Introduction
Background
Bladder cystitis is defined as inflammation of the urinary bladder from any cause. It is a relatively common condition affecting both sexes and all ages. It has no racial predisposition, but female individuals, especially those younger than 50 years, are affected more often than male individuals. In fact, almost every woman will have had cystitis at least once in her lifetime. The incidence of cystitis is high in women because of the short length of the urethra and because of the proximity of the urethra to the anus. This anatomy makes the female urinary bladder relatively easily accessible to intestinal pathogens.1,2,3,4,5
Left, Scout image obtained before intravenous urography (IVU) in a 62-year-old man with recurrent urinary tract infections shows multiple opaque bladder calculi (left). Note calculi in the right kidney. Right, Image obtained 20 minutes after the administration of contrast material shows a left hydronephrosis, hydroureter, bladder trabeculation secondary to bladder outlet obstruction, and bladder calculi.
Cystitis may be symptomatic or asymptomatic. Patients with cystitis may present with symptoms of urgency, frequency, dysuria, hematuria, cloudy and offensive-smelling urine, or suprapubic discomfort. These symptoms may occur singly or in combination. The symptom of urgency results from the stimulation of the afferent arc of the micturition reflex; the offensive smell results from the bacterial conversion of urea to ammonia.
Related eMedicine topics:
Urinary Tract Infection, Female
Urinary Tract Infection, Males
Schistosomiasis, Bladder
Pathophysiology
Types of cystitis
Most patients with cystitis have nonspecific acute or chronic inflammation of the bladder. Hyperemia of the mucosa is occasionally associated with an exudate. When a hemorrhagic component is present, the condition is termed hemorrhagic cystitis. The accumulation of a large amount of mucosal suppurative exudate is designated suppurative cystitis. When large areas of mucosal ulceration accompany cystitis, the term ulcerative cystitis is applied. In patients with chronic indwelling urinary bladder catheters, hypertrophy of the mucosa occurs; in this condition, the mucosa bulges into the bladder lumen in a polypoid fashion. This condition is termed polypoid cystitis.
Acute and chronic cystitis
Cystitis occurs in acute and chronic forms. Acute cystitis is more common than chronic cystitis; the onset of symptoms (described above) may be gradual or sudden. For male patients, acute cystitis is generally associated with an underlying disorder; therefore, male patients with acute cystitis should be thoroughly investigated. In female patients, a single episode of acute cystitis may usually be treated safely with antibiotics. However, recurrent episodes should be investigated.
Chemical cystitis
Chemical cystitis may occur in an acute setting. Chemical cystitis occurs in the absence of microorganisms. The causative chemicals may be deodorants sprayed in the perineal area or found on wipes. Chemical cystitis may also occur in association with the use of detergents in bath water. One important chemical that commonly causes cystitis is the cytotoxic drug cyclophosphamide.
The metabolite of cyclophosphamide, acrolein, is an oxidizing agent that is toxic to urothelial cells. Exposure results in the sloughing of these cells and in hemorrhagic cystitis. This condition usually occurs when cyclophosphamide is given intravenously in high doses.
Repeated episodes of acute cystitis or an ongoing unresolved cystitis gives rise to chronic cystitis. For patients receiving long courses of antibiotics, repeated episodes may result from resistance of the invading organism to the antimicrobial. Chronic cystitis may also result when the causative organism is not an intestinal pathogen; in such cases, special microbiologic tests are required to identify the organism. In certain cases, long-term, low-dose antimicrobial therapy may be necessary.
Tuberculous cystitis
Tuberculous cystitis is usually secondary to renal tuberculosis. It is more common in developing countries, but the incidence is rising in the United States and in Europe. The presenting symptoms are similar to those of any urinary tract infection (UTI).6 Patients may also have systemic symptoms of tuberculosis, such as fever, night sweats, and weight loss.
Cystoscopy reveals a contracted bladder, edematous mucosa, and tubercles, which appear as elevated spots. In early tuberculosis, the changes are seen around the ureteric orifices and the trigone of the bladder. If tuberculosis is suspected, 3 morning samples should be obtained for culturing. Tuberculous cystitis is treated with antituberculosis antimicrobials. In cases of a contracted bladder, augmentation cystoplasty may be necessary.
