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, such as fluoroquinolones or third-generation cephalosporins, is reasonable, with a treatment duration of 7 to 14 days adjusted per clinical response 1. Some key points to consider in the management of emphysematous cystitis include:
- Prompt diagnosis and treatment with broad-spectrum antibiotics
- Urgent urologic evaluation
- Adequate hydration
- Strict glycemic control if diabetic
- Bladder catheterization may be necessary to relieve obstruction
- Follow-up imaging is recommended after treatment completion to ensure resolution of the infection and gas collections It is essential to note that severe instances of emphysematous cystitis may require surgical intervention, and percutaneous catheter drainage, along with antibiotics, shows lower mortality for emphysematous pyelonephritis and is advisable in severe cases 1. The gas formation in emphysematous cystitis results from fermentation of glucose or albumin by gas-producing organisms, and diagnosis is confirmed through imaging studies such as CT scan or ultrasound showing characteristic gas patterns in the bladder wall. Without proper treatment, emphysematous cystitis can progress to emphysematous pyelonephritis, bladder rupture, or sepsis, highlighting the importance of prompt and effective management 1.
From the Research
Definition and Characteristics
- Emphysematous cystitis is a rare urologic condition characterized by abdominal pain, hematuria, and dysuria 2.
- It is typically associated with gas within the bladder wall and lumen, and can be diagnosed using imaging methods such as plain conventional abdominal radiography and computed tomography 3.
- The condition is often seen in elderly women with severe diabetes mellitus, and Escherichia coli and Klebsiella pneumoniae are commonly isolated from urine cultures 3.
Clinical Presentation
- Patients with emphysematous cystitis may present with variable clinical manifestations, ranging from asymptomatic to severe sepsis 3.
- Common symptoms include lower abdominal pain, gross hematuria, and dysuria 2, 4.
- Examination may reveal suprapubic tenderness and gross hematuria 2.
Treatment and Management
- Most cases of emphysematous cystitis can be treated with a combination of antibiotics, bladder drainage, and glycemic control 3.
- Broad-spectrum antibiotics and strict glycemic control are essential components of management 5.
- Conservative management with bladder drainage and antibiotic treatment can be effective, even in severe cases 6.
- Surgical treatment may be required in some cases, particularly if complications arise 5.