Danylo Halytsky Lviv National Medical University

I.V. Danyleichenko, O.Y. Soldatenko

State Clinical Hospital of Lviv Railways State Territorial Branch Company

O.M. Merentsov

Encrusted Cystitis Diagnosing and Treatment Criteria

(practical case).

Encrusted cystitis belongs to diseases that occur rarely. This is a chronic inflammation of the bladder followed by formation on the surface of its mucosal lining of flocculated salt layers.

According to medical references, the primary part in progression of this disease is played by microorganisms breaking up salt. The most common among them is Corinebacteria spp. It is also proved that the disease may be caused by Nanobacteria, E.coli, Ureaplasta urealisticum, Corinebacterium Urealisticum – gram-positive saprophytic skin microorganisms.

Based on the experience of many specialists, it is known that development of encrusted cystitis requires certain factors decreasing antimicrobial body resistance. Such factors include an old age, immunosuppressive therapy as well as suffered by a patient traumatic injuries of the bladder, endoscopic surgeries and a radiotherapy impact on the bladder wall. It also has been proved that encrusted cystitis more often occurs in men and may follow metal-plastic and neoplastic transformation of bladder urothelium.

The most common symptoms of the disease are erythrocyturia, rest pain above pubic and urination pain, urinary sand passage and sometimes urinary incontinence. A long-term course may cause anemia, reduction of bladder capacity (microcyst formation), involvement in encrustation process of the upper urinary tract, progression of encrusted pyelitis and occurrence of chronic renal insufficiency.

A medical case from practice.

A 75 years old patient S. has been hospitalized at the Neurology Department of the Lviv Railways Clinical Hospital with the symptoms of acute ischemic stroke. In the setting of acute retention of urine, bladder catheterization with a Foley catheter has been carried out. After 3 days, hyperthermia and macrohaematuria occurred. A bladder irrigation system with NaCl 0.9% solution has been set up and antibiotic and hemostatic treatment conducted. After relative stabilization of the condition and disappearance of erythrocyturia events, cystoscopy took place, revealing total bladder lining lesion with salt encrustation, under which the mucous membrane had ulcerative changes and was bleeding at contact with the endoscope. Mucous biopsy has been made. The diagnose was glandular polypoid necrotic encrusted cystitis.

General urinary test showed alkalinuria, large amount of salt and fresh erythrocytes, the whole field of view of leukocytes and a lot of phosphate salt. The diagnostic ultrasound indicated on hyperechoic formations in the bladder cavity and thickening of the hyperechoic wall of the bladder up to 8 mm. Bladder capacity was reduced, wall elasticity decreased, and we noticed incomplete urinary bladder emptying.

The patient took the course of antibacterial therapy, cranberry-based medications (in order to acidify urine), disintoxication therapy and bladder cavity irrigation by a catheter with Betadine solution. The condition normalized after 10 days, the Foley catheter was removed, urine passage was restored and chronic urine retention events were not observed at the diagnostic ultrasound.

2 months after treatment the patient underwent follow-up cystoscopy: bladder capacity remained below 200 sq.cm., bladder lining was pale pink with trabecular change and several pseudodiverticula of 1 cm diameter were detected. No cystitis events were found. The urinary test was within normal indications.

In diagnostics of encrusted cystitis a preference is given to interpretation of urinary analyses determining erythrocyturia, leukocyturia and crystalluria together with cystoscopy data – salt encrustation of the bladder, as it was in case of our patient.

Today there is no uniform methodology for treatment of encrusted cystitis. We propose using antibacterial therapy with semisynthetic medications of a penicillin type (ciprofloxacin, ofloxacin) and fluoroquinolone medications. In our case, a good effect of local treatment was achieved due to the use of Betadine solution.

Ii should be kept in mind that the long-lasting course of a chronic process in the urinary tract causes formation of strains insensitive to antibacterial medications. Unfortunately, there is no uniform method for diagnosing and treatment of encrusted cystitis at present. Therefore, the described above case can be used as an example for diagnosing and treatment of this disease.