Schistosomiasis (bilharziasis)
Schistosomiasis (bilharziasis) is an infection with the trematodes Schistosoma haematobium. This disease is endemic in Africa, the Middle East, and the Nile valley. Man is the only definitive host.
The fluke embryos (cercariae) penetrate the skin of the host from infected water. They then migrate to the vesical venous plexus, where sexual reproduction takes place. The eggs are laid in the submucosal veins and penetrate the bladder wall to enter the urine. In the bladder, the eggs produce an acute inflammatory reaction with polyp formation. This produces symptoms of dysuria, frequency, and hematuria approximately 3 months after the initial infection.
Leukoplakia, squamous metaplasia, and carcinoma in situ may result.7 Chronic inflammation may result in bladder fibrosis with ureteral or urethral strictures. Calcification of the dead eggs within the bladder may produce a calcified bladder or bladder stones.
The diagnosis is made by examining samples from the end of the early morning urine sample; samples may need to be evaluated for several days. Treatment is with a single dose of praziquantel or metrifonate. Surgery is required to treat the bladder contraction or bladder cancer.
Radiation cystitis
Radiation is used to treat pelvic malignancies such as rectal carcinoma. The bladder is sensitive to radiation; early changes are vasodilatation and edema of the bladder. The late sequelae are endarteritis obliterans with sloughing of the mucosa; ulceration; and, eventually, bladder fibrosis. Secondary bacterial infection may complicate the inflammation. Bleeding from telangiectasia may be problematic.8 Transfusion and diathermy of the bleeding area may be required.
Interstitial cystitis (Hunner ulcer)
Lynes and associates described the histologic features in bladder biopsy specimens obtained from patients with interstitial cystitis and compared them with biopsy specimens from a control population.9 Although both the incidence and the degree of denuded epithelium, ulceration, and submucosal inflammation was increased for the patients as a group, none of these findings were considered pathognomonic. In addition, these findings occurred only in patients who had interstitial cystitis and pyuria or a small bladder.
The inflammatory infiltrate seen in interstitial cystitis consisted predominantly of lymphocytes; the number of plasma cells increased as the degree of inflammation increased. The inflammatory infiltrate had no specific predilection to be perineural. Submucosal inflammation was associated with denuded epithelium, ulceration, pyuria, and a clinical response to therapy that suggested a pathophysiologic relationship.
Interstitial cystitis is a painful bladder disease characterized by chronic urinary urgency, frequency, and pain without evidence of bacterial infection. Nearly 90% of patients with interstitial cystitis are women. Somatization disorder is a psychiatric condition occurring most often in women who report a variety of symptoms, such as dysmenorrhea, a burning sensation in the sex organs, dyspareunia, irregular menstrual periods, and painful urination. Because the diagnosis of interstitial cystitis may take many years, health care providers must be alert to the risks of overdiagnosing psychiatric problems and underdiagnosing interstitial cystitis.10
In one study, epithelial and basement membrane thickness, submucosal edema, vascular ectasia, fibrosis, and detrusor muscle inflammation and fibrosis were not substantially different in patients with interstitial cystitis than in control subjects. The findings suggested that interstitial cystitis is a chronic submucosal inflammatory disease, at least in patients with pyuria or small bladder capacity.
Interstitial cystitis is best diagnosed on the basis of its clinical features. The histologic changes identified by means of bladder biopsy support the diagnosis.
Mast cells play a limited role in the diagnosis. There are no clear diagnostic criteria for interstitial cystitis, and the incidence is unknown. It most commonly occurs in middle-aged women. It causes suprapubic pain in association with urgency and frequency. The pain is relieved by micturition. Bladder capacity is reduced because of inflammation and fibrosis of the bladder wall. The urine is sterile. Cystoscopy at first may show no abnormality. However, when the bladder is filled and allowed to empty, linear ulcers appear with cascade hemorrhage. Biopsy of the bladder wall often shows a pancystitis with heavy mast cell infiltration.
Several treatment options are available, none of which are highly successful. Distention of the bladder, cauterization of the ulcers, and instillation of dimethylsulphoxide have all had limited success. The symptoms usually recur. In some cases, the only remedy is cystectomy.11
Frequency
United States
Urinary tract infections (UTIs) are the most common infections seen in the hospital setting; they are the second most common infections occurring in the general population.
