From the Guidelines
Behçet's disease can cause cystitis as part of its systemic manifestations, and treatment typically involves immunosuppressive therapy to manage the underlying autoimmune inflammation. The most recent and highest quality study on the topic is not directly provided, but based on the available evidence, treatment with corticosteroids like prednisone (starting at 0.5-1 mg/kg/day) is recommended as first-line treatment for acute flares 1. For maintenance therapy, colchicine (0.5-1.2 mg daily) may help manage milder urinary symptoms. In more severe or resistant cases, stronger immunosuppressants such as azathioprine (2-3 mg/kg/day), cyclosporine (3-5 mg/kg/day), or TNF-alpha inhibitors like infliximab (5 mg/kg IV at weeks 0,2,6, then every 8 weeks) may be necessary 1.
Key Considerations
- Symptomatic relief can be provided with phenazopyridine (100-200 mg three times daily) for urinary pain and anticholinergics like oxybutynin (5 mg twice daily) for urgency and frequency.
- Patients should increase fluid intake to 2-3 liters daily to dilute urine and reduce irritation.
- Regular urological follow-up is essential to monitor bladder function and prevent complications like scarring or reduced bladder capacity.
- Behçet's disease involves immune dysregulation with neutrophil hyperactivity and vasculitis affecting multiple organ systems, including the urinary tract 1.
Management Approach
The approach to managing Behçet's disease-related cystitis should prioritize reducing inflammation and preventing complications. This can be achieved through a combination of immunosuppressive therapy, symptomatic relief, and lifestyle modifications. By targeting the underlying autoimmune inflammation, it is possible to improve morbidity, mortality, and quality of life outcomes for patients with Behçet's disease-related cystitis.
From the Research
Behçet's Disease and Cystitis
- Behçet's disease is a rare systemic vasculitis characterized by oral aphthous ulcers, genital ulcers, ocular lesions, and other systemic manifestations 2.
- The disease can affect various parts of the body, including the genitourinary tract, with symptoms such as genital apthous ulcers, epididymitis, urethritis, and recurrent cystitis 3.
- Neurogenic bladder dysfunction due to neural involvement of Behçet's disease has been reported, although it is extremely rare 3.
- A case study reported a patient with Behçet's disease who developed neurogenic bladder dysfunction, which was diagnosed urodynamically as hyperreflexic detrusor 3.
- The patient underwent augmentation clam-type sigmoidocystoplasty after failing medical treatment, and was asymptomatic from lower urinary tract symptoms four years postoperatively 3.
Treatment Options
- There is no specific treatment for Behçet's disease, but various medications can help manage its symptoms, including corticosteroids, immunosuppressants, and tumor necrosis factor inhibitors 2, 4, 5.
- For genitourinary tract involvement, treatment may include medical management of symptoms such as recurrent cystitis, as well as surgical interventions like augmentation cystoplasty in cases of neurogenic bladder dysfunction 3.
- The treatment approach may vary depending on the severity and extent of the disease, as well as the individual patient's response to different therapies 4, 5.