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LITERATURE REVIEW

CYSTITIS
FAHIDAH
HASYIM KASIM

DEPARTEMENT OF INTERNAL MEDICINE


FACULTY OF MEDICINE HASANUDIN UNIVERSITY

I. INTRODUCTION

Cystitis is an inflammation of the bladder, usually


mild and can heal spontaneously

Cystitis is urinary tract infections (UTIs) can


involve men and women of all ages

Clinical manifestations and causes various

National Kidney Foundation 10-20% of women


had at least one episode of cystitis, and 80% of
this group will suffer recurrent infections

II.ETIOLOGY

A. Infection Cystitis
Commonly caused by negative gram bacteria, especially
Escherichia coli (85%)
Other bacteria are Enterococci, Enterobacter, S.aureus, S.
epidermidis, Proteus mirabilis, Klebsiella, & Pseudomonas
Viruses often founded in urine without acute symptoms
of UTI Adenovirus tipe 11 &12
Schistosoma hematobium
C. albicans dan C.tropicalis

B. Non Infection Cystitis


1. Interstitial cystitiS

Causes of chronic inflammation of the bladder,


called as painful bladder syndrome

2. Drug-induced cystitis

Certain medications, especially chemotherapy


drugs such as cyclophosphamide and ifosfamide

3. Radiation cystitis

Giving radiation in the pelvic area

4. Foreign body cystitis

Long-term use of a catheter can cause tissue


damage

5. Chemical cystitis

Chemicals contained in certain products, such as


bubble bath, feminine hygiene sprays or spermicidal
jelly

6. Cystitis associated with other conditions

Complications from other diseases, such as


gynecological cancers, pelvic inflammation,
endometriosis, Crohn's disease, diverticulitis, lupus
and tuberculosis.

III. RISK FACTORS


WOMEN
SEX ACTIVITY
USED CONTRACEPTIONS
MENOPAUSE
PREGNANCY
PATTERN OF MICTURITION
INSTRUMENT
HEALTY STATE
OTHERS

IV. PATHOGENESIS

The spread in the vicinity of or asending,


haematogenous, limfogen, and exogenous due to
use of tools such as catheters or cystoscopy

Asending infections is major pathway

Various factors are responsible:


Anatomy Factors
Urinary stress factors
Urethral manipulation
Hormonal changes during menstruation and

pregnancy, genital hygiene, use of contraceptives.

Several factors local defense of the body against an

infection are:
The mechanism of regular emptying of urine from the bladder

and ureter peristalsis (wash-out mechanism)


The degree of acidity (pH) of urine is low
The existence urea in the urine
Urine osmolarity is enough high
Estrogen in women of childbearing age
The length of the urethra in men
The existence of of antibacterial substances or PAF (prostatic

antibacterial factor)
The existence of uromukoid that inhibit the attachment of

bacteria to the urothelium

This defense depends on the interaction of


several factors such as the effects of
flushing and dilution of urine, urine
antibacterial properties and intrinsic defense
bladder mucosa
The occurrence of infection depends on the
balance between speed proliferation of
bacteria and endurance bladder mucosa

V. CLINICAL MANIFESTATIONS
Cystitis

symptoms are not typical, and sometime


with no symptoms
Trias : urgency, frequency, dysuri
Nocturia, stranguria, tenesmus, hematuria, burning
sensation when urinating, cloudy,
Other symptoms that may be found including
intercourse pain, pain in the penis, and discomfort in
the suprapubic and pelvic area.
Systemic symptoms are usually minimal, mild fever,
fatigue, nausea, vomiting, and may be high fever
accompanied by delirium

Physical

examination, including a pelvic


exam, to rule out gynecological disorders,
neurological or colorectal
On physical examination is usually normal,

except in the suprapubic tenderness.