Trotman and associates reported the incidence of hemorrhagic cystitis to be 18.2% in 681 patients receiving hemopoietic stem cell transplants.12
Approximately 50-80% of patients with emphysematous cystitis have diabetes; the incidence is higher in female patients than in male patients.
Roberts et al calculated the community-based incidence of interstitial cystitis.13 In women, the age-adjusted incidence was 1.6 cases per 100,000; in men, the incidence was 0.6 per 100,000 men (P = 0.04). The median age at initial diagnosis was 44.5 years (range, 27-76 y) in women; it was 71.5 years (range, 23-79 y) in men (P = 0.26). The median number of episodes of visits to health care providers for relief of symptoms before diagnosis was 1 for women and 4.5 for men (P = 0.03). The median duration from the onset of symptoms until the first diagnosis was 0.06 and 2.2 years for women and men, respectively (P = 0.2). These findings suggest that the incidence of interstitial cystitis in the community is extremely low. Although the sex difference may be real, the trend toward a later diagnosis in men than in women suggests a potential for missed diagnosis in men.
Curhan et al estimated that the prevalence of interstitial cystitis in the United States was more than 50% greater than previously reported and 3-fold greater than the reported prevalence in Europe.14
International
In a Finnish study, Leppilahti et al found the prevalence of urinary symptoms representing probable interstitial cystitis to be 450 cases per 100,000 population (95% confidence interval: 100, 800).15 This rate is an order of magnitude higher than those previously reported.
Schistosomiasis is more common in the Middle East than in the United States; tuberculous cystitis is more common in developing countries than in the United States.
Mortality/Morbidity
Urinary tract infection (UTI) results in clinically significant morbidity and mortality and consumes large amounts of national resources. The prevention, diagnosis, and treatment of UTI produce both costs and benefits; economic analysis provides a rational framework for examining these effects.16
Chung et al reported the death of a male patient from gross encrustations of the entire upper urinary tract and bladder by a Corynebacterium group D2 organism; the patient had no history of renal transplantation or prolonged catheterizations.17 The case demonstrates that debilitated patients who have undergone an endoscopic procedure are at risk for this disease. Prolonged treatment with appropriate antibiotics, acidification of the urine, and removal of crusts is essential for proper management.
Chronic radiation cystitis after pelvic irradiation occasionally causes massive bleeding that is difficult to control with conventional means. Cheng and Foo evaluated 42 such cases, of which 9 were classified as severe on the basis of the need for repeat cystodiathermy, massive transfusions, and open surgical intervention.18 Six patients required emergency bilateral percutaneous nephrostomy for proximal urinary diversions to help stop the bleeding. Despite aggressive treatment, 2 patients died in hospital, and 2 died shortly after discharge. Three eventually required elective ileal conduit diversion of a contracted defunctionalized bladder. Therefore, this essentially benign condition has relatively high morbidity and mortality rates. Increased physician awareness and timely percutaneous nephrostomy may improve the prognosis.
Maatman et al studied morbidity and mortality associated with intracavitary irradiation for noninvasive papillary transitional cell carcinoma and carcinoma in situ of the bladder.19 Mortality has been associated with this form of therapy. Associated morbidity consisted of mild to severe radiation cystitis. Two cases of severe irradiation cystitis were reported. One was from a series of 65 patients with noninvasive bladder tumors who underwent treatment with intracavitary irradiation at Maatman et al's clinic. The second case involved a patient with noninvasive bladder tumors who was treated elsewhere. In both cases, severe radiation cystitis developed and required simple cystectomy and urinary diversion. This potentially serious adverse effect must be considered when therapy for these cancers is chosen.
Supravesical urinary diversion without cystectomy is a common procedure performed to manage a variety of lower urinary tract pathologies, including intractable chronic cystitis. A variety of complications are associated with a defunctionalized bladder; these include pyocystis, hemorrhage, pain/spasm, and neoplastic transformation. The defunctionalized bladder also has implications for sexual function and pregnancy.
