Cystitis

Cystitis is an inflammation of the bladder. There are at acute and chronic cystitis, by their origin - primary and secondary, on etiology - specific (syphilis, gonorrhea, tuberculosis and others) and non-specific (staphylococcal and others). Women suffering from cystitis significantly more often than men.
Primary cystitis caused by infection downward path from the upper urinary tract or ascending through the urethra, hematogenous and lymphogenous ways of inflammatory lesions in other organs. The development of cystitis contribute: cooling of the body, alcohol intake, constipation, mental disorder, violation of rules of aseptics instrumental examination of the urinary tract; in addition, women cystitis observed in pregnancy, postpartum period.
Secondary cystitis (often chronic) is the result: stone, foreign body, tumor, diverticulum, tuberculosis bladder, adenoma of the prostate. Cystitis can cause some medicines (urotropine, cantharidin), and toxic substances (antifreeze, moonshine and others) when you receive them inside. Radiation therapy for malignant tumors of the small pelvis sometimes causes the so-called radiation cystitis.

acute cystitis
Zitostaticescoe picture:
Fig. 7. In acute cystitis.
Fig. 8. In acute hemorrhagic cystitis.

For acute cystitis typical triad of symptoms: pain in the urine urgency and especially at the end of urination; significant increases urination up to 5-10 times per hour (see Pollakiuriya); pus in the urine (see Peoria). Body temperature is usually not elevated, which is connected with peculiarity of the bladder mucosa not to suck products of inflammation. In the propagation process at higher - or underlying path (pyelonephritis, urethritis, prostatitis) General condition worsens, increased body temperature. In urine find a large number of leukocytes and erythrocytes. In acute cystitis blood vessels walls of the bladder dramatically expanded mucosa edema, it is the focal hemorrhage (Fig. 7 and 8). Catheterization and introduction of tools into the bladder in diagnostic or therapeutic purposes in acute cystitis is contraindicated.
If timely treatment of acute cystitis forecast is favorable.
Treatment: in bed, elimination of food spicy food (canned food, herring, pickled cucumbers, pepper, mustard, vinegar), alcoholic beverages. Appoint drink plenty of water (tea with milk, Borjomi), heat (heating pad on the area of pubic hair, sitting baths), analgesic and antispasmodic (microclysters: 100 ml of warm water and 0.5 g of antipyrine or the same with 5-10 drops of tincture of opium; rectal candles: Extr. Opii 0,015, Butyri Cacao 2,5; or Furadonini 0,1, Methylenblau Of 0.05, Antipyrini 0,5, Butyri Cacao 1,5). Inside appoint an antibacterial agent: furadonin 0.1 g 3-4 times a day, prosulpin, etazol, sulfadimezin, norsulfazol by 1.0 g 4 times a day for 5-6 days. Antibiotics are set after sowing urine on the microbial flora and determine its sensitivity to them; to use antibiotics need in large enough doses (for example, chloramphenicol, 0.5 g, tetracycline 200 000 IU 4-6 times a day). Treatment should be not less than 5-6 days, even if the symptoms of cystitis disappear. In the event of an insufficient effect, treatment should continue, replacing the drug. The period of temporary incapacity for acute cystitis, on average 5-10 days.
Complications. Gangrenous cystitis is manifested by a sharp pain in the bladder, constant urge to urination, hematuria. With the development of the disease is possible full urinary retention, in severe cases, the rupture of the bladder and peritonitis. Surgical treatment. Cm. also the bladder. Parasitic - inflammation okolopostelnoy fiber. The symptoms reminds cystitis, however, takes place at a high or a low grade fever. Treatment with antibacterial, in the formation of the abscess is a surgical opening the abscess. Trigona - inflammation of the gallbladder triangle in the absence of changes for the rest of the mucous membrane of the urinary bladder. Diagnosis during cystoscopy. Treatment is the same as for cystitis. Cystalgia is a disease of the bladder in women, manifested increase and painful urination, in the absence of pyuria. Cystalgia occurs when a breach of the blood and lymph circulation of the triangle and the bladder neck (see) as a result of inflammatory diseases of small pelvis and retroperitoneal fat; there is also in the period of menopause due to reduction in production of estrogen (see Sex hormones). Treatment: removal of gynecological diseases, hormone therapy (prednisolone 20 mg 2 times a day for 5-7 days, cortisone 25 mg - 6-8 days). Good results are the blockade novocaine - 100-150 ml of 0.5% solution.

