Inflammation of the Bladder (Cystitis)

In cystitis – colloquially called cystitis – (synonyms: UTI; urinary bladder infection; urinary bladder catarrh; urinary tract infection (UTI); cystitis; plural: cystitis; Greek κυστίτις from κύστις kýstis “bladder,” “urinary bladder”; ICD-10 N30.-: Cystitis) is an inflammation of the mucous membrane of the urinary bladder. It is a typical and frequent urinary tract infection (UTI) of the so-called lower urinary tract. A cystitis (= lower urinary tract infection, UTI) is assumed if the acute symptoms refer only to the lower urinary tract, e.g. new onset of pain during urination (alguria), imperative urge to urinate (urge to urinate that cannot be suppressed or controlled), pollakiuria (urge to urinate frequently without increased urination), pain above the symphysis (pubic symphysis). In asymptomatic bacteriuria, colonization (colonization with microorganisms) is usually assumed, but not infection. Furthermore, an uncomplicated urinary tract infection (UTI) is distinguished from a complicated UTI:

  • Uncomplicated UTI: UTI is classified as uncomplicated when there are no relevant functional or anatomic abnormalities in the urinary tract, no relevant renal dysfunction, and no relevant concomitant diseases/differential diagnoses that promote UTI or serious complications.
  • Complicated UTI: UTI in the presence of concomitant urinary tract abnormalities, metabolic disorders (eg, diabetes mellitus), or foreign bodies (eg, horizontal transurethral catheter).

Acute uncomplicated cystitis (AUZ) is caused in most cases by Escherichia coli (gram-negative rods from the intestinal flora). Cocci (gram-positive), mycoplasma, ureaplasma, yeast, chlamydia, and viruses can also cause cystitis. Cystitis can be divided by type of symptoms into:

  • Symptomatic cystitis – accompanied by discomfort.
  • Asymptomatic cystitis (bacteriuria/presence of bacteria in urine and leukocyturia/increased presence of white blood cells (leukocytes) without symptoms) – without symptoms.

Cystitis can be divided by cause into:

  • Nosocomial cystitis – cystitis caused by the hospital, for example, infectious urinary catheters.
  • Non-nosocomial cystitis, which occur outside the hospital, are relatively common, and affect, for example, one to three percent of school-aged girls

Urinary tract infections (UTI), Clostridioides difficile infections (CDI), pneumonias / pneumonia (HAP), primary bloodstream infections (BSI) and surgical infections (SSI) are responsible for about 80% of all hospital infections (nosocomial infections). Furthermore, an acute cystitis is distinguished from a chronic cystitis. Recurrent UTI is said to occur when there are ≥ 2 symptomatic episodes within 6 months or ≥ 3 symptomatic episodes within 12 months. The occurrence of acute cystitis after a honeymoon is referred to as “honeymoon cystitis.” Urinary tract infections (UTIs) represent the most common bacterial infections in childhood. Sex ratio: because women have a shorter urethra (urethra), they are significantly more likely to be affected by cystitis. Frequency peak: the disease often occurs in older men with benign prostatic hyperplasia (BPH, benign prostatic hyperplasia). In contrast, cystitis is exceedingly rare in men younger than 50 years of age. The lifetime prevalence (disease frequency, based on the entire lifetime) is 50-70 % of all women (in Germany). Approximately 5% of pregnant women have cystitis. Course and prognosis: Acute uncomplicated cystitis (AUZ) is present when there are no functional or anatomical abnormalities in the urinary tract, no renal dysfunction, and no concomitant diseases that favor urinary tract infection. Treatment of UTI usually lasts 1-3 days (antibiotic therapy). A possible complication is pyelonephritis (inflammation of the renal pelvis). Cystitis may be recurrent (recurring). The recurrence rate is 5-10%.