Risk factors for complications are chronic infection, inadequate drainage, interstitial cystitis, and previous irradiation. The incidence of neoplastic change in the defunctionalized bladder is low, but long-term follow-up examination is advised, because carcinoma may develop many decades after diversion. Sexual function is better preserved after urinary diversion when the bladder is retained.20
See also Special Concerns, below.
Race
- Schistosomiasis is rare in the United States, but it is common in Middle Eastern countries, notably, Egypt and Yemen.
- Tuberculous cystitis is also rare in the United States, but it is common in developing countries.
Sex
See also Frequency above.
- Because of differences in anatomy, urinary tract infections (UTIs) are especially problematic in women; as many as one third of all women have a UTI at some point during their lifetime.
- Acute cystitis is approximately 3 times more common in female individuals than in male individuals, though the exact rates are not available.
- Interstitial cystitis is also approximately 3 times more common in females than in males.
Age
Cystitis of the bladder may affect persons of any age.
Presentation
Disorders
A wide variety of focal and diffuse inflammatory or infectious disorders may affect the abdominal or pelvic cavity.21 Some of the diseases, such as pyelonephritis, cystitis, and pelvic inflammatory disease, are relatively benign; these conditions are usually diagnosed without imaging and are treated without complications. Some disorders, such as abdominal abscesses, are more serious and may defy clinical diagnosis. These disorders are associated with significant morbidity and mortality; they may remain undetected or insufficiently characterized despite the use of several imaging studies.
Predisposing factors
Incomplete voiding of the bladder results in stasis of urine and, hence, the concentration of bladder bacteria. Incomplete voiding may result from bladder outflow obstruction. This may be caused by conditions such as a neurogenic bladder, urethral strictures, bladder diverticulum, and prostatic hypertrophy.
Other predisposing factors include the following:
- Foreign body or a neoplasm in the bladder
- Bladder instrumentation
- Improper hygiene
- Abnormal communication between the bladder and nearby structures (fistulae)
- Lowered local resistance, as occurs in patients with diabetes mellitus and those with low estrogen levels
- Bladder trauma, as may occur with instrumentation of the bladder
Clinical presentation
Regardless of the etiology of cystitis, it is generally characterized by a triad of symptoms, including pelvic pain,4,5 dysuria, and micturition of a frequency such that the patient voids every 15-20 minutes.
Associated systemic manifestations include fever, chills, and general malaise, though systemic manifestations with a bladder infection are unusual. Local bladder symptoms may be disturbing, but more importantly, these symptoms may precede acute pyelonephritis. It is also important to remember that cystitis may result from an underlying structural bladder abnormality, such as a neurogenic bladder, bladder outlet obstruction, calculi, tumor, or cystocele. These primary causes need to be corrected before resolution of the cystitis is possible.
Cystoscopic findings and infectious organisms
Cystoscopy reveals a red, inflamed mucosa that bleeds on contact.22 In both sexes, the most common causative organism is the coliform bacteria Escherichia coli; it is found in more than 80% of non–hospital-acquired infections and in more than 40% of inpatients. Other common causative organisms are Klebsiella species, Proteus mirabilis, and Streptococcus faecalis.
In patients with a neurogenic bladder or with a long-standing indwelling catheter, mixed organisms, including Pseudomonas organisms, Staphylococcus aureus, Enterobacter organisms, and other species of streptococci, are commonly found. Rare causes include herpesvirus, Chlamydia species, and Neisseria gonorrhoeae. These organisms are most commonly found in people younger than 30 years.
Histopathologic findings
On pathologic evaluation, acute cystitis differs from chronic cystitis only in the character of the inflammatory infiltrate. In the acute form, there is more heaping up of the epithelium than in the chronic form; this heaping up of the epithelium is often associated with red, friable, granular, and occasionally ulcerated surface mucosa. Chronic bladder inflammation leads to fibrous thickening of the tunic propria; this in turn leads to thickening and causes inelasticity of the bladder, with a concomitant reduction in bladder capacity.
In general, histologic findings in both acute and chronic cystitis are those of a nonspecific acute or chronic inflammation. However, there are a number of special forms of cystitis, which are discussed in this article. One special form of chronic cystitis is characterized by the accumulation of lymphocytes so as to form lymph follicles in the bladder mucosa and underlying wall; this results in a variant of chronic cystitis known as cystitis follicularis.
