An unusual presentation of emphysematous cystitis

Emphysematous cystitis is a rare disorder most commonly seen in women and associated with urinary tract infections and poorly controlled diabetes mellitus. We report the case of a 76-year-old woman who presented with diarrhea and abdominal discomfort, and emphysematous cystitis was revealed on the abdominal X-ray series. This case is unique in that the patient had no evidence of urinary tract infection, diabetes, or recent instrumentation. As the patient was treated for emphysematous cystitis (bladder irrigation and intravenous antibiotics), the diarrhea rapidly resolved and the radiographic abnormalities of the emphysematous cystitis also resolved. This may suggest a causal relationship, although a specific mechanism is unknown.     

超声在腺性膀胱炎鉴别诊断中的作用

目的：总结分析腺性膀胱炎二维和彩色超声共性和特点,探讨超声在腺性膀胱炎诊断与鉴别诊断中的作用。材料与方法：对膀胱镜病理证实的腺性膀胱炎３１例进行超声、膀胱镜及病理所见对比分析。结果：本组声像图表现分为两型：局限型６例;弥漫型２５例。其共性和特点：①病变局限于粘膜层,基底平坦,与膀胱壁强回声界线清晰;②基底部无肿瘤滋养动脉长入,无树枝关彩色血流及中高速度动脉频谱显示;③弥漫型并发上尿路梗阻,多呈双侧     

Emphysematous cystitis: a rare cause of gross hematuria

Emphysematous cystitis is a relatively rare infectious condition of the urinary bladder. The mortality rate is high if the diagnosis is delayed or if the treatment is inadequate. We present an uncommon case of emphysematous cystitis and highlight the risk factors for this disease. An 81-year-old man with a past medical history of type 2 diabetes and a central pontine infarction presented to the Emergency Department due to gross hematuria. Computed tomography (CT) and plain radiography revealed localized gas within the bladder that was compatible with the diagnosis of emphysematous cystitis. A Foley catheter was inserted. Urine culture grew Klebsiella pneumoniae; 2 g cefotaxime daily was initiated. Subsequent plain radiography and CT scan showed regression of intraluminal gas. We recommend CT for the definitive diagnosis of emphysematous cystitis. Adequate antibiotic therapy, strict blood glucose control, adequate drainage of urine, and early goal-directed therapy for suspected sepsis are suggested to prevent the complications of emphysematous cystitis.     

腺性膀胱炎的超声声像图表现与分型

目的探讨腺性膀胱炎的超声声像图特征及诊断价值。方法对52例经膀胱镜活检及手术病理证实的腺性膀胱炎患者的声像图表现进行回顾性总结分析。结果52例腺性膀胱炎声像图表现分为三种类型：Ⅰ型：乳头增生型22例,膀胱内壁呈乳头状或息肉样增生;Ⅱ型：结节增生型24例,膀胱内壁局限性增生呈团块状或结节状隆起;Ⅲ型：弥漫增生肥厚型6例,膀胱壁呈节段性或弥漫性增生肥厚,累及整个膀胱壁。超声与手术病理符合率90.38%（47/52）,误诊率9.62%（5/52）。结论超声检查对腺性膀胱炎具有重要的诊断价值。     

慢性膀胱炎声像图分析及其超声诊断价值

探索超声对慢性膀胱炎诊断的可行性价值,寻找和总结超声诊断规律和特点。方法：对９９例经膀胱镜、病理活检、手术诊断或临床观察治疗证实的慢性膀胱炎患者的临床资料和声像特征进行分析。结果：１膀胱粘膜图像可分为三类：Ａ、粘膜未见确切异常回声,但尿液有漂移光点;Ｂ粘膜弥漫性增厚,回声增强,粗糙不光滑呈细颗粒状、断续状表现;Ｃ、粘膜局灶性增厚呈棱形或扁平状;２、膀胱壁回声可正常,弥漫性增厚或局灶性增厚,三层结构     

超声诊断腺性膀胱炎及分型意义探讨

目的:探讨超声对腺性膀胱炎的诊断价值。材料与方法:对有相应临床症状的患者进行泌尿系超声检查,详细记录膀胱病变部位的声像图表现,并仔细观察肾及输尿管的相应改变。结果:20例腺性膀胱炎超声图像上可分为三种类型:(1)局部扁平增厚型,多灵敏表现在膀胱三角区。(2)弥漫增厚型,即全膀胱壁不均匀增厚。(3)类肿瘤结节型,可于膀胱壁任何一处见瘤样结节突向膀胱腔。病变位于膀胱三角区且范围较大者,可有肾及输尿管积水扩张等继发表现。与病理对照,本组病例超声诊断符合率为85%,误诊病例均为肿瘤结节型。结论:腺性膀胱炎在超声图像上有其特征性表现,可以为临床提供有价值的诊断信息。     

