Abacterial cystitis: Description, Causes and Risk Factors:
Abacterial cystitis is the name given to the syndrome in which there are symptoms and signs of cystitis but no organisms can be demonstrated in the urine by ordinary methods of examination.
It has been suggested by several observers that the causative organism may be a spirochaete. Coutts and Vargas-Zalazar stated that they found "spirilla of diverse morphology" on dark-ground examination of the urine in five cases and Fieldsend found "numerous spirillum-like bodies" in one case. These observers did not identify the organism further. It is known that spirochaetes are not uncommonly present even in the healthy genitourinary tract, and that "spirillum-like bodies" may be seen in degenerating pus. It is difficult, therefore, to determine the significance of such findings in the urines of cases of abacterial cystitis unless the spirochaetes are more exactly defined.
Abacterial cystitis is most common in women of childbearing years. The exact cause is often unknown. However, it has been associated with the use of:
- Radiation therapy to the pelvis area.
- Certain types of chemotherapy medications.
- History of severe or repeated bladder infections.
Although most cases of abacterial cystitis are uncomfortable, the symptoms usually get better over time.
Characteristically, there is no constitutional upset, but the local symptoms are severe, with dysuria, frequency, and urgency of micturition, and sometimes terminal hematuria; there may or may not be a preceding or coincidental urethritis; Cystoscopy reveals an intense cystitis and marked reduction of bladder capacity; and pyelography may show slight dilatation of the ureters and renal pelvis. The urine is loaded with pus and sometimes red blood cells, but no organisms can be seen in the stained centrifuged deposit, and no growth is obtained on the usual culture media, either aerobically or anaerobically. Tuberculosis is often suspected, but tubercle bacilli are never found even after guinea-pig inoculation.
Diagnosis may include:
A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). A microscopic examination of the urine may be done to look for cancerous cells.
- A urine culture (clean catch) is done to look for a bacterial infection.
- A cystoscopy (use of lighted instrument to look inside the bladder) may be done if you have, symptoms related to radiation therapy or chemotherapy, symptoms that do not get better with treatment, blood in the urine.
Local treatment of the bladder, and the use of urinary antiseptics, sulphonamides, and penicillin may or may not be helpful. The attack may clear up spontaneously, but in many cases of cystitis persists for months and even for years. After the administration of neoarsphenamine there is always a dramatic response and rapid cure, irrespective of the duration of symptoms. The pyuria disappears, and the bladder capacity, the bladder mucous membrane, the ureters, and the renal pelvis all return to normal. Recent reports indicate that arsenoxide ("mapharside") and quinquevalent arsenicals are as effective and that streptomycin and "aureomycin" may also be of value.
Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.
NOTE: The above information has an educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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