes mellitus with immune deficiency and sugary urine as a "breeding ground" for bacteria.
• Indwelling bladder catheter , rarely single-use catheterization.
• Interventions such as a bladder irrigation , cystoscopy , micturition cystourethrography .
• Immunosuppression with immune deficiency.

In an albeit small prospective study with 796 healthy women aged 18 to 40 years, only the use of a diaphragm or a spermicide and sexual intercourse in the past seven days and a history of recurrent urinary tract infections were found to be statistically significant independent risk factors.

Symptoms

Typical symptoms of a cystitis are:

• Dysuria / alguria - pain and burning sensation when urinating
• Pollakiuria - Frequent need to urinate with small portions of urine
• Bladder tenesmas - bladder spasms

Other symptoms can include:

• Hematuria - blood admixture with the urine, either visible as macrohematuria or invisible as microhematuria
• Pain in the abdomen
• Strong urge to urinate with loss of urine ( urge incontinence ) can also occur

Fever does not occur with a bladder infection. Fever combined with the above symptoms always indicates involvement of either the kidneys or, in men, the prostate.

Diagnosis

Rapid urine test

In addition to taking the medical history and the physical examination, urine diagnostics come first. For this purpose, “clean midstream urine ” is taken; H. the first portion of urine is discarded, just like the last. You should also make sure that you only take 10 ml of urine, because more is not necessary for diagnostics. It is important that the genitals are thoroughly cleaned beforehand in order to avoid contamination of the urine with normal mucosal flora, with fluorine vaginalis or the like. Furthermore, care must be taken with the woman that the correct technique is used, which means that the labia are spread apart so that the urine has as little contact with the environment as possible. It is also possible to collect the urine by means of single-use catheterization or, better, a suprapubic bladder puncture . These invasive options can also be used on an outpatient basis. A first test is carried out with so-called urine test strips . This is used to detect red blood cells , white blood cells and nitrite . Nitrite is formed by many of the bacteria that cause infections (e.g. Escherichia coli) from food nitrate. In a further step, the urine is examined microscopically . The cells mentioned above as well as bacteria and crystals can be identified. In the last step, a urine culture is created to precisely differentiate the pathogen. This also serves to determine the bacterial count (a urinary tract infection is likely from around 10 ⁵ CFU per milliliter) and to create an antibiogram in order to enable targeted antibiotic therapy if necessary.

Further diagnostics include an ultrasound examination of the kidneys and the urinary bladder . In the case of recurrent cystitis, an excretory urography to assess the drainage pathways and a cystoscopy to assess the urethra and bladder accurately is useful. The gynecological examination should also be considered, especially with older women.

therapy

Acute cystitis is treated with antibiotics . If the therapy is calculated, d. H. Without resistance testing of the causative germs, otherwise healthy women should be given fosfomycin 1 × 3 g or nitrofurantoin 2 × 100 mg per day for 5 days or pivotmecillinam 3 × 200–400 mg per day for 3 days. Since there is increased resistance to fluoroquinolones and cephalosporins , these are no longer recommended for initial therapy, as is ampicillin and cotrimoxazole for calculated antimicrobial therapy. For longer therapy, targeted antibiotic therapy should be carried out according to the sensitivity of the pathogen . Against the bladder tenesmas antispasmodics such. B. Butylscopolaminiumbromid prescribed. Plenty of fluids, regular urination, and local warmth are also recommended.

In the case of frequently recurring urinary tract infections, the guideline of the German Society for Urology initially recommends advice on causal risks (e.g. sexual intercourse) and possible changes in behavior. Further therapy options consist of long-term treatment with herbal therapeutics , the sugar mannose, or immunoprophylactic drugs .

Herbal therapeutics play an important role in the everyday treatment of simple bladder infections. For uncomplicated urinary tract infections, for example, mustard oils from nasturtiums and horseradish can be used, the effectiveness of which has been proven by studies. So far, no development of resistance has been known for mustard oils even after long-term therapy. The S3 guideline for the treatment of uncomplicated urinary tract infections , updated in 2017, recommends the use of medicinal products with nasturtiums and horseradish and as a herbal treatment option for frequently recurring bladder infections .

