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Tips for diagnosis/management

• Dysuria: most specific symptom, differentiate from vaginitis
• If only symptoms are foul-smelling or cloudy urine, encourage hydration and reassess
• Symptom predictiveness: dysuria + frequency + no vaginal irritation, UTI probability > 90%
• Spontaneous resolution: approximately 30% women will have resolution of UTI without treatment
• First-line therapy: bactrim DS BID x3d, macrobid 100mg BID x5d, or fosfomycin x1 dose
• "Test of cure" UCx: not necessary if symptoms resolve with treatment

Complex cystitis

Complicated cystitis factors

• Anatomic: cystocele, fistula, diverticulum
• Obstruction: BOO, UPJO, stricture
• Iatrogenic: hospital-acquired infection, recent GU surgery, indwelling catheter
• Functional: NGB, PFD, VUR, elevated PVR, incontinence
• Other factors: male gender, pregnancy, stones, DM, immunosuppresion

Emphysematous cystitis

• Complicating factors: DM, age, BOO, NGB
• Imaging: CT required for diagnosis, shows air within bladder wall (submucosal), air in lumen not technically emphysematous cystitis
• Treatment: antibiotics, catheterization (usually foley x1 week), and DM management, rarely debridement or cystectomy

Pyocystis

• Causes: defunctionalized bladder usually secondary to renal failure or urinary diversion without cystectomy
• Presentation: urethral discharge, suprapubic pain, fever, full bladder on imaging
• Initial management: catheter drainage, IV antibiotics, consider intravesical antibiotics
• Surgical management: offer cystectomy, vaginal vesicostomy in women, perineal vesicostomy in men