Cystitis (cystitis; from the Greek. kystis - bladder - is an inflammation of the bladder. The most frequent urological diseases in outpatient practice. Women suffering from cystitis more often than men, which is explained mainly by the frequency of inflammatory diseases situated in the immediate proximity to the bladder internal female genitals, short urethra, favorable for the development of infection conditions during menstruation, pregnancy, postpartum period. Cystitis can occur at any age.
The most frequent cause cystitis infection. Microbes penetrate into the bladder from the urethra, adjacent organs (sexual, large intestine, fiber pelvis), from any purulent located at a distance, in infectious diseases. The most common causative agent of cystitis include E. coli, Staphylococcus, much less Proteus, Streptococcus spp, Pseudomonas aeruginosa. Some patients (about 10%) cystitis occurs as a result of the impact of mixed flora - usually E. coli with aureus, Staphylococcus with Proteus. Cystitis caused by Proteus or by Escherichia coli, is more resistant character, due largely to the absence or limited exposure to modern antibiotics against these pathogens.
Microbes are planted and from the urine of healthy people. Cystitis occurs only in the presence of favourable to the development of infections conditions. The latter can be of a General nature (weakening of the body's resistance to infection) or local (violations of passage of urine through the neck of the bladder or urethra, previous diseases of the bladder, inflammation of the neighbouring organs and tissues). The common reasons are also the value of infectious diseases, diseases of the intestinal tract, causing colibacillus, overwork, malnutrition, vitamin deficiencies. Regarding the role of cooling there is disagreement. According to some researchers, the contingent of patients, cystitis equally numerous in various periods of the year, however, most authors think that the cooling is high among the causes conducive to the development of cystitis.
Many patients recurrent cystitis note that as the original disease, and subsequent relapses coincided with cooling.
To local processes, predisposing to cystitis include stones, diverticula, tumors of the bladder, pathological conditions, resulting in violation of the evacuation of urine from the bladder (diseases of the Central nervous system, compression of the urethra tumors of the prostate, narrowing his clearance or obliteration), purulent-inflammatory diseases of internal genital organs in women, prostate cancer in men, venous stasis in the pelvis. Practical observations suggest that in the etiology of cystitis is set conscious prolonged retention of urine. Surveillance, I. Goldin has shown clear role of mental injury in the pathogenesis of cystitis.
Much less bacterial cystitis meet cystitis, causative agents of which are the simplest. Slightly increased the number of patients Trichomonas cystitis.
Cystitis can also be the result of a chemical burn.
Finally, cystitis often occurs as a complication of radiation therapy in patients with tumors of the bladder and neighboring organs, most commonly the cervix.
Classification. On etiological characteristics distinguish bacterial, medicine, radiation cystitis; morphological - catarrhal, hemorrhagic, and so on; by their origin - primary, secondary; the characteristics of the course - acute and chronic; on the prevalence of inflammation - Trinity, cervical, diffuse cystitis.
A working classification of cystitis should be based on a combination of these criteria (see table).

Under the terms of occurrence and etiopathogenesis The degree distribution With the flow By morphological changes
I. Primary
1. Infectious
a) microbial
b) Trichomonas
2. Chemical
3. Radiation
Diffuse Sharp Catarrhal
Hemorrhagic
Ulcerative and fibrinous-ulcer
Gangrenous
Cervical
Trinity Chronic Catarrhal
Ulcerative and fibrinous-ulcer
Cystic
Polypous
Encrusting
II. Secondary
(always infectious)
1. In patients with spinal cord injury
2. In violation of patency of the urethra
3. Calculous
4. When tumors of the bladder, etc.
Diffuse Sharp Catarrhal
Ulcerative and fibrinous-ulcer
Gangrenous
Localized Chronic Catarrhal
Ulcerative and fibrinous-ulcer
Pseudopolymelia

