Emphysematous Cystitis: Report of Two Cases and Review of the Literature

Emphysematous cystitis is a rare complication of lower urinary tract infection whose prognosis is conditioned by the delay in treatment. The predisposition of diabetic patients to urinary infections caused by gas-producing bacteria is considered one of the most common factors in the occurrence of emphysematous cystitis. The currently recommended diagnostic test is CT scanning, which has definite value in assessing gas accumulation in the bladder wall and lumen. The authors report the observations of two patients aged 68 and 80 who were treated for emphysematous cystitis complicating diabetes mellitus. The evolution was favorable under treatment with antibiotic therapy, insulin therapy and bladder drainage.

Hemorrhagic cystitis in gastric cancer after nanoparticle albuminbound paclitaxel:A case report

BACKGROUND The advanced first-line regimen for advanced gastric cancer is based on a combination of fluoropyrimidine and platinum and/or paclitaxel(PTX),forming a two-or three-drug regimen.Compared to conventional PTX,nanoparticle albumin-bound PTX(Nab-PTX)has better therapeutic effects and fewer adverse effects reported in studies.Nab-PTX is a great option for patients presenting with advanced gastric cancer.Herein,we highlight an adverse event(hemorrhagic cystitis)of Nab-PTX in advanced gastric cancer.CASE SUMMARY A 55-year-old male was diagnosed with lymph node metastasis after a laparo-scopic-assisted radical gastrectomy for gastric cancer that was treated by Nab-PTX and S-1(AS).On the 15th day after treatment with AS,he was diagnosed with hemorrhagic cystitis.CONCLUSION Physicians should be aware that hemorrhagic cystitis is a potential adverse event associated with Nab-PTX treatment.

This pain drives me crazy:Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome

BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.

Unusual case of emphysematous cystitis mimicking intestinal perforation:A case report

BACKGROUND Emphysematous cystitis(EC)is a bladder condition commonly caused by gasgenerating bacterial infections.Factors that increase the risk for developing this condition include female gender,age≥60 years,and diabetes mellitus,glycosuria,and urinary stasis.The symptoms of EC often lack specificity,making diagnostic imaging techniques crucial for accurate identification of the condition.CASE SUMMARY This report presents an unusual case of EC that mimicked intestinal perforation.While it was initially challenging to differentiate between intestinal perforation and EC on admission,the patient managed to avoid unnecessary surgery and made a good recovery solely through antibiotic treatment.CONCLUSION Successful treatment of the patient described herein highlights the importance of accurately diagnosing EC,which can be difficult to differentiate from intestinal perforation.

Prolonged impacts of COVID-19-associated cystitis:A study on longterm consequences

BACKGROUND The Coronavirus Disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 virus is an international health concern with substantial morbidity and mortality.COVID-associated cystitis(CAC),presents as new onset or exacerbated urinary symptoms,resembling overactive bladder(OAB)symptoms.AIM To examines the long-term outcomes of patients with CAC in the context of Long COVID.METHODS A cohort of 350 patients admitted to Detroit Hospitals with COVID-19 between May and December 2020,displaying CAC symptoms following discharge,was prospectively followed.Initial urologic evaluations occurred at 10-14 wk and were repeated at 21-28 mo postdischarge.Symptoms were managed conservatively,employing behavioral modifications and standard OAB medications.Participants completed surveys assessing urinary symptoms and quality of life(QoL)at both time points.The primary outcome was the Urology Care Foundation Overactive Bladder Assessment Tool.RESULTS 87%of the final cohort(n=310)reported symptom improvement at 21-28 mo post-discharge.Patients with new onset CAC symptoms showed a median decrease of 9-10 points in OAB and QoL scores,while those with existing symptoms experienced a decrease of 6 points.Overall,95.4%of patients with new onset symptoms reported symptom improvement at follow-up,contrasting with 60.7%among those with existing symptoms.CONCLUSION This study presents the first long-term follow-up of adult patients with CAC,revealing a promising prognosis with conservative management measures in the context of Long COVID.These findings provide reassurance to patients regarding symptom resolution and underscore the need for further research into this evolving aspect of COVID-19's impact on urological health.

Eosinophilic gastroenteritis associated with eosinophilic cystitis:Computed tomography and magnetic resonance imaging findings

Eosinophilic gastroenteritis(EG) is a rare,distinct clinical entity,and EG associated with eosinophilic cystitis(EC) is extremely rare and has not been well documented.Here,we report two cases of EG and coexistent EC along with findings from computed tomography(CT) and magnetic resonance imaging(MRI).An 18-year-old male with a history of hematuria,urgency and occasional urodynia for two weeks and a 34-year-old male with a history of abdominal distention for one week were admitted to our hospital.Abdominal contrast-enhanced CT in both patients revealed wall thickening in different parts of the gastrointestinal tract with inhomogeneous reinforcement,coexistent with local or diffuse bladder wall thickening with progressive enhancement,and also showed that the bladder mucosal lining was nondestructive.Pelvic MRI showed that the local or diffuse thickened bladder wall was iso-intense on T1-weighted images,hypointense on T2-weighted images,and slightly restricted on diffusion weighted imaging(DWI) in one case.After therapy,the thickened wall of the gastrointestinal tract and urinary bladder had improved markedly in the two cases.To the best of our knowledge,this is the first report on the radiological imaging of EG and coexistent EC by both CT and MRI and the first with DWI findings.

