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BLADDER INFECTION

Clinical Presentation. BLADDER INFECTION. Lim, Syndel Raina W. Acute Cystitis. Infection of the urinary bladder Women > men Ascending mode of infection Periurethral Vaginal Fecal flora E coli – most common. Acute Cystitis. Findings Irritative voiding symptoms: Dysuria Frequency

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BLADDER INFECTION

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  1. Clinical Presentation BLADDERINFECTION 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 CystitisManagement • 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 / UTIManagement • 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. MalacoplakiaManagement • 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)

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