From the Guidelines
Emphysematous cystitis should be treated with early appropriate antibiotics targeting common pathogens like Escherichia coli and Klebsiella species, with a general treatment approach mirroring that for nonemphysematous UTIs, as recommended by the most recent guidelines 1. The treatment of emphysematous cystitis lacks robust data, with recommendations mostly relying on clinical judgment and case studies.
- The clinical review found insufficient quality of evidence to enable a clear recommendation, but most authors believe a treatment duration of 7 to 14 days (adjusted per clinical response) is reasonable 1.
- Early appropriate antibiotics, such as fluoroquinolones, third-generation cephalosporins, or carbapenems, are essential for targeting common pathogens.
- Hospitalization is often necessary, especially for severe cases requiring IV antibiotics, fluid resuscitation, and bladder catheterization to ensure proper drainage.
- Percutaneous catheter drainage, along with antibiotics, shows lower mortality for emphysematous pyelonephritis and is advisable in severe cases to include broader coverage until culture results are available 1.
- Strict glycemic control is essential for diabetic patients, and any urinary obstruction should be addressed.
- Follow-up imaging is recommended to confirm resolution of the infection.
- While most cases respond to medical therapy, severe instances may need surgical intervention.
From the Research
Definition and Characteristics
- Emphysematous cystitis is a relatively rare and potentially life-threatening condition characterized by the collection of gas in the bladder wall and lumen due to infection caused by gas-forming organisms 2, 3, 4.
- The condition is typically observed in elderly women with severe diabetes mellitus, and Escherichia coli and Klebsiella pneumoniae are often isolated from urine cultures 3.
- Patients with emphysematous cystitis present with variable clinical manifestations ranging from asymptomatic to severe sepsis 3.
Diagnosis and Imaging
- Imaging studies, such as plain conventional abdominal radiography and computed tomography, are necessary to detect emphysematous cystitis and obtain a definitive diagnosis 2, 3, 4.
- A computed tomography scan can reveal gas within the urinary bladder wall and lumen, and cystoscopy can confirm diffuse submucosal emphysema throughout the bladder 5.
Treatment and Management
- The management of emphysematous cystitis consists of broad-spectrum antibiotics, strict glycemic control, and bladder drainage 2, 3, 5.
- Most cases can be treated with a combination of antibiotics, bladder drainage, and glycemic control, and early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention 3.
- Complications may arise in some cases, requiring surgical treatment, and the mortality rate is around 7% 3.
Risk Factors and Prognosis
- Diabetes mellitus is a primary risk factor for emphysematous cystitis, and the condition should be considered in cases of urinary tract infections in diabetic patients with unusual presentations 3, 4.
- Emphysematous cystitis can also present in an undifferentiated fashion without traditional risk factors, and prompt management along with appropriate consultation with specialists are crucial to mitigate the risk of adverse outcomes 6.
- Accurate diagnosis and appropriate treatment typically result in a favorable prognosis and can improve the outcome 4.