Cystitis

Objectives

Define cystitis
Enumerate causes of cystitis
classify types of cystitis
Recognize special types of cystitis
 ? WHAT IS CYSTITIS

 It is inflammation of urinary bladder

resulting from urinary tract infection.
 It occurs when the normally sterile lower urinary tract

(urethra and bladder) is infected by bacteria.

 More in female due to ascending infection from short

urethra
 Cystitis does not always come from an infection. For

example, certain medicines, irradiation, drugs and hygiene

products can also cause inflammation
PATHOGENESIS OF CYSTITIS

Due to frequent irritation of the mucosal surface of the urethra

.and bladder
Infection result when bacteria ascend to the urinary bladder.
These bacteria are members of perineal flora and derived from
.large intestine floral
.Toxins are produced by uropathogens

:Conditions lead to access of bacteria

.During sexual intercourse due to short urethra
CAUSES OF CYSTITIS
1. Bacterial infection :E.coli (most common)
2. Chronic bladder inflammation (interstitial cystitis)
3. Catheterization of urinary tract
4. Radiation
5. Bladder stones
6. Diabetes mellitus
Risk factors in males:
Mainly due to persistent bacterial infection of prostate
Risk factors in females:
Short urethra, pregnancy, decreased estrogen production
during menopause
INVESTIGATIONS
:Specimen collection
Most important is clean catch urine (MSU)
Suprapubic aspiration is used in children
Endoscopic biopsy is indicated in TB and malakoplakia

:Microscopic examination
of patients have > 10 WBCs/ cmm 90%
Gram stain of uncentrifuged samples is sensitive and specific
 TYPES OF CYSTITIS
 Acute cystitis
 Chronic cystitis
Chronic specific cystitis
Bilharziasis
Tuberculosis
Toxoplasmosis
BCG: in the treatment of
papillary transitional cell
carcinoma grade I
Chronic non- specific cystitis
Interstitial (Hanner's cystitis)
Eosinophilic cystitis
Polypoid cystitis
Emphysematous cystitis
Hemorrhagic cystitis
Malakoplakia
ACUTE CYSTITIS

GROSS PICTURE
mucosal hyperemia with
.superficial minute ulceration

MICROSCOPIC PICTURE
The lamina propria shows infiltration by neutrophils with
.congested blood vessels and may be hemorrhage
CHRONIC CYSTITIS

Due to bacterial persistence or reinfection

Predisposing factors: Calculi, Diverticulum, Fistula

.Chronic specific cystitis as bilharziasis or tuberculosis

chronic non-specific as interstitial or eosinophilic.cystitis
INTERSTITIAL CYSTITIS (IC)
HANNER'S CHRONIC NON-SPECIFIC CYSTITIS

It is chronic pelvic pain syndrome

.Characterized by intermittent suprapubic pain

CYTOSCOPIC FINDINGS
bladder mucosa show ulceration, fissures , )1
punctate hemorrhage
) glomerulations( )2
Marked lamina propria edema )3

Late in course Transmural fibrosis may ensue leading to

contracted bladder
EOSINOPHILIC CYSTITIS
a rare condition, can be associated with allergic and
autoimmune diseases such as lupus, parasitic infection as
bilharziasis
Eosinophilic cystitis is more common in males and may affect
.both adults and children

GROSS PICTURE
Edematous and erythematous mucosa with polypoid growths
resembling allergic polyps of nasal septum
MICROSCOPIC PICTURE

.Histological changes can be acute, chronic or both

The acute changes are characterized by edema, congestion
with inflammatory infiltrate composed of eosinophils and
.lymphocytes
Eosinophils are more prominent in cases with muscle
.necrosis
MALAKOPLAKIA
Rare chronic cystitis characterized by mucosal yellowish
.plaques, nodules or polyps
Often misdiagnosed clinically as a malignant condition
EPIDEMIOLOGY
More common in immunocompromised (HIV, renal transplant
recipients) and women
Mean age at diagnosis is fifth decade
Rare in children
CYTOPATHIC FINDINGS

defects in phagocytic or degradative functions of

histiocytes in response to gram negative coliforms (E. coli
or Proteus) that results in chronic inflammatory state
dense collections of macrophages with abundant granular
cytoplasm , followed by intracellular deposition of iron and
: calcium (known as Michaelis-Gutmann bodies)
Lamellated concretions stain positively with PAS
POLYPOID CYSTITIS

Polypoid cystitis is a non-cancerous and reversible condition

caused by chronic (long-standing) inflammation due to
.irritation of bladder mucosa

Polypoid cystitis most commonly results from injury caused by

.long standing urinary catheters

It’s also marked by submucosal edema

CYTOPATHIC FINDINGS

Mucosa may appear unremarkable

It may be bullous cystitis (round broad elevations) or
papillary cystitis (thin and villous

.Papillary cystitis is the chronic phase of polypoid cystitis

EMPHYSEMATOUS CYSTITIS

Rare special type of cystitis ,associated with diabetes, with

gas filled vesicles in bladder wall
Due to gas forming bacteria (Clostridium perfringes, E.
coli)
CYTOPATHIC FINDINGS
Cysts often lined by multinucleated giant cells
HEMORRHAGIC CYSTITIS

It is a type of inflammation of the bladder that can manifest

in different symptoms such as hemorrhage, hematuria, and
.dysuria
It can be caused by chemotherapy, (Drugs as
cyclophosphamide)
In children, temporary hematuria can also be caused by a
viral infection (adenovirus as herpes simplex and CMV)
SOURCES
https://apfed.org/about-ead/eosinophilic-cystitis/
‫‪PROJECT TEAM‬‬
‫‪ ‬حبيبة محمد السيد الحفناوي‬
‫‪ ‬حسام احمد ابو خليل العزب‬
‫‪ ‬حسام المرسي البنداري المرسي الشاعر‬
‫‪ ‬حسام رضا محمد عبدالعزيز بالل‬
‫‪ ‬حسن عماد محمد موسى‬
‫‪ ‬حسن محمد حسن محمود رسالن‬
‫‪ ‬حسن محمد فتحي حسن السراجي‬
‫‪ ‬حسين اشرف حسين احمد حربي‬
‫‪ ‬حسين عماد قنبر‬
‫‪ ‬حمدي عالء الدين حمدي السيد الشين‬
‫‪ ‬حمدي محمد الحسنين حماد‬