Clinical Investigation on the Correlation between Lower Urinary Tract Infection and Cystitis Glandularis

Summary: In order to study the association between lower urinary tract infection and cystitis glandularis (CG), 120 cases of CG were diagnosed by cystoscopic biopsy in the suspicious foci of the bladder. Among them, 72 cases were subjected to bacterial counting culture of urine and microscopic examination of urinary sediment, and 60 cases to fluorescence quantitative polymerase chain reaction (FQ-PCR) assay to detect HPV, CMV and HSV DNA in urine samples. In the 72 cases of CG, the positive rate of bacterial counting culture of urine was 15.3 % (11/72), and gray zone rate was 18.1 % (13/72). 31.9 % (23/72) patients were positive in bacterioscopy of urinary sediment. There was statistically significant difference as compared with the control group (P<0.01). Only 4 of 60 urine samples were positive by FQ-PCR in detection of the three viruses mentioned above with the positive rate being 6.67 %. Compared with the control group, there was no significant difference (P>0.05). It was concluded that the genesis of CG was closely correlated with the chronic lower urinary tract infection, especially caused by Esch coli.

Etiological Study on Cystitis Glandularis Caused by Bacterial Infection

To study the relationship between bacterial infection and the etiology of cystitis glandularis, 36 female Wistar rats were divided into 3 groups. No intervention was given to the rats in the blank group. NS was infused into the bladder of the rats of the control group, and solution containing E. coil was injected into the bladder of experimental group. Three months later, tissue samples of bladder were collected and observed visually and under light microscope. The results showed that tissues of the blank group were normal＇, one sample in the control group showed Brunn＇s nests and cystitis cystica, and 10 in the experimental group had the change of cystitis glandularis. Compared to the blank and control group, samples in the experimental group showed significant change （P〈0.05）. There were no significant difference between blank group and control group （P〉0.05）. It is concluded that bladder instillation of E. coil can induce cystitis glandularis, which confirms that infection is the cause of cystitis glandularis.

Expression of hTERT, p53 and PCNA in Cystitis Glandularis

To examine the expression of human telomere reverse transcriptase （hTERT）, p53 and proliferating cell nuclear antigen （PCNA） in cystitis glandulafis, 38 patients were divided into two grouips： group A （including 18 cases of papillary cystitis glandularis） and group B （including 20 subjects with normal bladder mucosa）. All the cases were immunohistochemically examined by using antibodies specifically against p53 and PCNA, and hTERT was determined by in situ hybridization. hTERT was found in 6 cases （33.3%） and p53 was detected in 4 cases （22.2%） in group A, while they were not detected in group B. There were significant differences in hTERT and p53 expression between groups A and B （P〈0.05 for both）. PCNA was detected in 7 cases （38.9%） in group A and 1 case （5.0%） in group B, and significant difference in PCNA expression was found between the two groups （P〈0.05）. The expressions of hTERT, p53 and PCNA were significantly higher in group A than in group B, suggesting that papillary cystitis glandularis is predisposed to cancerous change, and p53, PCNA, hTERT may be related to the malignant alteration.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Successful treatment of encrusted cystitis:A case report and review of literature

BACKGROUND Encrusted cystitis(EC)is a chronic inflammation of the bladder associated with mucosal encrustations.Early diagnosis and optimal treatment are not well established.Here,we report a case of EC successfully treated with com-bination therapy.CASE SUMMARY A 27-year-old man presented with frequency,urgency,dysuria,gross hematuria and suprapubic pain for 2 mo.He was diagnosed with EC based on characteristic calcifications of the bladder wall(most of them were struvite),cystoscopy and histopathological examination.He was cured after combined therapy of elimination of encrustations,bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into bladder submucosal tissue.CONCLUSION Bladder instillation of hyaluronic acid and injection of botulinum-A neurotoxin into the bladder submucosal tissue can be used for treatment of EC.

Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor:A case report

BACKGROUND Pelvic lipomatosis(PL)is a rare benign condition with characteristic overgrowth of histologically benign fat and invasion and compression of pelvic organs,often leading to non-specific lower urinary tract symptoms(LUTS).Approximately 40%of patients with PL have cystitis glandularis(CG).The cause of PL combined with CG is poorly understood,and there is currently no effective treatment.Refractory CG with upper urinary tract obstruction even requires partial or radical bladder resection.CASE SUMMARY In this case,a patient suffering from PL with CG was treated by transurethral resection of bladder tumour(TUR-BT)and oral administration of celecoxib,a selective cyclooxygenase-2(COX-2)inhibitor.The LUTS were alleviated,and the cystoscopy results improved significantly.Immunohistochemistry showed upregulated COX-2 expression in the epithelium of TUR-BT samples,suggesting that COX-2 may participate in the pathophysiological process of PL combined with CG.CONCLUSION We report for the first time that celecoxib may be an effective treatment strategy for PL combined with refractory CG.

Intravesical Infusion of Budesonide Foam Improves Symptoms in a Bladder Pain Syndrome/Interstitial Cystitis Rat Model

Purpose: Since intravesically administered steroid therapy may treat bladder pain syndrome/interstitial cystitis (BPS/IC) with fewer side effects than the current treatment of orally administered steroids, we investigated whether the intravesical infusion of budesonide foam can effectively treat BPS/IC symptoms in a rat model of tranilast-induced BPS/IC. Methods: There were 6 rat treatment groups (n = 8 per group): control + single or daily saline infusion, tranilast + single or daily saline infusion, and tranilast + single or daily budesonide infusion. All groups except for the controls were fed a tranilast supplemented diet for 5 weeks. Budesonide and saline were infused intravesically. After the BPS/IC rat model underwent single infusion treatments, we measured the paw pain threshold using the von Frey test and continuous cystometry was taken. After two weeks of daily intravesical infusions, we measured locomotor activity and serum cortisol levels;harvested bladders underwent histological analysis. Results: Both pain threshold and locomotor activity were significantly lower in the saline-infused groups receiving the tranilast diet, but there were no differences between the budesonide-infused groups and the controls. The interval between bladder contractions was significantly shorter in the tranilast group than the control or tranilast + budesonide infusion groups. The serum cortisol levels did not change. Hematoxylin-Eosin stainings of the bladder showed thickening of the bladder muscle layer and mucosal edema in the tranilast group, while the tranilast + budesonide infusion group showed only mild changes. Conclusion: Intravesical infusion of budesonide effectively treated BPS/IC symptoms in a rat model of BPS/IC.

Intravesical Non-Alkalinized Lidocaine Instillation for Interstitial Cystitis/Bladder Pain Syndrome Patients

Purpose: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Patients and methods: Five female patients (40 - 71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0 - 7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient's requirements and symptoms. The treatment effect was evaluated comparing O'Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of lidocaine therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O'Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis findings on cystoscopy disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder-filling pain decreased from 7 to 3 as a visual analog scale score. One patient complained palpitation at 11th instillation and abandoned treatment thereafter, otherwise, none of these patients showed side effect concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis/bladder pain syndrome patients were an easy, safe and effective treatment.

Cystitis Glandularis: A Rare Benign Condition Presenting as Bladder Tumor

Cystitis glandularis or glandular metaplasia of the urinary bladder, is a benignreactive metaplasia of the urothelium, which occurs in the context of chronic irritation, in less than 2% of the general population. It is a condition in most casesasymptomatic, but also characterized by nonspecific symptoms and paraclinical findings, which is why this condition is underdiagnosed. Its evolution is mainly focused on the risk of malignant degeneration. This condition affects men much more commonly than women. Two forms of cystitis glandularis are recognized: typical and intestinal form. They differ in their histology, incidence, difficulty of diagnosis, and possible association with adenocarcinoma of the bladder. Diagnosis of certainty is histological by careful analysis of chips from bladder endoscopic resection. This rare pathology is managed by endoscopic bladder resection, with repeated cystoscopy as a monitoring tool. Extensive surgical is needed in severe or recurrent cases. We present here-in a case of a female patient having cystitis glandularis presenting with lower urinary tract symptoms. We review equally data reported in literature. To the best of our knowledge our case represents the fourth case of cystitis glandularis affecting a female patient reported in the English literature so far.

Hyperbaric Oxygen Therapy in Interstitial Cystitis/Painful Bladder Syndrome

Introduction: Hyperbaric oxygen therapy (HBO) is emerging as an alternative technique for treating refractory interstitial cystitis (IC). The theory is that the increased dissolved oxygen in the blood raises the levels of oxygen in the tissues and improves tissue healing. Other urological disorders such as radiation cystitis, Fournier’s gangrene and cyclophosphamide cystitis have also shown a good response to HBO therapy. Method: A literature search with the terms “interstitial cystitis”, “painful bladder syndrome” and “hyperbaric oxygen therapy” found four papers that have trialed HBO therapy in IC patients;three case series and one randomized control trial. Results: A total of 31 patients have been treated with HBO therapy. All four studies show a symptomatic improvement in pain, urgency, bladder capacity and O’Leary-Sant interstitial cystitis index. Urinary frequency only improved in three out of four of the trials. The percentage of patients considered as responders to treatment varied at 25%, 66.7%, 82% and 100%. Conclusion: Preliminary trials of HBO therapy seem to have a good patient response with effective symptomatic relief. The patient response rates varied greatly between the trials. This is due to each trial’s different definition of a “patient responder”. Further work in urology departments at HBO centers is required to further assess the benefits of HBO treatment in IC.

