Nonbacterial Cystitis Workup

  • Author: Lynda A Frassetto, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Apr 21, 2010
 

Laboratory Studies

Infectious etiologies

  • Viral infections are often difficult to diagnose. Viral culture results can be falsely negative. Some viruses can be detected by polymerase chain reaction (PCR) or by detection of antibodies to the virus.
  • Chlamydia can also be difficult to grow, and chlamydial culture results may be falsely negative. Chlamydia infection can also be diagnosed by cell cytology, enzyme-linked immunoassays, and PCR. Of all of these tests, PCR is probably the most reliable.[26]
  • Prior mycobacterial infection, such as Mycobacterium tuberculosis, can be detected by intracutaneous injection of a dose of intermediate-strength tuberculin-purified protein derivative. The test is considered positive if an induration of at least 10 mm develops at the injection site within 48-72 hours. More recently, an assay has been developed that quantifies interferon-gamma released from T cells sensitized to tuberculosis antigens (the QuantiFeron test); the second-generation assay uses antigens almost completely specific for M tuberculosis and can be performed using whole blood samples.
  • Mycobacteria can also be detected with examination of tissue stained with the acid-fast dye carbol fuchsin as slender, curved, polychromatic beaded rods in pairs or small clumps. Growing the bacteria on highly selective media allows cultivation within 1-2 weeks, although identification and antibiotic sensitivity testing may take longer. Finally, mycobacterial infection can be detected with PCR. In a study by Moussa et al, the sensitivity of acid-fast bacilli (AFB) staining was 52% versus 96% for PCR when compared with cultures.[27]
  • Fungal infection can be indicated by the findings of hyphae and/or spores on microscopic evaluation of wet smears or histopathologic sections or by culture. Microbiologic diagnosis of funguria is based on a fungal concentration of more than 103/µL in the urine.[19] Some fungi, such as Candida species, grow on many media, while others, such as B dermatitidis, require specialized culture techniques. More recently, DNA probes for detection of numerous fungal infections by PCR have also become available.[28]
  • Schistosomal infection is detected by searching for terminally spined eggs in urinary sediment. Histopathologic analysis can also be performed with a squash preparation on a glass slide.
  • Urinary, urethral, and/or vaginal or prostatic cultures can also be performed. Special stains or PCR for viruses, chlamydia, fungi, and mycobacteria should be included in selected patients.

Noninfectious etiologies

  • The diagnosis of cystitis due to radiation therapy, chemicals, or autoimmune disease can be established in part by obtaining the relevant history. In patients with radiation cystitis, associated UTIs are not uncommon. Cystoscopy may be required to exclude other causes of bleeding, such as recurrent tumor, a new primary tumor, or benign prostatic hyperplasia.
  • Diagnosis of autoimmune diseases relies on a compatible history supported by serologic or tissue confirmation. Detection of antinuclear antibodies (ANA) is often used as a screening test for connective-tissue disease; positive test results are subjected to assays that are more specific.
  • Cystoscopy with biopsy is the criterion standard for diagnosing eosinophilic cystitis.[12] Some patients may also have peripheral eosinophilia.
  • Serologic tests likely to be positive in patients with SLE include low C3, anti–double stranded (ds) DNA, anti-Smith (Sm), and antiribonucleoprotein (anti-RNP) antibodies.
  • Biopsy of affected organs may show vasculitis. Tests likely to have positive results in patients with Sjögren syndrome include the Schirmer tear test, anti-Ro(SS-A) and anti-La(SS-B), and minor lacrimal gland biopsy. Urine cytology can be a useful first step in the diagnosis of genitourinary malignancies.
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Imaging Studies

Possible imaging tests include abdominal ultrasonography, CT scanning, or MRI for stones, tumors, or endometriosis or dye studies to evaluate for bladder or ureteral strictures and obstruction. Example radiographs of genitourinary tuberculosis can be found in the article Tuberculosis, Genitourinary Tract.

In patients with SLE and bladder involvement, abdominal CT scanning demonstrated thickening of the bladder wall, hydronephrosis, ascites, and bowel-wall thickening.[23]

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Contributor Information and Disclosures
Author

Lynda A Frassetto, MD  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)

Benjamin N Breyer, MD  Clinical Instructor, Department of Urology, University of California, San Francisco Medical Center

Benjamin N Breyer, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Urological Association, and Endourological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

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: Baxter Healthcare 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 Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

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Gross anatomy of the female pelvis.
Gross anatomy of the bladder.
Female perineal anatomy. The urogenital diaphragm and levator ani muscles have been removed, revealing the internal pudendal nerves and vessels, the rectum, and the posterior vaginal wall.
Schistosomiasis of the ureter.
Gross pathology, bladder with candidal infection and hemorrhage.
Infiltration of yeast in the bladder wall.
 
 
 
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