Bladder, ureter & renal pelvis


Acute cystitis

Last author update: 1 May 2011
Last staff update: 5 June 2023 (update in progress)

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PubMed Search: Acute cystitis[title]

Anil Parwani, M.D., Ph.D., M.B.A.
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Cite this page: Parwani A. Acute cystitis. website. Accessed June 6th, 2023.
Definition / general
  • A clinical diagnosis, usually with a triad of frequency, lower abdominal pain and dysuria (pain or burning during urination)
  • There is usually no surgical specimen for acute cystitis, although it may be a finding in a specimen obtained for other purposes, or at autopsy
  • Common in young women of reproductive age; also older men and women
  • Bladder or lower urinary tract (urethra)
  • Most common bacterial agents are E. coli, Proteus, Klebsiella, Enterobacter
  • Also due to Candida or Cryptococcus in immunocompromised, Schistosoma haematobium in Egypt; also adenovirus, chlamydia, mycoplasma
  • Noninfectious causes are chemotherapy, radiation therapy and trauma
  • For E. coli infections, the host's fecal flora (and in women, vaginal flora) is the most common immediate source for the infecting strain
  • The E. coli strain may represent the most prevalent fecal/vaginal E. coli clones of the individual (the prevalence hypothesis) or a distinctive, highly selected subset of the fecal/vaginal E. coli population with enhanced virulence potential (the special-pathogenicity hypothesis, J Clin Microbiol 2008;46:2529)
Clinical features
  • Patients may be asymptomatic
  • May also be caused by obstruction, cystocele or diverticula
  • May lead to pyelonephritis
  • Uncomplicated:occurs in otherwise healthy nonpregnant adult women
  • Complicated: associated with conditions that increase the risk of therapy failure, such as an upper tract infection or drug resistant pathogen; a broader spectrum antimicrobial is recommended in these cases
  • Excellent prognosis; symptoms usually resolve within 1-2 days after treatment
  • Suggested clinical algorithm: treat empirically with antibiotics if 2 of 3 variables present: dysuria, urine WBC > trace, urine nitrites); otherwise obtain culture and wait for results (Arch Intern Med 2007;167:2201)
  • Complicated cases require a broader spectrum antibiotic for a longer period of time
Gross description
  • The bladder may show no gross abnormalities
  • Occasionally, the mucosa may be hyperemic with variable exudate
Microscopic (histologic) description
  • Usually neutrophils
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