This document discusses cystitis, an inflammation of the bladder. It describes the acute and chronic forms of cystitis, including common causes such as bacterial and fungal infections. Predisposing factors like diabetes, urinary obstruction, and immune deficiency are mentioned. Gross and microscopic findings for acute, chronic, and specific types of cystitis like schistosomal and interstitial cystitis are summarized. Complications involving fibrosis and bladder cancer are also noted. The document provides an overview of cystitis and guidance on evaluation, diagnosis, and key characteristics of different cystitis types.

1. Cystitis
The acute and chronic form
Made easy

3. THE CASE
• 55 yrs old poorly controlled diabetic
female presented with burning pain
at micturition , excessive need to
urinate but each time she goes , she
was passing only small amount of
cloudy coloured urine that has a fishy
odour

4. Case highlights
• 55 yrs old poorly contolled diabetic
female presented with burning pain
at micturition , excessive need to
urinate but each time she goes , she
was passing only small amount of
cloudy coloured urine that has a
fishy odour

5. So what to do
• Extended history
• Physical examination including the vital
signs ( fever , tachycardia ) and searching
for suprapubic tenderness
• Urinalysis to look for the microorganism
that caused the trouble
• Complete blood picture will reveal
leukocytosis
• Urine culture that takes a day or two

6. What can cause the trouble ?
• Bacterial cystitis :
1. E.coli
2. Proteus
3. Klebsiella
• Tuberculous cystitis
• Fungal cystitis ( candida albicans)
Immunesuppressed and those on long term ABCs
• Schistosomal cystitis
• Viruses , chlamydia , mycoplasma
• Other non infectious causes : drugs (cyclophosphamide)
and radiation ( radiation cystitis)

7. Predisposing factors5
• Urinary obstruction ( BPH , bladder calculi
and tumors )
• Cystocele or diverticula
• D.M
• Instrumentation
• Immune defeciency

8. Grossly , what to see ?
• Hyperemia of the mucosa
• Hemorrhagic cystitis : (after Radio,Chemo or Adeno)
• Suppurative cystitis : large amounts of suppurative
exudate
• Ulcerative cystitis : large mucosal ulcers and
sometimes ulceration of entire bladder mucosa !
• IF the infection persists Chronic cystitis that’s
seen as Red , Friable , Granular mucosa ANOTHER
association is the fibrosing thickening and inelasticity
of bladder wall

9. Post-radiotherapy hemorragic cystitis

10. Fibrous thickening of bladder wall

11. Microscopically there is :
• acute cystitis acute infammation
• chronic cystitis chronic inflammatory
cells ( ? ) with fibrosis
• two variants of
chronic cystitis :
1. Follicular cystitis
2. Eosinophilic cystitis

12. Schistosomal cystitis
• Caused by S. Hematobuim
• Eggs (by anastomosis) travel from sup. Rect. V.
to the veins of bladder wall , these eggs are
irritating so causing granulomatous cystitis
with eosinphilic infiltrate and fibrosis
• These granulomas are seen as minute
granules hence the name (sand grain cystitis)
• The eggs die and calcify

13. What are the complications ?
• extensive fibrosis ( that may impinge on
ureteric orifices to cause hydronephrosis
• CA bladder (squamous type) :
Schistosomal
cystitis
Squamous
metaplasia
Carcinoma

17. Special forms of cystitis
1. Interstitial cystitis (Hunner ulcer) :
• painful form of chronic cystitis (very painful)
• most frequently in women
• Cystoscopy shows : fissures and punctate
hemorrhages in the mucosa , sometimes with
chronic mucosal ulcers
• mast cell infiltrate is characteristic
• Maybe of autoimmune origin

19. Special forms of cystitis
2. Malakoplakia :
• Macroscopically : soft , yellow , slightly raised
mucosal plaques 3-4 cm in diameter
• Microscopically : infiltration by large foamy
macrophages with debris of bacterial origin
(E.coli)
• Michaelis – Gutmann bodies (laminated
mineralized concretions) are typically present
• Occurs in increased frequency in immune
suppressed transplant recipients

21. Special forms of cystitis
3. Polypoid cystitis :
• Results from irritation of bladder mucosa by
indwelling catheters
• Submucosal Edema causes broad , bulbous ,
polypoid projections

22. Review
• cystitis is either infectious or non infectious
• 5 predisposing factors for cystitis
• The acute form seen grossly : hyperemia,
hemorrhagic cystitis , suppurative cystitis and
ulcerative cystitis microscopically : acute
inflammation.
• The chronic form grossly : red , friable , granular
ulcerated mucosa, and fibrous thickening and
inelasticity of wall , microscopically : chronic cell
infiltrate and fibrosis

23. Review
• schistosomal cystitis : S. hematobium
• Eggs in the walls causing granulomas,
eosinophilic infiltrate, fibrosis
• granulomas look like sand grains
• 2 complications ( extensive fibrosis impenge
ureters causing hydronephosis , and squamous
metaplasia and carcinoma of bladder )