1. BLADDER INFECTION Clinical Presentation Lim, Syndel Raina W.

2. Acute Cystitis Infection of the urinary bladder Women > men Ascending mode of infection – Periurethral – Vaginal – Fecal flora E coli – most common

3. Acute Cystitis Findings – Irritative voiding symptoms: Dysuria Frequency Urgency – Low back & suprapubic pain – Hematuria – Cloudy/foul smelling urine – Urinalysis: WBC & hematuria – Urine culture: Confirm diagnosis Identify organism Radiographic Imaging – If uncomplicated: Radiologic evaluation is not necessary

4. Acute Cystitis Management Short course of oral antibiotics – Trimethoprim – sulfamethoxazole (less expensive) – Nitrofurantoin (less expensive) – Fluoroquinolones Duration: 3-5 days Longer therapy not indicated Single dose: floroquinolones (long half-lives) Not recommended: – penicillins; aminopenicillins (high resistance)

5. Recurrent Cystitis / UTI Bacterial persistence or reinfection w/ another organism Mx: Bacterial persistence ≠ reinfection Radiographic Imaging – Ultrasonography Screening evaluation of the GUT – IV pyelogram – Cystoscopy – CT scan – Retrograde pyelogram

6. Recurrent Cystitis / UTI Management Bacterial persistence - surgical removal of source (urinary calculi) Bacterial reinfection- surgically repair fistulas – 95% reduction – medical mx: low dose continuous prophylactic antibiotic Alternatives: – Intravaginal estriol – Lactobacillus vaginal suppositories – cranberry juice

7. Malacoplakia Uncommon inflammatory disease of the bladder Can also affect the ureters & kidneys Plaques or nodules – Von Hansemann cells Large histiocytes – Micahelis-Gutmann bodies Laminar inclusion bodies Women > men

8. Malacoplakia Findings – Hx of UTI – Chronic illness or immunosuppressed – Irritative voiding symptoms: Urgency Frequency – Hematuria Radiologic Imaging – Ultrasonography – CT scan Bladder mass Ureter: obstruction Kidney – Focal or diffuse – Hypodense – Parenchymal masses

9. Malacoplakia Management Antibiotic therapy – TMP-SMX – Fluoroquinolones (decreased mortality rate ) Bethanecol & ascorbic acid – enhance phagolysosomal activity According to site of involvement: Lower urinary tract: antibiotic therapy Ureter & kidney: surgical excision + antibiotic therapy – Prognosis: poor; high mortality rate (bilateral renal involvement)