Emphysematous cystitis is a rare, severe infection affecting the bladder. It is characterized by the presence of gas within the bladder wall or its lumen. This condition is a serious form of urinary tract infection that demands prompt medical attention. Recognizing its distinctive features is important for timely intervention.
What Exactly Is It?
Emphysematous cystitis is caused by gas-forming bacteria or, less commonly, fungi. Common bacteria include Escherichia coli, Klebsiella pneumoniae, and Enterobacter species. These microorganisms produce gas, such as carbon dioxide, hydrogen, and nitrogen, by fermenting glucose present in the urine and bladder tissue.
The process involves bacteria invading the bladder wall and releasing gases, which accumulate as bubbles. This gas accumulation gives the bladder a characteristic bubbly appearance on medical imaging. Unlike a typical bladder infection, emphysematous cystitis is distinguished by this unique gas formation, indicating a more severe and complicated infection.
Who Is Most Susceptible?
Several factors increase susceptibility to emphysematous cystitis. The most prominent risk factor is poorly controlled diabetes mellitus. High glucose concentrations in the urine provide a readily available food source for gas-forming bacteria, promoting their growth and gas production.
Other important risk factors include conditions that impair urinary flow or bladder function, such as urinary tract obstruction from an enlarged prostate, bladder stones, or tumors. A neurogenic bladder, which involves a lack of bladder control due to nerve damage, also increases risk. Chronic urinary tract infections, a weakened immune system, and prolonged bladder catheterization also increase risk. These factors can lead to urinary stasis or compromised immune responses, creating an environment conducive to infection.
Identifying the Symptoms
Symptoms of emphysematous cystitis can overlap with common urinary tract infections, including painful urination, increased frequency, urgency, and lower abdominal pain. However, more severe and distinct symptoms are often present. These include pneumaturia (passage of gas in urine) and macroscopic hematuria (visible blood in urine).
Patients might also experience fever, nausea, vomiting, and severe tenderness in the abdominal area. The presence of gas and tissue damage within the bladder often leads to symptoms that are more acute and intense compared to a standard urinary tract infection. While pneumaturia is a highly specific sign, it is not always recognized or reported by patients.
Diagnosis and Management
Diagnosis typically involves medical imaging to visualize gas within the bladder. X-rays, ultrasounds, and especially computed tomography (CT) scans of the abdomen and pelvis are effective in showing gas within the bladder wall or lumen. CT scans are considered the preferred imaging method for a detailed assessment.
Laboratory tests are crucial for diagnosis and guiding treatment. Urine samples are analyzed through urinalysis and urine culture to identify the gas-forming bacteria and determine their susceptibility to antibiotics. Blood tests may assess the overall severity of the infection and the patient’s general health.
Treatment involves aggressive antibiotic therapy, often administered intravenously, to target the identified bacteria. Bladder drainage, frequently achieved with a urinary catheter, is often necessary to relieve pressure and facilitate healing by allowing gas and infected urine to exit the bladder. In rare and severe cases where initial medical management is insufficient, surgical intervention, such as debridement of damaged tissue or partial removal of the bladder, may be required. Managing underlying conditions, such as strict blood sugar control in diabetic patients, is important to prevent recurrence and improve outcomes.