Urology: Lower UTI - Cystitis

Question 1

Outline the pathophysiology of cystitis

Answer 1

Colonization with ascending spread

Hematogenous spread

Periurogenital spread

Shorter length of the female urethra allows uropathogens easier access to the bladder

Question 2

Outline the aetiology of cystitis

Answer 2

Bacterial = most common e.coli

Urethral catheterisation

Sexual intercourse

Structural abnormalities (calculi, tract anomalies, indwelling catheter, obstruction)

Metabolic disease (DM, renal insufficiency)

Impaired host defences (HIV infection, current chemotherapy, underlying active cancer)

Question 3

What are the signs and symptoms of cystitis

Answer 3

Dysuria

Urinary urgency and frequency

A sensation of bladder fullness or lower abdominal discomfort

Suprapubic tenderness

Flank pain and costovertebral angle tenderness (present in cystitis but suggest upper UTI)

Bloody urine

Fevers, chills, and malaise (noted in pts with cystitis, more frequently associated with upper UTI)

Question 4

How is cystitis investigated

Answer 4

Dipstick (<65) = +ve leukocyte esterase

Urinalysis MSU = microscopy, WBC count

Urine culture = >1000 colony-forming units (CFU)/mL

Question 5

How would you manage cystitis?

Answer 5

Lower uncomplicated = 3 day nitrofurantoin

Lower complicated = 5-7 day nitrofurantoin

General = paracetamol, increased fluid intake

Question 6

What are the complications of cystitis?

Answer 6

Kidney infection

Blood in the urine