eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Cystitis, Nonbacterial: Follow-up

Author: Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Coauthor(s): Donna Y Deng, MD, Assistant Professor of Urology, Pelvic Reconstruction, Incontinence, and Neurourology, Department of Urology, University of California San Francisco School of Medicine
Contributor Information and Disclosures

Updated: Dec 12, 2008

Outcome and Prognosis

Infectious etiologies

Infectious causes of nonbacterial cystitis, such as HSV-1 or HSV-2, can now be treated; however, the treatment does not eliminate the dormant virus integrated into the host genome, so the disease can recur.

Both chlamydial and mycobacterial infections can be cured. For chlamydial disease, cure is not protective and the disease can be reacquired. In addition, while mycobacterial infections can generally be cured with regimens containing 3 or 4 drugs, in the review by Mnif et al of 60 cases of urogenital tuberculosis, only 2 were cured by medical therapy alone.38 Fifty-four patients required surgical intervention, including nephrectomy (43), ureterovesical reimplantation (7), augmentation enterocystoplasty (11), or other ureteral diversions (5). Two patients whose medical and nutritional status was poor to begin with died despite aggressive therapy.

Fungal infections are usually curable, depending on the underlying health status of the patient. Because patients with severe immunosuppression (eg, those with untreatable malignancies, AIDS, poorly-controlled diabetes, transplant patients) are the ones most likely to develop these infections, some patients may require continued treatment to ensure that the infection does not recur.

Noninfectious etiologies

Radiation cystitis, when it does occur, is usually mild and does not require specific therapy.37 The incidence of bleeding, scarring, and/or obstruction increases over time, and symptoms may occur for the first time many years after the radiation treatment. Some patients with heavy bleeding, strictures, or obstruction may require urinary diversion surgery for symptom relief.39

Chemical cystitis due to chemotherapy agents is generally mild, with no long-term consequences, and stops when the medications are stopped.

No known cures exist for autoimmune disease–associated cystitis, but symptoms can often be controlled with anti-inflammatory agents or corticosteroids.

Eosinophilic cystitis often recurs despite resection of the lesion and anti-inflammatory treatments, so long-term follow-up is required.13

Interstitial cystitis

Interstitial cystitis is probably the most difficult disease to treat. The symptoms of many patients can be ameliorated, although not completely eradicated, with medical treatment and a combined modality therapy program.

Relief of symptoms in the highly selected subset of patients who undergo surgery has been reported to be 60-90% for supra-trigonal cystectomy and more variable for total cystectomy. Some patients have continued pain despite total cystourethrectomy, emphasizing the poorly understood nature of the disease.

Future and Controversies

Many controversies exist in nonbacterial cystitis, including possible etiologic agents, methods of diagnosis, and treatment, especially for noninfectious causes.

The National Institutes of Health (NIH) has sponsored research on the topic of nonbacterial cystitis, and several organizations are devoted to helping patients with nonbacterial cystitis (particularly interstitial cystitis) and promoting research.

Advances in understanding the pathophysiology of complex pain syndromes have demonstrated growth of bridging neurons in the dorsal horns of the spinal cord between the type C pain fibers and the type A pain fibers, indicating perception of pain started by stimulus that is usually nonpainful. Another example of neural cross-talk in rats is an experiment that demonstrated increased muscle spasm in the bladder with colonic irritation and in the colon with bladder irritation, perhaps helping to explain the concomitant occurrences of irritable bowel syndrome, pelvic pain syndrome, and interstitial cystitis.

Other anti-inflammatory agents are also under investigation, such as IPD-1151T, an immunoregulatory agent that suppresses T cell–mediated cytokines responsible for IgE production and eosinophilia, as well as IL-4 and IL-5.

Some kinds of infectious, recurrent, nonbacterial cystitis are being treated with transfer factor (TF) specific for the kind of infection (Candida, herpes). De Vinci and associates demonstrated a marked decrease in the number of recurrences (P <0.001) in females treated with TF for this disorder.40

  • More information about interstitial cystitis and support information for patients can be obtained from the following associations:
    • Interstitial Cystitis Association
      51 Monroe St. Suite 1402
      Rockville, MD 20580
      Telephone toll-free: 1-800-help ICA
      Email: ICAmail@ichelp.com
      WWW.ichelp.org
    • American Foundation for Urologic Disease, Inc.
      300 West Pratt St. Suite 401
      Baltimore, MD 21201
      Telephone toll-free: 1-800-242-2383
  • The following is a Web site about interstitial cystitis: HealthlinkUSA
  • Patient materials and links (a urologic opinion of interstitial cystitis) can be found at the following:
    • Cystitis Support Group - United Kingdom
    • Interstitial Cystitis Network
    • The Interstitial Cystitis Network is a large archive of information on the Web for interstitial cystitis, including patient materials, a research library, and physician referrals.
    • The NIH maintains a patient information site for Interstitial Cystitis.
    • Urology Channel is another good source of general health information about urological subjects with a nice review of interstitial cystitis.
    • Also see Interstitial Cystitis.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors Drs. Grannum R Sant and Stephen Leslie to the development and writing of this article.



More on Cystitis, Nonbacterial

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Treatment: Cystitis, Nonbacterial
Follow-up: Cystitis, Nonbacterial
Multimedia: Cystitis, Nonbacterial
References
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Further Reading

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Keywords

nonbacterial cystitis, interstitial cystitis, IC, noninfectious cystitis, urgency-frequency syndrome, chemical cystitis, radiation cystitis, autoimmune cystitis, viral cystitis, mycobacterial cystitis, chlamydial cystitis, fungal cystitis, hypersensitivity cystitis, nonbacterial infectious cystitis, potassium leak test, chronic pelvic pain syndrome, painful bladder syndrome, PBS, infectious cystitis, tuberculous cystitis, eosinophilic cystitis

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Contributor Information and Disclosures

Author

Lynda A Frassetto, MD, Associate Clinical Professor, Department of Internal Medicine, University of California at San Francisco School of Medicine
Lynda A Frassetto, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Coauthor(s)

Donna Y Deng, MD, Assistant Professor of Urology, Pelvic Reconstruction, Incontinence, and Neurourology, Department of Urology, University of California San Francisco School of Medicine
Donna Y Deng, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, California Medical Association, International Continence Society, Société Internationale d'Urologie (International Society of Urology), and Society of Women in Urology
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Professor, Department of Urology, College of Physicians and Surgeons, Columbia University; Director of Urology, Allen Pavilion, New York Presbyterian Hospital
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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