Complications of a urinary tract infection

The pyelonephritis is a serious complication of cystitis. It occurs when the pathogen ascends through the ureter into the renal pelvis and kidneys . In its maximum severity, this then leads to a generalized severe infection, known as urosepsis . In men, the pathogen can cause inflammation of the epididymis when the pathogen ascends into the spermatic duct .

prevention

• Since the most common pathogens causing cystitis and urinary tract infections in general are intestinal bacteria, the importance of anal hygiene (including avoiding the "wrong direction of wiping") and sexual hygiene follows logically . All sexual practices that are capable of carrying intestinal bacteria into the vagina and the region of the urethral orifice tend to favor the development of cystitis. Female urination after intercourse flushes bacteria out of the bladder. In the case of recurrent cystitis, the preventive intake of a small dose of trimethoprim or nitrofurantoin after sexual intercourse can be useful. In postmenopausal women who are not on hormone replacement therapy and who have urethral atrophy, topical application of an ointment containing estrogen to the urethral orifice is an option.

• Mustard oils from nasturtiums and horseradish can be used as a preventative measure, as they are well tolerated. A randomized, placebo-controlled, double-blind study showed that they can be used effectively to prevent recurring cystitis. Accordingly, they are recommended in the S3 guideline updated in 2017 for the treatment of uncomplicated urinary tract infections in the case of frequently recurring bladder infections.

• Cranberry capsules and / or juice could be effective . They contain substances that make it difficult for pathogens to colonize the mucous membrane and thus nutritionally prevent or counteract an infection of the urinary tract. However, there are also criticisms of the ingredient oligomeric proanthocyanidins . ^{[Document is missing]}

Small studies with only a few study participants indicate that the ingredients prevent bacteria from adhering to the epithelium of the lower urinary tract and thus contribute to the prevention of urinary tract infections (UTIs). Ingesting cranberry juice significantly reduced the number of bacteria in the urine.

Contrary to expectations, the results of a small Spanish study with 20 participants showed an increase in the pH value after taking cranberry juice and no bacteriostatic effect.

A small Finnish study of 150 women with an average age of 30 years found a significant reduction in the recurrence rate of urinary tract infections when consuming cranberry and cranberry juice . The prescription of antibiotics could also be reduced significantly. A significant effect was observed with regard to acute cystitis in high-risk young women and strong evidence with regard to recurrent uncomplicated urinary tract infections, especially in sexually active women.

A meta-analysis by the Cochrane Collaboration published in the Cochrane Library in 2008 confirmed a certain amount of evidence for the effectiveness of cranberry preparations, but also referred to the high failure rate among study participants, so that the outstanding and side-effect-free success of this form of therapy can also be doubted.

• The natural monosaccharide D- mannose makes it difficult for germs to dock onto the urothelium of the urinary bladder and can thus reduce the recurrence rate.

• The natural amino acid L-methionine is used to lower (acidify) the pH value of the urine.

Background: The pH optimum of E. coli (the most common cause of bladder infections) is in the neutral range (around a pH value of 7). The further the pH of the urine deviates from the optimum pH of E. coli , the more difficult it is for E. coli to multiply. Both urine acidification and extreme alkalinization can help cystitis caused by E. coli . In principle, both approaches are promising, but the acidification corresponds more to the natural protective mechanism of the body, since the urine in healthy people is more acidic.

Criticism: This effect of methionine in urinary tract infections has recently been viewed critically, because some bacteria and fungi find the best living and reproductive conditions even in an acidic environment. It is therefore questionable whether the urine should generally be acidified. However, the relevant guidelines take a less critical view of this, and studies cannot confirm the doubts about acidification either.