According to the classification detailed diagnosis should sound as follows: "Acute diffuse primary ulcer cystitis, Chronic cervical cystic cystitis", "Secondary calculous diffuse chronic ulcerative cystitis". Despite the awkwardness of this definition has the advantage of full reflection of the patient.
Pathological anatomy. Pathological changes in different forms of cystitis vary from moderate hyperemia of the mucosa up to necrosis of the wall. Redness of the mucous membrane, moderate its edema have been observed in catarrhal form, submucosal hemorrhage in hemorrhagic, ulcers and fibrinous raids in ulcerative and fibrinous-ulcer, total necrosis of the gallbladder wall at gangrenous form. For cystic forms characteristic small cysts translucent when zitostaticescoy study; in some cases, the standard procedure we formed cells with glandular building. Long-term chronic inflammation can lead to the formation pseudopolyps growths that may be mistakenly interpreted as tumours of the bladder. In the rare cases in the result of a desquamation of the epithelium occurs deposition of calcium salts on the surface of the mucous membrane with capture part or all of the bubble - encrusting cystitis.




Inflammation of the bladder (cystitis)

Inflammation of the bladder is called, typically infection and only in rare cases, chemicals, mistakenly or to treat introduced into the bladder (the soapy water, acid, iodine tincture and so on). For developing cystitis, in addition to infection, necessary favorable conditions of cooling of the body, injury bladder, a violation of the outflow of urine (for example, the urethra stricture, adenoma of prostate, bladder diverticulum, diseases of the Central nervous system), the presence of stones, foreign bodies, or tumors of the bladder.
Cause cystitis most often E. coli, Staphylococcus, Streptococcus, less vulgar Proteus - separately or in various combinations.
The bacteria penetrate into the bladder in several ways: 1) through the urethra; 2) from the kidney; 3) hematogenous route; 4) lymphogenous; 5) per continuitatem.
Most often, the infection reaches the bladder from the vagina through short and wide the female urethra. In men, the infection is introduced into the bladder through the urethra in inflammatory processes in the back of the urethra or prostate, with the introduction of catheters, Buga, lithotripters.
The downward path of infection is often observed in acute pielit (pielotsistit) and tuberculosis of the kidneys, rarely with chronic pyelonephritis, janefrose.
Lymphogenous by the infection penetrates into the bladder from the adjacent organs, such as endometritis, salpingooforit, vesiculitis, prostatitis.
Hematogenous route infection enters the form of microbial pitch into the thickness of the mucous membrane of the bubble in infectious diseases, sepsis.
Per continuitatem it penetrates from the adjacent inflammatory focus when his breakthrough into the bladder, gallbladder-rectal fistula, etc.
In acute cystitis pathological process captures the mucous and submucous membrane of the bubble. There hyperemia, swelling, places dotted haemorrhage (Fig. 75). The bladder epithelium rejected, tainted by the urine, with leukocytes and bacteria causing her blushing. Most changes are expressed in the area of the triangle and bladder neck. If inflammation capture only the area of the triangle or neck, talk about trigonica or cervical cystitis (trigonitis, cystitis colli).

acute cystitis cystoscopy
Fig. 75. Acute cystitis. Cystoscopy.

Chronic cystitis in the inflammatory process involves the muscular layer of the bladder. Proliferative infiltration muscle layer leads to the development of connective tissue, which, sclerosis, is a persistent reduction in the capacity of the bladder to 50-100 ml (Microcystis). The mucous membrane becomes dull, whitish-gray color. Long-term irritation of mucous membrane leads to metaplasia cystic glandular epithelium in education mucous cysts (cystitis cystica) or multi-layer flat orogovevshi education sharply defined areas thickened mucous membrane whitish color (leukoplakia bladder, Fig. 76). Chronic irritation of the bladder are fine podperevalny infiltrates round shape, reminiscent of the follicles (follicular cystitis, Fig. 77).

leukoplakia bladder
Fig. 76. Leukoplakia of the bladder.
follicular cystitis
Fig. 77. Follicular cystitis.

