Emphysematous Cystitis

Abstract

Emphysematous cystitis is a rare disease characterized by primary infection of the urinary bladder with gas-producing pathogens. There is a paucity of information on this entity in the English-language literature covering the last 45 years, and the clinical picture is poorly outlined. We carried out a comprehensive, retrospective review of the English-language literature from 1986 to 2006, searching for reports describing cases of emphysematous cystitis. The demographic, clinical, laboratory, imaging, and outcome characteristics of every eligible patient were excerpted. In the present report, we describe a typical case of emphysematous cystitis, followed by an analysis of the literature. Of the 53 eligible cases, most were elderly women with diabetes mellitus (62.2%). Classic symptoms of urinary tract infection were present in only 53.3% of cases. Abdominal tenderness and hematuria were noted in 65.6% and 82.3% of cases, respectively. Plain abdominal X-ray was highly sensitive (97.4%), while abdominal computerized tomography was the most sensitive and specific diagnostic tool. A complicated course attributable to emphysematous cystitis was described in 18.8% of cases. The exact mechanism contributing to the formation of gas in such cases is unknown. Various theories have been suggested, including fermentation of glucose in urine, with emphasis on disequilibrium between gas formation and clearance. Emphysematous cystitis has a highly variable presentation and course, with a considerable potential for complications. Further diagnostic imaging is highly recommended in diabetic patients with urinary tract infection who present with abdominal pain and hematuria. Knowledge of this rare entity may lead to early diagnosis and appropriate management.

Emphysematous cystitis: The role of CT imaging and appropriate treatment

“…Since the infection also affects non-diabetics, it is thought that tissue proteins and urinary lactulose can also serve as substrates. 6 Impaired gas transport due to local inflammation or obstructive processes (which increase intracellular pressure while simultaneously decreasing circulation) may also increase the risk of pneumaturia. The release of bacterial endotoxin in complicated UTIs may contribute to the inflammatory process and may induce urinary tract paralysis and urinary stasis.…”

“…9 However, CT is required for a definitive diagnosis and will allow differentiation from other causes. 1,2,6 As observed with emphysematous pyelonephritis, about two-thirds of emphysematous cystitis infections are caused by E. coli; the remaining third are caused by Enterobacter species, Clostridium species, Klebsiella pneumonia, Staphylococcus aureus, or Proteus mirabi. 1,3,10 Candida species may also be responsible.…”

Emphysematous cystitis: An atypical multi-organism presentation

“…The most common symptom was abdominal pain, as seen in this case. 10 The diagnosis of EC has seen a substantial increase recently due to a number of factors, including more awareness of the condition, higher volume of imaging, and a rise in the diabetic and elderly population. In contrast to typical UTIs, one cannot always rely on history and urinalysis for the diagnosis of EC.…”

“…Grupper and colleagues found that a median length of 10 days is effective. 10 In rare cases, when patients do not respond to conservative treatment, surgery may be required (cystectomy, surgical debridement).…”

A rare cause of acute lower abdominal pain: Emphysematous cystitis

“…İdrar analizinde lökositüri olguların %87,5' unda, hematüri ise %82,3'ünde izlenir. [8] Amfizematöz sistin tanısında bu hastalığın varlığını düşündüren ciddi bir klinik bulgu yoktur. Teşhis radyolojik olarak konur.…”