Preferred Examination
In patients with suspected acute cystitis, a urine sample should be obtained and sent for microscopic analysis. It should also be cultured for bacteria, and the bacterial sensitivity should be analyzed.
Cystitis is a clinical diagnosis; in most patients, imaging is not required. The diagnosis is generally made by means of cystoscopy. However, some clinicians use ultrasonography to exclude secondary causes of cystitis, such as bladder outlet obstruction and bladder calculi. Ultrasonography is also employed to look for associated renal disease; it is also a good modality for measuring bladder capacity, which may be a major concern in cases of cystitis.
Left, Scout image obtained before intravenous urography (IVU) in a 62-year-old man with recurrent urinary tract infections shows multiple opaque bladder calculi (left). Note calculi in the right kidney. Right, Image obtained 20 minutes after the administration of contrast material shows a left hydronephrosis, hydroureter, bladder trabeculation secondary to bladder outlet obstruction, and bladder calculi.
Common to all forms of cystitis are bladder wall and mucosal thickening; irregularity; and mucosal ulceration of varying intensity. These changes may be focal or diffuse. These findings are depicted with a variety of imaging modalities. Plain radiography is noninvasive and is good for diagnosing renal and bladder calculi and bladder calcification, as occurs in some forms of chronic cystitis (see Images 3-11).
Plain abdominal radiograph in a male patient with genitourinary tuberculosis shows left renal, bladder, and seminal vesicle calcification.
Contrast-enhanced studies (intravenous urography [IVU] or cystography) are good at showing structural abnormalities of the kidneys, ureters, and bladder. IVU also allows a rough assessment of renal function. Mucosal bladder irregularity, polypoid bladder masses, bladder trabeculation, and diverticula are usually well depicted on cystograms; bladder emptying may also be assessed with postvoiding cystograms.
Nuclear medicine and angiography have no defined role in the assessment and diagnosis of cystitis. Sinuses and fistulae formation may complicate certain chronic forms of cystitis. MRI is best for imaging these conditions. MRI is also the preferred modality in cases of postirradiation and hemorrhagic cystitis. CT scans show bladder calcification to advantage; CT is the preferred modality for the diagnosis of granulomatous and emphysematous cystitis.
Limitations of Techniques
The imaging features of cystitis are nonspecific; on imaging alone, one form of cystitis cannot be differentiated from another. Bladder tumors may cause mucosal and bladder wall changes that are similar to the changes seen in cystitis, and vice versa. Problems may even arise in differentiating malignancy from cystitis with cystoscopy, and biopsy may be required. Bladder calcification is a nonspecific finding and has several etiologies.
Differential Diagnoses
Endometrioma/Endometriosis
Pelvic Inflammatory Disease/Tubo-ovarian
Abscess
Other Problems to Be Considered
Tuberculous cystitis
Radiation cystitis
Genitourinary tumor
Chemical cystitis
Active genital herpes
Chlamydia trachomatous infection
Vaginitis
Vulvar vestibulitis
Urethral diverticulum
Neuropathic bladder dysfunction
Prostatitis
Urethritis
Urethral syndrome
Jain and associates described 6 cases of localized urinary bladder amyloidosis that were suspected on clinical and cystoscopic grounds as being bladder tumor or cystitis; these cases occurred over a period of 10 years.23
More on Bladder, Cystitis |
 Overview: Bladder, Cystitis |
| Imaging: Bladder, Cystitis |
| Follow-up: Bladder, Cystitis |
| Multimedia: Bladder, Cystitis |
| References |
| Next Page » |
References
Klutke CG, Klutke JJ. Interstitial cystitis/painful bladder syndrome for the primary care physician. Can J Urol. Aug 2008;15 Suppl 1:44-52; discussion 52-3. [Medline].
Seth A, Teichman JM. What's new in the diagnosis and management of painful bladder syndrome/interstitial cystitis?. Curr Urol Rep. Sep 2008;9(5):349-57. [Medline].
Bharucha AE, Trabuco E. Functional and chronic anorectal and pelvic pain disorders. Gastroenterol Clin North Am. Sep 2008;37(3):685-96. [Medline].
