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Cystitis is an infection of the lower urinary tract, also known as a urinary tract infection (UTI). Cystitis can be simple, in healthy men or non-pregnant women, or complicated, in people with risk factors, such as spermicide use, a new sexual partner, a previous UTI, or family history of UTI. Bacteria that cause acute cystitis include Escherichia coli, which is the most common etiologic agent, as well as Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus saprophyticus. Cystitis is more common in women, with about a 12% annual incidence whereas men report less than 10 cases per 10,000 men. Despite the difference in incidence rates, both men and women experiencing simple cystitis present with the same symptoms of dysuria, urinary frequency, and urgency. Risk factors for cystitis include sexual intercourse, new sexual partner, previous UTI, nephrolithiasis, and an immunocompromised status.
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Urinalysis and urine culture must be done to diagnose cystitis and develop a treatment plan. Laboratory evidence of pyuria and symptoms consistent with a lower urinary tract infection indicate acute cystitis. Patients with pyelonephritis or vaginitis should have a physical examination before a diagnosis is made, and men with recurring cystitis should be evaluated for prostatitis. Urine dipsticks may be used as a diagnostic tool to detect the presence of leukocyte esterase. In cases of complicated cystitis and a lack of response to antibiotic treatment, physicians may use computed tomography (CT), ultrasonography, or cystoscopy to detect abnormal processes interfering with treatment.
Listen to leading physicians discuss cystitis on the BackTable Urology Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
We talk with Dr. Yahir Santiago-Lastra, director of the Women's Pelvic Medicine Center at UC San Diego Health about the management of cystitis and pelvic pain syndromes. She shares her insights on genitourinary syndrome of menopause, pain evaulation and treatment, and procedural options including botox and sacral neuromodulation.
Antibiotic therapy is used to treat acute cystitis. The most common antimicrobial agent used for treatment is Nitrofurantoin, as it does not promote resistance of yeast overgrowth. Other common antibiotics used are Sulfamethoxazole-trimethoprim (SMX-TMP) and Fosfomycin. Multidrug resistant organisms pose a challenge for the treatment of acute cystitis, and the selection of treatments should be individualized to the patient’s risk for infection. Patients at risk for multidrug resistant organisms should undergo a urine culture and sensitivity testing before a regimen is developed. A single dose of an IV parenteral agent can be used to start patients on treatment in the emergency room.
 Li, R., & Leslie, S. W. (2021, August 12). Cystitis. StatPearls [Internet]. Retrieved October 19, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK482435/
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