间质性膀胱炎的护理

目的通过自我护理指导,提高间质性膀胱炎（IC）患者的的生活质量及疼痛耐受能力。方法回顾我科2009年1月～12月53例IC患者的临床资料,入院后给予患者心理护理、饮食指导,教会患者减轻疼痛、缓解压力和减轻膀胱刺激症的方法。结果患者均好转出院,出院前疼痛、尿频、尿急、性交疼痛及焦虑的评分较入院时明显降低（P〈0.05）。结论合理有效的护理可以改善IC患者的生活质量和耐受力。     

Interstitial cystitis

PURPOSE: To describe the pathophysiology, assessment, diagnosis, and management of interstitial cystitis. DATA SOURCES: Selected professional publications and presentations. CONCLUSIONS: Interstitial cystitis (IC) is a chronic and disabling condition. Symptoms include urinary frequency and urgency, pain, dyspareunia, and nocturia. It occurs primarily in women. Onset is predominately in adulthood although IC does occur in childhood. Bladder wall defects, auto-immune disorder, viral and/or bacterial infection, toxin exposure, pelvic floor dysfunction and inflammatory response are possible causes. Diagnosis is by history, physical examination, laboratory tests, and cystoscopic examination. The management of interstitial cystitis includes dietary changes, antihistamines, tricyclic antidepressants, oral and intravesicle glucosaminoglycans, hydrodistention, pain management and emotional support. IMPLICATIONS FOR PRACTICE: Nurse practitioners need to be knowledgeable about the occurrence and debilitating effect of IC. Inclusion of IC into the differential diagnoses related to urgency, frequency, and abdominal pain will help assure the timely and effective diagnosis and management of this unusual disease.     

Eosinophilic cystitis and its management

Eosinophilic cystitis (EC) is a rare clinicopathological condition characterized by transmural inflammation of the bladder predominantly with eosinophils, associated with fibrosis with or without muscle necrosis. The cause of EC remains unclear, although it has been associated with various aetiological factors, such as allergy, bladder tumour, bladder trauma, parasitic infections and chemotherapeutic agents. EC is, probably, caused by the antigen-antibody reaction. This leads to the production of various immunoglobulins, which, in turn, cause the activation of eosinophils and initiates the inflammatory process. The most common symptom complex consists of frequency, haematuria, dysuria and suprapubic pain. Cystoscopy and biopsy are the gold standard for diagnosis. Additional laboratory evidence supporting the diagnosis includes proteinuria, microscopic haematuria and peripheral eosinophilia, the last one occurring in few patients. There is no curative treatment for this condition. Current treatment modalities include transurethral resection of the bladder lesion along with non-specific medical therapy, such as non-steroidal anti-inflammatory agents or steroids. Because the lesion tends to recur in spite of the above therapy, long-term follow-up is mandatory.     

经尿道电切联合吡柔比星膀胱灌注与单纯电切治疗腺性膀胱炎的meta分析

目的：评价经尿道电切联合吡柔比星膀胱灌注与单纯电切治疗腺性膀胱炎的疗效和安全性。方法：依据循证医学原则,用Cochrane系统评价方法,检索2005年-2011年期间中国知识资源总库,中国生物医学文献数据库,万方,重庆维普数据库等,纳入经尿道电切联合经尿道电切联合吡柔比星膀胱灌注膀胱灌注与单纯电切治疗腺性膀胱炎的疗效和安全性的随机对照实验（RCT）,采用RevMan5.1软件行meta分析。结果：纳入10个RCTS,共809例患者。根据Cochrane系统评价体系,结果质量均达B级。meta分析结果：经尿道电切联合吡柔比星膀胱灌注组患者随访1年腺性膀胱炎复发率比单纯电切治疗组低（OR=0.43,95%CI0.30～0.60,P〈0.05）。灌注吡柔比星后出现膀胱刺激征和血尿与单纯电切组存在明显差异（OR=1.07,95%CI1.03～2.82,P〈0.05）,（OR=1.35,95%CI0.64～2.82,P〈0.05）。结论：经尿道电切联合吡柔比星膀胱灌注能有效的防止腺性膀胱炎的复发,但其诱发的膀胱刺激征和血尿的发生率明显高于单纯电切。     

间质性膀胱炎治疗的研究进展

间质性膀胱炎是一种以膀胱和/或盆腔区疼痛为主要特征，伴有尿急、尿频和夜尿增多等症状的慢性疾病。该病的病因仍不清楚，目前还没有一种方法能有效缓解每位患者的症状，治疗效果和满意度因人而异，常需要反复治疗。本文对近年来治疗间质性膀胱炎的文献进行综述。     