Chemical conjunctivitis, disorders of blood circulation in the wall of the bubble lead to necrosis of the mucous membrane (cystitis gangraenosa).
Acute cystitis is characterized by three symptoms: 1) frequent urination (pollakiuriya), 2) painful urination (dysuria), 3) purulent urine (Peoria).
Urination ecasino both day and night, during the time of peace and in motion. The pain is especially pronounced in the end of urination, while reducing the gallbladder triangle, due to the large number established by the nerve receptors.
White blood cells in urine is a mandatory feature of cystitis. Painful and frequent urination with clean urine can be caused by other diseases, bladder stones, prostate, and so on
To optional symptoms of cystitis include hematuria, which is more often the terminal, in the form of blood staining the last portion of urine.
The temperature is usually not increased due to the weak absorption capacity of the mucous membrane of the bubble. Temperature increases are usually indicates a complication of cystitis with pyelitis or pyelonephritis.
Acute cystitis runs in cycles. The disease lasts from 1 to 3 weeks. If during this time cystitis not cured, it is necessary to search for the cause of supporting chronic disease: stones, tumors, diverticula bladder, prostate disease, urogenital TB, inflammation of the female genital organs.
During the great Patriotic war was observed primary thrust cystitis, which for months and even years did not respond to therapy. Chronic disease caused by the weak resistance of the organism under the influence of psychological factors (cystitis war time"). To treat them with the greatest success was used intravenous orally as tablets 0.15-0.3 g every 2-3 days.
The diagnosis of acute cystitis put on the grounds mentioned triad of symptoms: heart urination, painful urination and purulent urine. In severe cases, cystoscopy and catheterization is contraindicated because of possible complications (prostatitis, pielit).
Chronic inflammation of the bladder cystoscopy is an important method of research. It gives a clear indication of the nature of the inflammatory changes and helps to identify etiological factor (adenoma of the prostate, bladder diverticulum). Zitostaticescoe picture helps to differentiate chronic cystitis from other urinary bladder diseases: tuberculosis, ulcers, tumors, stone.
In its clinical picture of acute cystitis similar to the acute prostatitis, but dysuric prostatitis occur mainly at night, and for cystitis they are permanent. Acute prostatitis the prostate is enlarged, heavy, painful, a fever, and urination not only ecasino, but difficult.
Trestina test is conducted with the differential diagnosis of cystitis with urethritis and prostatitis (acute or chronic). The patient produces urine in the 1st Cup, the most part - in the 2-nd Cup, the rest - to the 3-d glasses. For cystitis all 3 servings muddy, urethritis muddy the first portion, and the remaining transparent for prostatitis muddy the first and third helpings.
Women urine for research must take the catheter in order to avoid the ingress of vaginal discharge.
Treatment mainly medication - antibiotics, sulfanilamides, furadonin. Antibiotics are used depending on the type of pathogen and its sensitivity. Penicillin, the most effective when coccal flora, appoint 200000-300 000 IU 2-3 times a day intramuscularly. The syntomycin and chloramphenicol are taking 0.5 g 4 times, biomitsin and terramycin - 200 000 IU 4-5 times a day orally for 8-10 days, and furadonin appoint 0.1 g 3-4 times a day for 10-15 days.
In acute cystitis, if the patient has severe pains render analgesic effect of heat on the area of the bladder, sessile warm bath. You can assign promedol, pantopon in candles, aspirin (1 g on a half-glass of warm water) as microclysters.
The irrigation of the bladder with acute cystitis is contraindicated.
Radical treatment of chronic cystitis requires the elimination of the underlying disease stones, tumors of the bladder, inflammation of the genital organs, and so on, chronic cystitis shows the irrigation of the bladder with a warm solution of silver nitrate, oxycyanides mercury, rivanol (1:3000-1:5000). Drug therapy is the same as for acute cystitis.
An essential element of therapy for cystitis is a diet that excludes sharp, irritating dishes. Recommended abundant liquid intake. It should be especially carefully monitored during treatment for regularity of activity of intestines.