Hanno P, Nordling J, van Ophoven A. What is new in bladder pain syndrome/interstitial cystitis?. Curr Opin Urol. Jul 2008;18(4):353-8. [Medline].
Klumpp DJ, Rudick CN. Summation model of pelvic pain in interstitial cystitis. Nat Clin Pract Urol. Sep 2008;5(9):494-500. [Medline].
Worawattanakul S, Semelka RC, Kelekis NL. Post radiation hemorrhagic cystitis: MR findings. Magn Reson Imaging. 1997;15(9):1103-6. [Medline].
Ghoneim MA. Bilharziasis of the genitourinary tract. BJU Int. Mar 2002;89 Suppl 1:22-30.
Crew JP, Jephcott CR, Reynard JM. Radiation-induced haemorrhagic cystitis. Eur Urol. Aug 2001;40(2):111-23.
Lynes WL, Flynn SD, Shortliffe LD, Stamey TA. The histology of interstitial cystitis. Am J Surg Pathol. Oct 1990;14(10):969-76. [Medline].
Webster DC. Interstitial cystitis: women at risk for psychiatric misdiagnosis. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993;4(2):236-43. [Medline].
Gousse AE, Tiguert R, Madjar S. Current investigations and treatment of interstitial cystitis. Curr Urol Rep. Oct 2000;1(3):190-8. [Medline].
Trotman J, Nivison-Smith I, Dodds A. Haemorrhagic cystitis: incidence and risk factors in a transplant population using hyperhydration. Bone Marrow Transplant. Apr 1999;23(8):797-801. [Medline].
Roberts RO, Bergstralh EJ, Bass SE, et al. Incidence of physician-diagnosed interstitial cystitis in Olmsted County: a community-based study. BJU Int. Feb 2003;91(3):181-5. [Medline].
Curhan GC, Speizer FE, Hunter DJ, et al. Epidemiology of interstitial cystitis: a population based study. J Urol. Feb 1999;161(2):549-52.
Leppilahti M, Sairanen J, Tammela TL, et al. Prevalence of clinically confirmed interstitial cystitis in women: a population based study in Finland. J Urol. Aug 2005;174(2):581-3. [Medline].
Patton JP, Nash DB, Abrutyn E. Urinary tract infection: economic considerations. Med Clin North Am. Mar 1991;75(2):495-513. [Medline].
Chung SY, Davies BJ, O''Donnell WF. Mortality from grossly encrusted bilateral pyelitis, ureteritis, and cystitis by Corynebacterium group D2. Urology. Feb 2003;61(2):463.
Cheng C, Foo KT. Management of severe chronic radiation cystitis. Ann Acad Med Singapore. May 1992;21(3):368-71.
Maatman TJ, Novick AC, Montague DK, Levin HS. Radiation-induced cystitis following intracavitary irradiation for superficial bladder cancer. J Urol. Aug 1983;130(2):338-9. [Medline].
Adeyoju AB, Lynch TH, Thornhill JA. The defunctionalized bladder. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(1):48-51. [Medline].
Warren JW, Brown V, Jacobs S, Horne L, Langenberg P, Greenberg P. Urinary tract infection and inflammation at onset of interstitial cystitis/painful bladder syndrome. Urology. Jun 2008;71(6):1085-90. [Medline].
Lopes RI, Nogueira L, Albertotti CJ, Takahashi DY, Lopes RN. Comparison of virtual cystoscopy and transabdominal ultrasonography with conventional cystoscopy for bladder tumor detection. J Endourol. Aug 2008;22(8):1725-9. [Medline].
Jain M, Kumari N, Chhabra P, Gupta RK. Localized amyloidosis of urinary bladder: A diagnostic dilemma. Indian J Pathol Microbiol. Apr 2008;51(2):247-9. [Medline].
Verguts L, Deconinck K, Mortelmans LL. Alkaline encrusting cystitis. Urol Radiol. 1987;9(1):53-5. [Medline].
Min JK, Byun JY, Lee SH, et al. Urinary bladder involvement in patients with systemic lupus erythematosus: with review of the literature. Korean J Intern Med. Jan 2000;15(1):42-50. [Medline].
