Cystitis (Inflammation of the bladder)
Uncomplicated acute cystitis (inflammation of the bladder) is a disease of children and women with a peak incidence in the 2. and 3. decade and after menopause (atrophy of the uretheral mucosa). Men are usually affected only in connection with diseases of the bladder (stone, tumors) or the prostate (obstruction). Typical acute cystitis in the female develops in an ascending pathway, for example after sexual intercourse (honeymoon cystitis). Enhancing factors are decreased infection resistance of the uretheral mucosa (hormonal influence, chronic infection, irradiation, immune insufficiency) residual urine, foreign bodies or stones.
Symptoms of acute cystitis are frequent urination urge with a small quantity of urine and pain on urination. These symptoms may be associated with visible blood (macrohaematuria).
Fever is not a symptom of acute cystitis. Acute cystitis is a bacterial infection. The most common germ involved is escherichia coli (E.coli), which is part of the normal intestinal flora.
For acute cystitis without complicating factors in the female, a three day course of antibiotics, as a rule, is sufficient. In case symptoms were present for more than a week, or a recent urinary tract infection, or by diabetes mellitus or pregnancy, a seven day course should be given. Single dose therapies are easier and less expensive, but the failure and relapse rates are higher than with longer treatment. Young healthy men without complicating factors can be treated with a seven day course of therapy. For older men and patients with structural or functional anomalies the course should be 10 to 21 days. After the acute symptoms have abated an endoscopic control should be made, especially in men.
Interstitial cystitis afflicts women in the 4. and 5. decade of life and with time leads to a decreased bladder capacity. The exact etiology is unknown. Aside from autoimmune processes and neurogenic factors, infections causes such as chlamydia, urea/mycoplasmen, garderella or viral have been discussed. In that these germs are found in urethral syndrome, they should primarily be ruled out or treated. In rare cases of interstitial cystitis symptomatic treatment with medication or bladder stretching is indicated. By severe loss of bladder capacity, surgical bladder substitution is necessary.
Urethral syndrome of women
This syndrome is one of the most frequent non diagnosed urological illnesses. The subjective symptoms of cystitis are typical, but without signs of infection in the urine sediment. The symptomology consists of frequent painful urination, imperative urinary urge, dull lower abdominal pain and burning in the urethra.
A cystoscopic examination combined with bladder wash fluid evaluation and possibly vaginal smears for bacteria and other germs may help diagnostically.
In that detection of these germs may be falsely negative, in practice a trial with doxycycline is justified. The sexual partner must be treated at the same time and sexual intercourse during treatment should only take place with condome protection to avoid the so-called "ping pong effect". A psychosomatic component has been discussed and psychosomatic treatment has been helpful in some cases.