Perhaps encounters urethritis, vaginitis and
cystocele with residual urine when done toucher
vaginal

VI. DIAGNOSIS
Clinical manifestations
Laboratory

Urine Analysis: Lekosuria, Hematuria, Bacteriuria


Dipstick test
Dip-slide test
Urine culture examination

Radiology
USG, BNO, IVP, Cystouretrography, Retrograde
Uretrography, CT Scan.

Cystoskopy

VII. DIFFERENTIAL DIAGNOSIS


Vaginitis, urethritis
Ectopic pregnancy or abortion
Diverticulitis
Chronic appendicitis
Sexually transmitted diseases

VIII. TREATMENTS
The principle of treatment of cystitis
include a lot of fluid intake, adequate
antibiotics and symptomatic treatment if
necessary
Cystitis due to bacterial infection treated
with antibiotics
Non-infectious cystitis depends on the
underlying cause

Factors affecting the selection of


antimicrobials in treating UTI :
Patients
History Of Allergy
The Existence Of Renal Dysfunction And Liver
Urologic Abnormalities

Drugs

Safe
Spectrum
Route Of Administration
Cost

Microorganisms
Grams
Culture dan Sensitivity

A single dose of trimethoprim/sulfamethoxazole


(TMP/SMZ) or a fluoroquinolone without preceded by
bacterial culture and sensitivity is quite effective

Generally, female patients took 3 days.

Some patients may require antibiotic therapy for 710 days, especially the elderly or patients with risk
factors

Antibiotics single dose or short term after


intercourse is recommended every episode of
cystitis

Increasing fluid intake, do not delay micturition


and soon after intercourse is important in the
treatment of recurrent cystitis.

For postmenopausal women, oral estrogen


administration, the use of vaginal estrogen
cream can prevent cystitis effectively.

Lactobacillus vaginal suppositories can be used


to reduce the recurrence rate of UTI

Anticholinergics (such as oxybutynin /

tolterodine DITROPAN and / DETROL)


Reduces the symptoms of urgency, frequency and

dysuria
need to be cautious in patients with prostatic
hypertrophy accompanied

Ascorbic acid or cranberry juice can be

recommended to reduce the concentration


of bacteria in the urine
Surgery

IX. PREVENTIONS
Drinking cranberry juice daily or 300 cc cranberry

pills
Increase fluid intake: 2-3 liters a day
Frequent urination, avoid holding urine for a long
time
Urinate immediately after intercourse and wash
the area gently genetal
Avoid sexual positions that can irritate and injure
the urethra or bladder
Avoid concurrent use of spermicide with
diaphragm
Use a lubricant during sex, especially watersoluble when dry to prevent vaginal irritation

For postmenopausal women who have atrophic

vaginitis or urethritis atrophy, estrogen cream for


the vulva or insert a suppository into the vagina
estrogen
Avoid using deodorant sprays or feminine
products in the genital area
Avoid wearing tight clothing and humid
Wipe from front to back after urination and
defecation
Bathing without adding bubble bath.

X. COMPLICATIONS
pyelonephritis
renal failure
anemia
Recurrent cystitis and chronic
Ulceration of the gallbladder wall
Reduced bladder capacity
urethral stricture
Bladder Cancer

XI. RESUME
Cystitis most often affects women who are active

sexually and could be a serious health problem if


the infection spreads to the kidneys and recurrent
Most of cystitis is caused by a bacterial infection

mainly by gram-negative (E. coli).


Clinical features of urinary tract infection varies

from asymptomatic to irritating symptoms such


as frekuency, urgency, disury and upper UTI
symptoms such as fever, chills, low back pain and
bacteremia

Diagnosis ased on clinical and laboratory

examinations
Radiological examination and cystoscopy is useful

to know the anatomy and structural abnormalities


that predispose to the occurrence of cystitis
Treatment of bacterial cystitis with adequate

antibiotic treatment, while non-infectious cystitis


depends on the underlying cause
Surgery may be necessary to correct the existing

structural abnormalities.

Thank you