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. However, the use of broad-spectrum antibiotics is reasonable, with a treatment duration of 7 to 14 days (adjusted per clinical response) being considered reasonable by most authors 1. Some key points to consider in the treatment of emphysematous cystitis include:
- The use of antibiotics such as fluoroquinolones, third-generation cephalosporins, or carbapenems, with adjustments based on culture results
- Immediate hospitalization for severe cases
- Strict glycemic control if diabetic, with blood glucose maintained below 180 mg/dL
- Adequate hydration and urinary catheterization for bladder decompression if needed
- Surgical intervention for complications like bladder necrosis It is essential to note that emphysematous cystitis can progress to emphysematous pyelonephritis or urosepsis if left untreated, with mortality rates of 7-10%, making early diagnosis and aggressive management crucial 1. The gas formation in emphysematous cystitis results from fermentation of glucose or albumin by bacteria such as E. coli and Klebsiella, creating carbon dioxide and hydrogen within bladder tissues. 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.
From the Research
Definition and Characteristics of Emphysematous Cystitis
- Emphysematous cystitis is a rare urologic condition characterized by the presence of gas within the bladder wall and lumen 2, 3, 4.
- It is typically associated with abdominal pain, hematuria, and dysuria, and can lead to complications such as bladder rupture, necrosis, and septic shock 2, 3.
Predisposing Factors
- Emphysematous cystitis has been associated with several predisposing medical conditions, including:
- However, it can also occur in patients without these traditional risk factors 2, 4.
Diagnosis and Treatment
- Diagnosis is typically made through radiological studies, such as CT scans or radiography 2, 3, 4, 5.
- Treatment requires prompt urinary drainage, antibiotic coverage, and correction of underlying causes 3, 4, 6, 5.
- Conservative management with antibiotics and bladder catheterization is often successful, but surgical intervention may be necessary in severe cases 3, 6, 5.