CystitisThe acute and chronic form

Made easy

Any Relationship !! ??

THE CASE

• 55 yrs old poorly controlled diabetic female presented with burning pain at micturition , excessive need to urinate but each time she goes , she was passing only small amount of cloudy coloured urine that has a fishy odour

Case highlights

• 55 yrs old poorly contolled diabetic female presented with burning pain at micturition , excessive need to urinate but each time she goes , she was passing only small amount of cloudy coloured urine that has a fishy odour

So what to do

• Extended history • Physical examination including the vital

signs ( fever , tachycardia ) and searching for suprapubic tenderness

• Urinalysis to look for the microorganism that caused the trouble

• Complete blood picture will reveal leukocytosis

• Urine culture that takes a day or two

What can cause the trouble? • Bacterial cystitis :1. E.coli 2. Proteus3. Klebsiella• Tuberculous cystitis• Fungal cystitis ( candida albicans) Immunesuppressed and those on long term ABCs • Schistosomal cystitis • Viruses , chlamydia , mycoplasma • Other non infectious causes : drugs (cyclophosphamide) and

radiation ( radiation cystitis)

Predisposing factors 5

• Urinary obstruction ( BPH , bladder calculi and tumors )

• Cystocele or diverticula • D.M• Instrumentation • Immune defeciency

Grossly , what to see ?

• Hyperemia of the mucosa • Hemorrhagic cystitis : (after Radio,Chemo or Adeno)

• Suppurative cystitis : large amounts of suppurative exudate

• Ulcerative cystitis : large mucosal ulcers and sometimes ulceration of entire bladder mucosa !

• IF the infection persists Chronic cystitis that’s seen as Red , Friable , Granular mucosa ANOTHER association is the fibrosing thickening and inelasticity of bladder wall

Post-radiotherapy hemorragic cystitis

Fibrous thickening of bladder wall

Microscopically there is: • acute cystitis acute infammation • chronic cystitis chronic inflammatory

cells ( ? ) with fibrosis• two variants of chronic cystitis :1. Follicular cystitis 2. Eosinophilic cystitis

Schistosomal cystitis • Caused by S. Hematobuim • Eggs (by anastomosis) travel from sup. Rect. V.

to the veins of bladder wall , these eggs are irritating so causing granulomatous cystitis with eosinphilic infiltrate and fibrosis

• These granulomas are seen as minute granules hence the name (sand grain cystitis)

• The eggs die and calcify

What are the complications? • extensive fibrosis ( that may impinge on

ureteric orifices to cause hydronephrosis • CA bladder (squamous type) :

Schistosomal cystitis

Squamous metaplasia Carcinoma

IRAQ …. LIKE A BOSS!!

Special forms of cystitis

1. Interstitial cystitis (Hunner ulcer) :• painful form of chronic cystitis (very painful)• most frequently in women • Cystoscopy shows : fissures and punctate

hemorrhages in the mucosa , sometimes with chronic mucosal ulcers

• mast cell infiltrate is characteristic • Maybe of autoimmune origin

Special forms of cystitis

2. Malakoplakia : • Macroscopically : soft , yellow , slightly raised

mucosal plaques 3-4 cm in diameter • Microscopically : infiltration by large foamy

macrophages with debris of bacterial origin (E.coli) • Michaelis – Gutmann bodies (laminated

mineralized concretions) are typically present• Occurs in increased frequency in immune

suppressed transplant recipients

Special forms of cystitis

3. Polypoid cystitis : • Results from irritation of bladder mucosa by

indwelling catheters • Submucosal Edema causes broad , bulbous ,

polypoid projections

Review • cystitis is either infectious or non infectious • 5 predisposing factors for cystitis • The acute form seen grossly : hyperemia,

hemorrhagic cystitis , suppurative cystitis and ulcerative cystitis microscopically : acute inflammation.

• The chronic form grossly : red , friable , granular ulcerated mucosa, and fibrous thickening and inelasticity of wall , microscopically : chronic cell infiltrate and fibrosis

Review

• schistosomal cystitis : S. hematobium• Eggs in the walls causing granulomas,

eosinophilic infiltrate, fibrosis • granulomas look like sand grains • 2 complications ( extensive fibrosis impenge

ureters causing hydronephosis , and squamous metaplasia and carcinoma of bladder )

Thank You