O''Dea MJ, Malek RS. Foreign body in bladder and perivesicular inflammation masquerading as pelvic lipomatosis. J Urol. Nov 1976;116(5):669-70. [Medline].
Ichikawa T, Tsukune Y, Ohya K, Mizuguchi K. 3D-CT cystography of submucosal elevated lesion of the bladder: report of two cases [in Japanese]. Nippon Igaku Hoshasen Gakkai Zasshi. Jan 1999;59(1):34-6. [Medline].
Braganca N, Cruz T, Fonseca J, et al. Gangrenous cystitis [in Portugese]. Acta Med Port. May-Jun 2001;14(3):357-9. [Medline].
Kawahara M, Kawahara K, Goto T, et al. Abdominal actinomycosis misdiagnosed as a secondary bladder tumor: a case report. Int J Urol. Sep 1998;5(5):498-500. [Medline].
Dhamborvorn T, Tritipsatit S, Meemongkoldilok S. Actinomycosis of the urinary bladder. J Med Assoc Thai. Jan 2001;84(1):109-12. [Medline].
Lee KR, Ko YS, Yu JW, et al. Primary vesical actinomycosis: a case diagnosed by multiple transabdominal needle biopsies. J Korean Med Sci. Feb 2002;17(1):121-4. [Medline].
Heer M, Hany A, Rauch R, Sulser H. Actinomycosis of the colon: clinical, endoscopic, serological and therapeutic aspects [in German]. Schweiz Med Wochenschr. Apr 19 1986;116(16):514-8. [Medline].
Epstein BM, Patel V, Porteous PH. CT appearance of bladder malakoplakia. J Comput Assist Tomogr. Jun 1983;7(3):541-3. [Medline].
Heverhagen JT, Hartlieb T, Boehm D, et al. Magnetic resonance cystometry: accurate assessment of bladder volume with magnetic resonance imaging. Urology. Aug 2002;60(2):309-14. [Medline].
Narumi Y, Kadota T, Inoue E, et al. Bladder wall morphology: in vitro MR imaging-histopathologic correlation. Radiology. Apr 1993;187(1):151-5. [Medline].
Koshiyama M, Yoshida M, Fujii H, et al. Ovarian actinomycosis complicated by diabetes mellitus simulating an advanced ovarian carcinoma. Eur J Obstet Gynecol Reprod Biol. Nov 1999;87(1):95-9. [Medline].
Nukui M, Nakagawa Y, Uchida M. Vesical malacoplakia accompanied with bilateral hydronephrosis: a case report [in Japanese]. Hinyokika Kiyo. Jan 1997;43(1):49-52. [Medline].
Ollier P, Bourrier P, Adil A, et al. A case of lymph nodes involvement in malakoplakia of the bladder [in French]. J Radiol. Feb 2000;81(2):158-60. [Medline].
Goodgold HM, Samuels LD. Misleading findings on indium-111 leukocyte images. Clin Nucl Med. Jun 1986;11(6):392-5. [Medline].
Hietala SO, Duchek M. Angiography in urinary bladder tuberculosis. Acta Radiol Diagn (Stockh). May 1975;16(3):297-304. [Medline].
Duchek M, Hietala SO, Winblad B. Diagnostic aspects of bladder angiography in urinary bladder tuberculosis. Int Urol Nephrol. 1976;8(4):287-94. [Medline].
Hendrickx P, Orth G, Grunert J. Embolisation of bleeding pelvic lesions from benign origin--long-term results. J Belge Radiol. Dec 1995;78(6):339-41. [Medline].
Thelen M, Bruhl P. Arterial catheter embolisation for bleeding from bladder carcinoma [in German]. ROFO Fortschr Geb Rontgenstr Nuklearmed. Aug 1978;129(2):198-201. [Medline].
Millar LK, Cox SM. Urinary tract infections complicating pregnancy. Infect Dis Clin North Am. Mar 1997;11(1):13-26. [Medline].
Yang CC, Hurd DD, Case LD, Assimos DG. Hemorrhagic cystitis in bone marrow transplantation. Urology. Sep 1994;44(3):322-8. [Medline].
