Emphysematous cystitis complication in a patient undergoing hemodialysis

Abstract

Emphysematous cystitis is a rare condition characterized by air formation in and around the bladder wall by gas-forming organisms. Although diabetes mellitus and chronic urinary infection, which are frequently encountered in patients with endstage renal disease (ESRD), are predisposing factors for this entity, emphysematous cystitis is actually not common in ESRD patients. Here we provide the first report of a hemodialysis patient who developed typical emphysematous cystitis. Unlike other cases, the emphysematous cystitis recurred after discontinuation of urinary drainage and antibiotic therapy. The possible reason that this case is of a less common type that is more refractory than the other cases, and the method by which patients with ESRD are commonly treated, are discussed. Not anuric but rather oliguric diabetic patients, even after long-term hemodialysis, are the patients at risk for emphysematous cystitis.

Emphysematous Cystitis: A Review of the Literature

“…Although pneumaturia appears to be a highly specific symptom, it is a rare patient complaint. Pneumaturia is observed in 70% of patients with bladder catheterization (7,9). Other symptoms of acute cystitis (dysuria, urinary frequency and urinary urgency) occur in approximately 50% of patients.…”

Emphysematous Cystitis: A Case Report

“…Prevalent symptoms include dysuria, hematuria, increased frequency of urination, fever, suprapubic pain and pneumaturia. Although pneumaturia is a more specific symptom than others, it is quite rare [5]. Thomas et alhave reported that 7% of cases is asymptomatic and incidentally detected by abdominal imaging [2].…”

Emphysematous Cystitis with Diabetic Neurogenic Bladder

“…A history of pneumaturia is also highly suggestive, but patients rarely report this symptom (14). The diagnosis is provided by radiographic imaging.…”

“…This suggests that diabetic patients, particularly women presenting with fever of unknown origin, warrant screening for the presence of gas within the bladder. Screening requires not only abdominal CT but also pelvic CT in such patients (14).…”

“…Antifungal agents may used if a fungal infection is reported (22). The bladder should be kept at rest by continuous catheter drainage for a substantial period with the ultimate goal of clearing detectable pathogens in the urine, particularly in patients with urinary retention and neurogenic bladder (14,18). In rare cases, surgery is needed if an abscess develops outside the bladder (11).…”