Acute and chronic recurrent cystitis in women

Infections of the urinary system are considered to be the most common infectious diseases of the genitourinary system in outpatient and hospital practice.

Uncomplicated urinary tract infections are one of the most frequent diseases of women of reproductive age. During the year, 25-35% of women aged 20 to 40 years experience at least one episode of urinary infection. The most common is acute cystitis. According to statistical data, in Russia, 26-36 million cases of disease per year are registered. The incidence of acute cystitis is 0.5-0.7 cases per year per woman. According to the latest international study of antibiotic resistance of strains of pathogens NIMP (2006), in which 61 countries took part, the leading causative agent of these diseases is E. Coli, which is isolated in 76.3% of cases. Then follows S. Saprophiticus (3.6%), Klebsiella pneumonia (3.5%), Proteus mirabilis (3.1%) and Enterococcus faecalis (3%).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of the acute and chronic recurrent cystitis in women

More than 95% of uncomplicated urinary tract infections are caused by a single microorganism. The most frequent pathogens are Gram-negative enterobacteria, usually Escherichia coli (70-95% of cases). The second most frequent pathogen is Staphylococcus saprophyticus (5-20% of all uncomplicated urinary tract infections), which is more often isolated in young women. Significantly less uncomplicated urinary tract infections cause Klebsiella spp. Or Proteus mirabilis. In 1-2% of cases, pathogens caused by uncomplicated urinary tract infections are Gram-positive microorganisms (Group B and D streptococci).

[11], [12], [13], [14], [15], [16], [17], [18]

Diagnostics of the acute and chronic recurrent cystitis in women

The plan for the examination of patients with chronic cystitis should include the following steps

• Careful collection of anamnesis (features of the course of recurrent urinary tract diseases that occur against the background of sexually transmitted infections):
  • duration of the disease for more than two years;
  • presence of pollakiuria outside the exacerbation period up to 11-14 times a day;
  • persistent severe pain over the bosom, in the urethra and vagina, leading to sexual and social maladjustment;
  • inefficiency of traditional antibiotic therapy.
• General urine analysis.
• Bacteriological study of urine with the definition of sensitivity to antibiotics.
• Examination of the vagina with the help of mirrors to exclude anatomical changes (with the O'Donnel sample).
• Examination by a gynecologist.
• Examination for sexually transmitted infections (STI), two methods from two loci (cervical canal and urethra).
• Ultrasound of the organs of the urinary and reproductive system.
• Cystoscopy with biopsy and morphological study of the biopsy.

If the diagnosis of cystitis in most cases does not cause difficulties, then treatment is not always effective, and the forecast is not always favorable, as in a number of patients it is not possible to establish and eliminate the cause that led to the onset of the disease.

[19], [20], [21], [22], [23]

Differential diagnosis

Differential diagnosis of chronic cystitis with diseases that have a similar clinical picture is necessary:

• cancer of the bladder;
• tuberculosis of the urinary tract;
• adenomyosis;
• vulvovaginitis;
• specific urethritis.

Treatment of the acute and chronic recurrent cystitis in women

Treatment of cystitis should be complex (etiological and pathogenetic) and directed primarily at eliminating the causes of frequent recurrence of infection of the lower urinary tract.

Cystitis is an infectious disease, and consequently, without an agent, there is no infection.

At present, pathogenetically substantiated algorithms for the conservative treatment of inflammatory diseases of the lower urinary tract have been developed.

Acute and chronic recurrent cystitis in women is also treated with surgical methods aimed at correcting anatomical changes and eliminating the causes of urodynamic abnormalities.