Cystitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Usama Talib, BSc, MD [3]


Cystitis may be classified according to the etiology and therapeutic approach into various subtypes such as traumatic, interstitial, eosinophilic, hemorrhagic cystitis, foreign body, emphysematous, and cystitis cystica. Cystitis can also be classified as acute or chronic depending on the duration of the infection. For the purpose of treatment, cystitis may also be classified into acute uncomplicated, complicated, and recurrent cystitis. It can be classified as bacterial, viral, fungal or parasitic depending on the causative pathogen.


Cystitis may be classified into several subtypes based on:[1]

Classification according to etiology

There are several medically distinct types of cystitis, each having a unique etiology and therapeutic approach:

Traumatic Cystitis

It is probably the most common form of cystitis in the female, and is due to bruising of the bladder, usually by abnormally forceful sexual intercourse. This is often followed by bacterial cystitis, frequently by coliform bacteria being transferred from the bowel through the urethra into the bladder. Lack of circumcision and intercourse are important risk factors for traumatic cystitis.[1][2]

Interstitial Cystitis

Interstitial cystitis is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. Certain urinary metabolites are being associated with the diagnosis of interstitial cystitis. Chronic interstitial cystitis can lead to changes in the expression of the neuropeptides leading to defected visceral sensations and hyperreflexia of the urinary bladder. Several therapies are now available.[3][4][5]

Eosinophilic Cystitis

It is a rare form of cystitis that is diagnosed by biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC may be attributed to infection by Schistosoma haematobium or by certain medications in afflicted children. Some consider it a form of interstitial cystitis.[6][7][8]

Hemorrhagic Cystitis

Blood in the bladder due to rupture of vessels, trauma, or tumour can act as an irritant and cause cystitis. Hemorrhagic cystitis can occur as a side effect of cyclophosphamide, ifosfamide, exposure to environmental toxins like aniline dyes, pesticides, and radiation therapy.[9] Radiation cystitis, one form of hemorrhagic cystitis is a rare consequence of patients undergoing radiation therapy for the treatment of cancer.[10] Several adenovirus serotypes have been associated with an acute, self-limited hemorrhagic cystitis, which occurs primarily in boys. It is characterized by hematuria, and virus can usually be recovered from the urine.[11][12][13][14]

Foreign Body Cystitis

This is the kind of inflammation of the urinary bladder that can result from foreign bodies like a kidney stone, tumour, contraceptive device, foley catheter, or an infection associated with these foreign bodies. When caused by a benign lesion obstructing the bladder, foreign body cystitis is called papillary or polypoid cystitis.[15][16][17][18]

Cystitis Cystica

This is a chronic cystitis glandularis accompanied by the formation of cysts. This disease can cause chronic urinary tract infections. It appears as small cysts filled with fluid and lined by one or more layers of epithelial cells. These are due to hydropic degeneration in the center of Brunn's nests.[19][20]

Emphysematous Cystitis

Emphysematous cystitis is associated with production of gas and is mostly caused by E Coli and klebsiella pneumoniae.[21]

Cystitis Glandularis

This is a premalignant type of cystitis. It is considered to be a precursor of adenocarcinoma of the bladder.[22]

Ketamine Cystitis

This kind of cystitis is caused by the anaesthetic agent, ketamine, which causes urothelial dysfunction.[23]

Classification according to pathogen

Cystitis can be classified according to the causative organisms.[24][25][26][27][28]

Classification according to duration and treatment

Cystitis may be classified based on the duration of infection and the treatment:

Acute uncomplicated cystitis[36]

  • Patients with acute uncomplicated cystitis have an infection that is restricted to the lower urinary tract and is most commonly seen in women with normal structure and function of the genitourinary tract and children older than age 2 years. Acute Urinary infections in men are always managed as complicated infections.
  • Patients with acute uncomplicated cystitis may be treated using a single antimicrobial therapy using either a single dose or a 3-day regimen.

Complicated cystitis[37][38]

  • Complicated urinary tract infections occur irrespective of age and gender in people who have either functional or structural malformations. Urinary tract infection in elderly men is always considered complicated.
  • Patients with complicated cystitis generally require a longer duration of therapy compared with patients with uncomplicated cystitis.

Recurrent/Chronic cystitis[5][39][40][41][42]


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