bladder infection
DESCRIPTION
Clinical Presentation. BLADDER INFECTION. Lim, Syndel Raina W. Acute Cystitis. Infection of the urinary bladder Women > men Ascending mode of infection Periurethral Vaginal Fecal flora E coli – most common. Acute Cystitis. Findings Irritative voiding symptoms: Dysuria Frequency - PowerPoint PPT PresentationTRANSCRIPT
BLADDER
INFECTION
Clinical Presentation
Lim, Syndel Raina W.
Acute Cystitis• Infection of the urinary
bladder• Women > men• Ascending mode of infection
– Periurethral– Vaginal– Fecal flora
• E coli – most common
Acute Cystitis• Findings
– Irritative voiding symptoms:• Dysuria• Frequency• Urgency
– Low back & suprapubic pain– Hematuria– Cloudy/foul smelling urine– Urinalysis: WBC &
hematuria– Urine culture:
• Confirm diagnosis• Identify organism
• Radiographic Imaging– If uncomplicated:
• Radiologic evaluation is not necessary
Acute Cystitis
Management
• Short course of oral antibiotics– Trimethoprim – sulfamethoxazole (less expensive)– Nitrofurantoin (less expensive)– Fluoroquinolones
• Duration: 3-5 days• Longer therapy not indicated• Single dose: floroquinolones (long half-lives)• Not recommended: – penicillins; aminopenicillins (high resistance)
Recurrent Cystitis / UTI
• Bacterial persistence or reinfection w/ another organism
• Mx: Bacterial persistence ≠ reinfection
• Radiographic Imaging– Ultrasonography
• Screening evaluation of the GUT
– IV pyelogram– Cystoscopy– CT scan– Retrograde pyelogram
Recurrent Cystitis / UTI Management
• Bacterial persistence - surgical removal of source (urinary calculi)
• Bacterial reinfection- surgically repair fistulas– 95% reduction – medical mx: low dose continuous
prophylactic antibiotic
• Alternatives:– Intravaginal estriol– Lactobacillus vaginal suppositories– cranberry juice
Malacoplakia
• Uncommon inflammatory disease of the bladder
• Can also affect the ureters & kidneys
• Plaques or nodules– Von Hansemann cells
• Large histiocytes– Micahelis-Gutmann bodies
• Laminar inclusion bodies
• Women > men
Malacoplakia
• Findings– Hx of UTI– Chronic illness or
immunosuppressed– Irritative voiding symptoms:
• Urgency• Frequency
– Hematuria
• Radiologic Imaging– Ultrasonography– CT scan
• Bladder mass• Ureter: obstruction• Kidney
– Focal or diffuse– Hypodense – Parenchymal masses
Malacoplakia
Management
• Antibiotic therapy– TMP-SMX– Fluoroquinolones (decreased mortality rate )
• Bethanecol & ascorbic acid – enhance phagolysosomal activity
According to site of involvement:• Lower urinary tract: antibiotic therapy• Ureter & kidney: surgical excision + antibiotic therapy
– Prognosis: poor; high mortality rate (bilateral renal involvement)