Leung AY, Mak R, Lie AK, et al. Clinicopathological features and risk factors of clinically overt haemorrhagic cystitis complicating bone marrow transplantation. Bone Marrow Transplant. Mar 2002;29(6):509-13. [Medline].
Agrons GA, Wagner BJ, Lonergan GJ, et al. From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic-pathologic correlation. Radiographics. Jul-Aug 1997;17(4):919-37. [Medline].
Biggi A, Dardanelli L, Pomero G, et al. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatr Nephrol. Sep 2001;16(9):733-8. [Medline].
Botella E, Burgues O, Navarro S, et al. Warty Carcinoma Arising in Condyloma Acuminatum of Urinary Bladder: A Case Report. Int J Surg Pathol. Jul 2000;8(3):253-259.
Bremnor JD, Sadovsky R. Evaluation of dysuria in adults. Am Fam Physician. Apr 15 2002;65(8):1589-96. [Medline].
Bron J, Haab F, Welker Y, et al. Pseudo-tumoral cystitis due to Toxoplasma in an patient with AIDS [in French]. Prog Urol. Apr 1995;5(2):270-3. [Medline].
Defoor W, Minevich E, Sheldon C. Unusual bladder masses in children. Urology. Nov 2002;60(5):911. [Medline].
Farina Perez LA, Menendez P, Astudillo A, et al. [Encrusted alkaline cystitis and malacoplakia]. Actas Urol Esp. Nov-Dec 1999;23(10):885-7. [Medline].
Grayson DE, Abbott RM, Levy AD, Sherman PM. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. May-Jun 2002;22(3):543-61. [Medline].
Hanus T, Zamecnik L, Jansky M, et al. The comparison of clinical and histopathologic features of interstitial cystitis. Urology. Jun 2001;57(6 Suppl 1):131. [Medline].
Hsin SC, Hsieh MC, Lin HY, et al. Emphysematous cystitis, a rare complication of urinary tract infection in a male diabetic patient: a case report. Kaohsiung J Med Sci. Mar 2003;19(3):132-5. [Medline].
Irwin GA, Craig R, Novotny P. CT of calcified bladder masses. Comput Radiol. May-Jun 1985;9(3):181-4. [Medline].
Kuromitsu S, Yokota H, Hiramoto M, Morita S, Mita H, Yamada T. Increased concentration of neutrophil elastase in urine from patients with interstitial cystitis. Scand J Urol Nephrol. Apr 30 2008;1-7. [Medline].
Ma JF, McClenathan JH. Emphysematous cystitis. J Am Coll Surg. Nov 2001;193(5):574. [Medline].
Singh I, Ansari MS. Cystitis cystica glandularis masquerading as a bladder tumor. Int Urol Nephrol. 2001;33(4):635-6. [Medline].
Thoumas D, Darmallaicq C, Pfister C, et al. Imaging characteristics of alkaline-encrusted cystitis and pyelitis. AJR Am J Roentgenol. Feb 2002;178(2):389-92. [Medline].
Tong RS, Larner T, Finlay M, et al. Pelvic lipomatosis associated with proliferative cystitis occurring in two brothers. Urology. Apr 2002;59(4):602. [Medline].
van den Ouden D. Diagnosis and management of eosinophilic cystitis: a pooled analysis of 135 cases. Eur Urol. Apr 2000;37(4):386-94. [Medline].
Wise GJ, Marella VK. Genitourinary manifestations of tuberculosis. Urol Clin North Am. Feb 2003;30(1):111-21. [Medline].
Further Reading
Keywords
cystitis of the bladder, lower urinary tract infection, UTI, lower UTI, acute bacterial cystitis, interstitial cystitis, eosinophilic cystitis, glandular cystitis, cystitis cystica, cystitis follicularis, bullous cystitis, cyclophosphamide-induced cystitis, methicillin cystitis, emphysematous cystitis, viral cystitis, alkaline encrusting cystitis, tuberculous cystitis, foreign body cystitis, catheter cystitis, fungal cystitis, schistosomiasis, gangrenous cystitis, nephrogenic adenoma, malakoplakia, actinomycosis, pelvic lipomatosis, cystitis associated with systemic lupus erythematosus, pyocystis, HIV cystitis, cystitis of extrinsic causes