Xanthogranulomatous Cystitis Presenting as Urinary Incontinence and a Vesicovaginal Fistula: a Case Report and Review of the Literature

Anthogranulomatous cystitis (XC) is an inflammatory condition of the urinary bladder that is benign and rarely seen. XC is a unique disease in which there have been only 26 cases described in the literature, including our case. Patients with XC often present with lower urinary tract symptoms, hematuria, abdominal pain, or abdominal mass. We present the unusual case of an 81 year old female who presents with urinary incontinence, which was later diagnosed as a vesicovaginal fistula. After describing the treatment of this patient, a review of the literature is detailed including presentation, possible etiologies, and treatment of XC.

Ultrasound Contribution to the Diagnosis of Emphysematous Cystitis

Emphysematous cystitis is a severe urinary tract infection which threatens patients’ life. Thus, it requires early diagnosis and computed tomography (CT) is the reference medical exam used to address it. However, ultrasound, which is a non-ionizing and very accessible technique, may also contribute to diagnosis. The aim of this study was to illustrate the contribution of ultrasound to the diagnosis of emphysematous cystitis. We report three cases of emphysematous cystitis diagnosed by ultrasound. In all the cases, ultrasound identified basic signs showing presence of gas, including a hyperechoic cystic parietal thickening, repeat echoes and dirty shadow cones of intraluminal focus. Diagnostic confirmation was made in two cases through X-ray and in one case by means of computed tomography. Through simple basic signs, ultrasound directs most usefully towards an emphysematous urinary tract infection. CT enables a more accurate diagnostic work-up of lesions and differential diagnosis with vesico-digestive fistula.

A case of follicular cystitis treated successfully with diethylcarbamazine

Follicular cystitis is a non-specific inflammatory condition of the bladder where the aetiology is unknown.The extent of the disease can be mild or proliferative and bulky.Antibiotics,steroids,therapies used for interstitial cystitis,palliative cystectomy and radiotherapy have been reported as successful treatment options.We report a case of follicular cystitis that responded to a course of oral diethyl carbamazine.

The Comparison of Acute Clinical Outcome between 30 and 40 Sessions of Hyperbaric Oxygen Therapy for Management of Visible Hematuria from Radiation-Induced Hemorrhagic Cystitis

Background: Radiotherapy is one of the most popular treatments for pelvic malignancy, which causes patients suffering from the adverse effect such as cystitis, hematuria, proctitis, hematochezia and distal ureteric stricture. The hematuria condition from radiation-induced hemorrhagic cystitis is the most common adverse event suffering the patients, losing properties, wasting time, and deteriorating quality of life. One of the most effective treatments for radiation-induced hemorrhagic cystitis is the hyperbaric oxygen therapy with no necessity for patients to be hospitalized, no need of anesthesia use, and also non-invasion. However, it requires that patients spend 90 - 120 minutes a day for 40 days administered out-patient treatment session. The transportation cost as well as the accommodation one will greatly burden the self-pay health care patients. In addition, there is still no definite standardized number of HBOT treatment session assignment at present. Objectives: To compare the treatment outcome (bladder mucosal characteristics, red blood cells in urine) between 30 and 40 sessions of HBOT for treatment of radiation-induced hemorrhagic cystitis. Methods: Prospective cohort observational study of patients (n = 15) who were diagnosed with radiation-induced hemorrhagic cystitis that were treated with hyperbaric oxygen therapy in Somdechprapinklao Hospital between October 2020 and September 2021. We compared the parameter about hemoglobin concentration, red blood cell number in urine during the course of HBOT treatment every 10 sessions and cystoscopic finding severity as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis in Table 1 before treatment, and after 30 and 40 sessions of treatment. Results: From 15 of treated patients, 93.3% of patients had evidence of posterior wall lesion. The mean duration from radiotherapy (radiation and brachytherapy) to the first episode gross hematuria is 112 months. This study shows no statistically different cystoscopic findings as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis after 30 and 40 sessions of HBOT (p = 0.653) and statistically significant improvement after the treatment of more than 30 sessions (p = 0.008). No relationship was found with the hemoglobin concentration and red blood cell number in urine during the course of HBOT. Conclusions: Radiation-induced hemorrhagic cystitis can be treated with HBOT. There is no different treatment outcome between 30 and 40 sessions of HBOT.