急性膀胱炎超声表现特点

目的探讨急性膀胱炎(AC)的超声声像图特点。方法将32例AC自然充盈膀胱后的左右径、上下径、前后径,膀胱壁厚度、膀胱壁光滑度及膀胱内透声状态与63例正常组所测膀胱对应各值比较。结果炎症组与正常对照组膀胱左右径、上下径及前后径比较均无显著性差异,膀胱壁厚度炎症组(0.446±0.036)cm,对照组(0.224±0.036)cm,两者间有非常显著性差异P<0.01。尿频症状明显同时伴有血尿者,膀胱壁增厚的几率增加。结论膀胱壁增厚(以黏膜层为著),尿液透声差或透声欠佳是AC的主要超声征像。     

Interstitial Cystitis: An Update on the Disease Process and Treatment

Abstract

Interstitial cystitis (IC) is a chronic pain disorder of the bladder that is often underdiagnosed and mistreated. The difficulties in diagnosis stem from numerous theories regarding pathophysiology and etiology, including the breakdown of the glycosaminoglycan (GAG) layer, altered permeability of the urothelium, uroinflammation, and neural up-regulation. Dysfunction of the bladder increases the struggle for proper treatment and continues to prove difficult for health care providers to correctly diagnose and manage IC. If diagnosed and/or managed inappropriately, IC may contribute to increased symptom burden and decreased quality of life with respect to activities of daily living. When evaluating a patient’s clinical presentation in combination with predefined risk factors, a health care provider can better establish a true diagnosis of IC, which, in turn, leads to better management of IC-associated symptoms. This review will help health care providers better understand the disease process by discussing pathophysiology, pain pathways, and common symptoms of IC, with the goal of better aiding them in the proper diagnosis and treatment of patients with IC.     

Unusual Cause of Dysuria: Migration of a Pacemaker Generator into the Urinary Bladder

Following pacemaker implantation, a 71-year-old female developed infection of the generator pocket. Five years after relocation posterior to the rectus muscle she suffered from cystitis. Cystoscopy revealed the pacemaker generator to be lying within the urinary bladder. Healing was achieved by removing the pacemaker and reutilizing it, after sterilization, in a new pectoral pocket.     

经尿道选择性光汽化术治疗腺性膀胱炎的疗效分析

目的 评价经尿道选择性光汽化术治疗腺性膀胱炎的临床疗效及安全性.方法 运用经尿道选择性光汽化术对75例腺性膀胱炎患者进行手术治疗,术后予羟基喜素碱或吡柔比星膀胱灌注治疗,每周1次,共8次.其后每月1次,直至1年.结果 所有患者手术1次成功,无1例发生膀胱穿孔、闭孔神经反射及水中毒现象.患者术后留置导尿3～5d,无须膀胱冲洗,拔管后排尿良好.随访6～50个月,仅2例因未正常灌注治疗而复发,余病例无复发.结论 经尿道选择性光汽化术对于腺性膀胱炎患者是一种安全有效的微创治疗方法.     

Clinical efficacy of oral administration of 200 mg gatifloxacin once daily for 3 days for the treatment of patients with uncomplicated cystitis

To assess the clinical efficacy of oral antibiotic administration for the treatment of lower urinary tract infection (UTI), 102 female patients were given gatifloxacin (200 mg once daily for 3 days). Five to nine days after treatment, drug safety and clinical efficacy were assessed by evaluation of urinalysis and symptoms. Further, the patients were asked to report by mail whether they had persistent or recurrent symptoms at 4–6 weeks after treatment. The overall clinical cure rate was 93.1% (95/102). Of 94 patients with susceptible pathogens and 8 with resistant pathogens, 89 (94.7%) and 6 (75.0%), respectively, were judged as clinically cured. Four to 6 weeks after treatment, 57 (55.9%) of the 102 patients reported their micturition status by mail, and 6 (10.5%) of them claimed that they had some symptoms. The outcomes of this study suggest that a therapeutic regimen such as administration of fluoroquinolones once daily for 3 days can be recommended for the treatment of uncomplicated cystitis.     

Eosinophilic cystitis: CT findings

Eosinophilic cystitis (EC) is a rare form of bladder inflammation of uncertain etiology, characterized by eosinophilic inflammation of the bladder. Presenting clinical symptoms include hematuria, dysuria, frequency, and suprapubic pain. To our knowledge, there have been only two other reports of computed tomographic (CT) scan findings of EC. In both cases, the findings were thought to represent invasive bladder cancer. We present a case report of biopsy-proven EC with previously unreported CT scan findings.