The Etiology of Incrusted Cystitis With Alkaline Urine

Abstract

parts together as they ought to be put. I have seen excellent results produced by that operation, but what percentage of results is one going to get by such an inaccurate method?With reference to Dr. Stern's remark about the wide angle, of course, the lever is automatically held to that wide angle by the posture of the limb that is put up in strong abduction, completely out beyond the limits of physiologic abduction. I have used small bone grafts in that V cavity, and at other times, I have not. Of course, we have a greenstick fracture there at the lower end and it is very favorable to union. Incrusted cystitis is a chronic inflammatory condition of the urinary bladder manifested clinically by symptoms of dysuria, urgency and frequency, and the passage of gritty material or sand. In certain cases the urine is strongly alkaline, the degree depending somewhat on the severity and chronicity of the process. Usually the urine contains a large amount of blood and mucus, and sometimes pus. The marked discrepancy between the number of red blood corpuscles and pus cells in the urine in this form of cystitis has often been contrasted with the ratio in ordinary cystitis.Because of the nature of the gritty material and the alkaline condition of the urine, this particular type of cystitis has been referred to as chronic alkaline phosphatic cystitis. On cystoscopic examination the bladder presents crusted material which is hard, is firmly embedded in the mucous membrane, and may be limited, affecting only a small area of the bladder surface, usually in the trigonum, or generalized, covering almost the entire mucous membrane. Often these deposits are found when patients give a history sug¬ gestive of previous ulcer of the bladder or mild cys¬ titis, and they sometimes appear in the bladder after fulguration following catheterization, or when tumor growths have been previously observed.Without considering the clinical characteristics of the disease further than to state that this rebellious form of cystitis is much more prevalent than is generally sup¬ posed, and that the treatment has often been unsatis¬ factory because of the obscure nature of the infection, we shall review some of the results obtained by an inten¬ sive study of three cases and a series of experiments on animals.Various etiologic factors and numerous types of bacteria have been regarded as specific causes of this disease. Since a large percentage of bladder infections descend from the kidney or are carried by the blood from remote primary foci, a systematic clinical study of patients so infected was made. While no particular focus could be found in the patients we felt it desirable to carry on some experimentation along the lines that have been so successfully pursued by Rosenow, Meisser, Hayden and others. It was difficult to obtain accurate information concerning the kidneys on account of the technical difficulties encountered in catheterizing the ureters. The small size of the bladder and the ten¬ dency of hemorrhage to follow overdistention, together with ...

Treatment of encrusted cystitis caused by Corynebacterium group D2 with norfloxacin, ciprofloxacin, and teicoplanin in an experimental model in rats

“…Stones induced by CGD2 were mainly composed of struvite, as has previously been reported (17), and they occur in most urinary tract infections caused by urea-splitting microorganisms (3,8). However, it is well known that rats receiving high doses of quinolones may develop crystalluria; this is especially true for animals with alkaline urine and for animals receiving long treatment (20).…”

“…Hager and Magath (3) related this disease to the implantation of urea-splitting microorganisms in a bladder which already harbored some form of inflammatory or tumorous lesion. At present, most cases of encrusted cystitis are produced by CGD2 (13), although there is information indicating that other microorganisms, mainly Proteus sp., may produce this type of infection (3).…”

Management of pediatric stone disease

“…Those bacteria that are capable of producing urease enzyme (Proteus, Klebsiella, Pseudomonas) are responsible for the formation of such stones. Urease converts urea into ammonia and bicarbonate [13]. This alkalinizes the urine, and bicarbonate is further converted into carbonate [14].…”

Bacteriological evaluation of bladder calculi: a study

“…2 Among all the site in human body urinary tract form the most frequent site for stone formation usually form when when concentrated urine reside long in bladder. 3 As urine stagnantes mineral in urine form various crystal that might be cause for vesical calculus. One in ten individual will experience a urinary stone, bacteria have long been recognized to contribute urinary stone, more common calcium oxalate and calcium phosphate.…”