2022 - Evaluation and Treatment of Noninfectious Cystitis Conditions Flashcards
Figure 1. Cystoscopic appearance of non-oncologic conditions that may mimic malignancy. A, Interstitial cystitis/bladder pain syndrome with telangiectasias.
B, Chronic urinary retention with papillary polypoid cystitis. C, Bladder pain syndrome with urothelial punctuate hemorrhage. D, Chronic
indwelling catheter cystitis showing granulation tissue and unremarkable urothelium. E, Female chronic urinary retention with debris and squamous
metaplasia of the bladder trigone. F, Hemorrhagic radiation cystitis showing partially denuded urothelium with acute and chronic inflammation.
G, Radiation cystitis with chronic catheter cystitis. H, Chronic fungal urinary tract infection with urothelial granulation tissue. Images courtesy
of Dr Amy Dobberfuhl.
What is cystitis, and what are its key symptoms?
Cystitis is inflammation of the bladder, defined by dysuria, frequency, urgency, suprapubic pain, hematuria, and fever. It requires determining if the cause is infectious or noninfectious.
What are the initial evaluation steps for noninfectious cystitis according to the AUA guidelines?
The initial evaluation includes a complete history, focused physical exam, review of prior urine cultures, and possibly obtaining a catheterized urine specimen.
What should be assessed in patients with cystitis for complicated risk factors, and when might additional imaging be considered?
Assess for risk factors like failure to respond to therapy, fever, hematuria, diabetes, etc. Cystoscopy and upper tract imaging may be considered for complicated cases.
What considerations should be made when routine urine cultures are negative for cystitis, and what procedure may be necessary?
Consider noninfectious causes if routine cultures are negative. If a bladder lesion is identified, a biopsy is typically necessary to exclude malignancy.
What is the pathophysiology of IC/BPS, and what factors might contribute to its onset?
IC/BPS’s pathogenesis may include chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of glycosaminoglycan barrier, and urine cytotoxicity. It may start with a painful event and persist due to neural hyperexcitability or central nervous system dysregulation.
What has animal research revealed about the neural components involved in IC/BPS?
Animal research found that the bladder is populated by afferent fibers, including C-fibers that transduce pain and urgency. A-delta fibers relay the sensation of bladder fullness, and cholinergic parasympathetic fibers are responsible for bladder emptying.
What are the AUA guidelines for diagnosing IC/BPS?
AUA guidelines include a careful history, physical exam, laboratory examination, voiding symptoms, pain levels, and bladder diary. In complex cases, cystoscopy and urodynamics may be considered.
What are the potential treatment options for IC/BPS, and what procedures might be considered?
Treatment may include behavioral treatments, medications, instillations, procedures, and surgery. Bladder biopsy for suspicious lesions, and ablative treatment for Hunner ulcers (with laser or electrocautery) should be considered.
What are the characteristics and histological findings of the acute phase of radiation cystitis?
Includes urinary urgency, frequency, nocturia, dysuria, bladder spasm, reversible inflammation, loss of glycosaminoglycan layer, urothelial sloughing, edema, and epithelial hyperplasia.
What are the characteristics and histological findings of the late/chronic phase of radiation cystitis?
Occurs years later, showing chronic inflammatory fibrosis, collagen deposition, smooth muscle atrophy, edema, endarteritis, hemorrhage, and may present years to decades after therapy.
What are the steps in diagnosing radiation cystitis?
Includes history, physical exam, urinalysis, surgical history, radiotherapy details, cystoscopy, renal bladder ultrasound, post-void residual, bladder diary, and possibly urodynamics.
What are the treatments for acute radiation cystitis?
Includes phenazopyridine, anticholinergics, beta-3 agonists, hydration, and possibly intradetrusor botulinumtoxin A for refractory cases.
What are the treatments for hemorrhagic radiation cystitis?
Includes clot evacuation, continuous bladder irrigation, cystoscopic fulguration, intravesical instillation, arterial embolization, urinary diversion, cystectomy, and hyperbaric oxygen.
What is the pathophysiology of chemotherapy-induced cystitis, and what compounds are involved?
Ifosfamide and cyclophosphamide generate acrolein, leading to cell death through reactive oxygen species and nitric oxide. Hemorrhagic cystitis occurs 24 to 48 hours after a dose.