Special forms

Emphysematous cystitis on computed tomography (lung window for better contrasting of the gas deposits)

• The hemorrhagic cystitis is with strong, visible blood addition to urine and is usually accompanied by viruses ( adenovirus ) or enterobacteria causes.
• Radiation cystitis - after radiation therapy.
• Interstitial cystitis - a chronic, non-bacterial cystitis.
• The emphysematous cystitis with gas formation in the bladder and the bladder wall by bacteria or fungi is a rare disease that often affects diabetics and women.

literature

• Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 130-136.

Individual evidence

1. ↑ M. Grabe et al. a .: Guidelines on The Management of Urinary and Male Genital Tract Infections. (PDF; 697 kB) European Association of Urology, 2008
2. ↑ Thomas M. Hooton, Delia Scholes, James P. Hughes, Carol Winter, Pacita L. Roberts, Ann E. Stapleton, Andy Stergachis, Walter E. Stamm: A Prospective Study of Risk Factors for Symptomatic Urinary Tract Infection in Young Women . In: N Engl J Med . tape 335 , no. 7 , 1996, pp. 468-474 , PMID 8672152 . (Full text; engl.)
3. ↑ ^{a b} S-3 guideline AWMF register no. 043/044: Epidemiology, diagnosis, therapy and management of uncomplicated bacterial community-acquired urinary tract infections in adult patients . June 17, 2010 (PDF; 1.4 MB)
4. ↑ Marianne Abele-Horn (2009), p. 131.
5. ↑ ^{a b c} S3 guideline uncomplicated urinary tract infections - update 2017 (interdisciplinary S3 guideline "Epidemiology, diagnostics, therapy, prevention and management of uncomplicated, bacterial, community-acquired urinary tract infections in adult patients", AWMF Register No. 043/044)
6. ↑ Uncomplicated to problematic, diagnosis and treatment of urinary tract infections. In: Deutsche Apotheker Zeitung , No. 18, May 2014, pp. 42–55.
7. ↑ Glucosinolates against bacterial infections. In: Deutsche Apotheker Zeitung. No. 25, June 2010, pp. 105-107.
8. ↑ Albrecht u. a .: A randomized, placebo-controlled, double-blind study of a herbal medicinal product made from nasturtiums and horseradish in the prophylaxis of recurrent urinary tract infections. In: Current Medical Research and Opinion. 23 (10), 2007, pp. 2415-2422.
9. ↑ ^{a b} L. Stothers: A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. In: Can. J. Urol. 9, 2002, pp. 1558-1562. PMID 12121581 .
10. ^ R. Monroy-Torres, AE Macías: Does cranberry juice have bacteriostatic activity? In: Rev Invest Clin . 2005, PMID 16187705 . (Full text; engl.)
11. ↑ N. Cimolai et al. a .: The cranberry and the urinary tract. In: Eur J Clin. Microbiol. Infect. Dis. 26, 2007, pp. 767-776.
12. ↑ RG Jepson, JC Craig: Cranberries for preventing urinary tract infections . In: Cochrane Database of Systematic Reviews . 2008, doi : 10.1002 / 14651858.CD001321.pub4 , PMID 18253990 .
13. ↑ Sugar protects as well as antibiotics . In: ÄrzteZeitung . August 16, 2013.
14. ^ F. Ankel, AB Wolfson, JS Stapczynski: Emphysematous cystitis: a complication of urinary tract infection occurring predominantly in diabetic women. In: Ann Emerg Med . 19 (4), Apr 1990, pp. 404-406.
15. ↑ RK Bobba, EL Arsura, PS Sarna, AK SAWH: emphysematous cystitis: an unusual disease of the Genito-Urinary system Suspected on imaging. In: Annals of clinical microbiology and antimicrobials. Volume 3, October 2004, p. 20, ISSN  1476-0711 . doi: 10.1186 / 1476-0711-3-20 . PMID 15462675 . PMC 524183 (free full text).

Web links

Wiktionary: cystitis  - explanations of meanings, word origins, synonyms, translations

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !