Common conditions in our urinary system

Urology is a branch of medicine which studies disease conditions related to the urinary system-kidneys, ureters, bladder and urethra. In this article, we will be talking about Cystitis and Pyelonephritis - two common disease conditions about which we get to hear often, how they present, their diagnosis and treatment followed by the features which might be helpful in differentiating one from the other.

What is Cystitis? 
Cystitis is defined as an infection of the bladder or urethra, most commonly due to a bacterial etiology. Accounting for a significant female predominance possibly due to the short urethra present in females, Cystitis equally affects both males and females.

Bacteria, especially Escherichia coli type, which is a part of the normal flora in the body, sometimes becomes highly virulent, especially in immune-comprised states and invades the walls of the bladder and urethra. They will then get attached to the walls using their pili and multiply resulting in an inflammation and irritation of the wall lining.

The major cause for cystitis to develop in an individual is known to be ascending infections where virulent bacteria enters the target organ through external genitalia. 

What are the major risk factors? 
 Usage of tampons
 Urinary catheterisation
 Pregnant women whose bladder is not emptied completely, most of the time
 Sexually active women
 Urinary tract obstruction
 Usage of diaphragms in women as a method of contraception
 Frequent or vigorous sexual activities
 Menopause
What you would present with, which require medical advice?
 Blood mixed urine
 Dark or cloudy urine
 Pain above the pubic bone, lower back or abdomen
 Difficulty in passing urine
 Frequency
 Burning sensation on urination
 High fever (100.4F)
 Irritability in children
 Loss of appetite
 Vomiting

However, some patients may only complain of generalised bodily symptoms such as fatigue, lethargy, nausea, vomiting and feverishness, without any of the features 
mentioned above.

What will my doctor do? 
Your doctor will take a complete history from you about the onset of symptoms and how severely they affect your day-to-day activities along with a thorough abdominal and genital examination which will give important clues towards confirming the diagnosis. However, investigations such as full blood count, urine full report and urine culture are mandatory to confirm the diagnosis.

Also, it is highly necessary to exclude other conditions which might mimic cystitis including, urethritis, sexually transmitted infections, bladder pain syndrome, prostatitis, benign prostatic hyperplasia in men and lower urinary tract infections.

Majority of the patients with this condition will recover on their own within 4 days. However, if your illness is lasting for more than 4 days, it is highly recommended to seek medical advice, without delaying further.

How will I get treated?
Antibiotics, depending on the organism is the treatment of choice for Cystitis and until the responsible organism is confirmed with the help of a urine culture, empirical antibiotic therapy will be carried out, covering up all possible bacteria.

Commonly used antibiotics for cystitis include Nitrofurantoin, Trimethoprim-Sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin and Levofloxacin. 

Also, it is important to stay appropriately hydrated, so drinking plenty of water is highly encouraged.
Are there any preventive measures? 

Since prevention is always better than cure, it is important to practice safety methods as much as possible to prevent cystitis, which significantly includes,
 Avoid using perfumed soap, cream or talc powder around genitals.
 Complete emptying the bladder when passing urine.
 Maintain a perfect hydration by drinking plenty of fluids always wiping your bottom from front to back when you go to the toilet
 Emptying the bladder after having sexual intercourse
  Avoid using Diaphragms as a method of contraception

What is Pyelonephritis?
Most urinary tract infections involve the bladder and urethra and it is referred to as Pyelonephritis when this damage extends up to the ureters and kidneys.

Generally, a majority of pyelonephritis cases take place as a result of a complication of bladder or urethral infection (E. coli or klebsiella) and can end up in contaminating blood giving rise to fatal scenarios. 

This condition can also occur due to a urinary tract obstruction possibly seen in benign prostatic hypertrophy (BPH), abdominal or pelvic masses and bladder, ureteric or renal calculi.  

There are two types of Pyelonephritis as follows:
 Acute - Sudden and self-limiting type which is effectively treated with antibiotics and rarely cause any long-lasting damage to the kidneys. 
 Chronic - A rare type which is usually caused by birth defects in the kidney and present as recurrent urinary tract infections particularly in children. This will also result in progressive scarring of the kidneys.

How will I present?
 Fever with chills and rigors
 Back pain or flank pain
 Malaise
 Lethargy
 Nausea and vomiting 
 Confusion with signs associated with cystitis including, blood in urine, dark or cloudy urine, pain on micturition, increased frequency and urgency of urination.

How will I get diagnosed and treated? 
A GP will diagnose pyelonephritis with the help of a complete history from the patient followed by an abdominal and pelvic examination. Investigations such as urine full report (to see increased white blood cells and the presence of red blood cells) and urine culture are mandatory to establish the exact diagnosis. Also, it is so important to find the etiology of the condition and therefore, imaging studies like x-ray, ultra sound scan of the pelvis and abdomen (to identify and abscesses, calculi and obstruction), CT and MRI may be useful.

A blood culture can be useful to identify any possible contamination of blood with the causative bacteria.

It is always advisable to treat pyelonephritis shortly and promptly after making the diagnosis, since there can be immense number of complications if the treatment is delayed or if left untreated. Whether to admit the patient or carry out treatment at home will depend on the severity of the condition and the treatment of choice for pyelonephritis is antibiotics, covering the responsible bacteria. 

In a nutshell 
 Cystitis is defined as an infection of the bladder or urethra, most commonly due to a bacterial etiology whereas pyelonephritis is a complication of it, caused when the damage extends up to the kidney through ureters. 

 Signs and symptoms of both the conditions are quite similar to each other, yet patients with the latter are usually severely ill, requiring hospital admission most of the time.

 Both Cystitis and Pyelonephritis are treated effectively with specific antibiotics, targeting the 
causative organism.