Diagnosis Of Emphysematous Cystitis Research Articles

Emphysematous Cystitis: A Rare Urologic Emergency.

BACKGROUND Emphysematous cystitis is a rare urologic condition typically characterized by abdominal pain, hematuria, and dysuria. In some cases, complications such as bladder rupture, necrosis, and septic shock have been reported. Emphysematous cystitis has been associated with several predisposing medical conditions, such as diabetes mellitus, recurrent urinary tract infections, and immunosuppression, but can also infrequently present in an undifferentiated fashion without these aforementioned risk factors, such as in our patient's case. CASE REPORT We describe a rare case of emphysematous cystitis in a 67-year-old woman presenting to the Emergency Department with hematuria. The patient's presenting symptoms also included severe lower abdominal pain and dysuria. Examination revealed suprapubic tenderness and gross hematuria. Imaging revealed gas within the bladder lumen and throughout the bladder wall. Radiography showed concerns for emphysematous cystitis, without evidence of bladder fistula formation with adjacent bowel loops or cysto-vaginal fistula. After consultation with the Urology Department, the patient was admitted for serial examinations, intravenous antibiotics, and continued monitoring. The patient was discharged in good condition after a 3-day hospitalization. CONCLUSIONS Clinicians evaluating patients for acute urologic symptoms should be alert to the possible diagnosis of emphysematous cystitis, given the potential for deterioration and concomitant complications. Although our patient's presentation included no traditional risk factors for emphysematous cholecystitis, she required hospitalization to ensure progressive improvement. Therefore, prompt management along with appropriate consultation with specialists are crucial to mitigate the risk of adverse outcomes in this rare urologic emergency.

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

Emphysematous cystitis (EC) is a complicated urinary tract infection (UTI) characterized by gas formation within the bladder wall and lumen. Immunocompetent people are less likely to suffer from complicated UTIs, but EC usually occurs in women with poorly controlled diabetes mellitus (DM). Other risk factors of EC include recurrent UTI, neurogenic bladder disorder, blood supply disorders, and prolonged catheterization, but DM is still the most important of all aspects. Our study investigated clinical scores in predicting clinical outcomes of patients with EC. Our analysis is unique in predicting EC clinical outcomes by using scoring system performance. We retrospectively collected EC patient data from the electronic clinical database of Taichung Veterans General Hospital between January 2007 and December 2020. Urinary cultures and computerized tomography confirmed EC. In addition, we investigated the demographics, clinical characteristics, and laboratory data for analysis. Finally, we used a variety of clinical scoring systems as a predictor of clinical outcomes. A total of 35 patients had confirmed EC, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. Their hospital stay averaged 19.9 ± 15.5 days. The in-hospital mortality rate was 22.9%. The Mortality in Emergency Department Sepsis (MEDS) score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p = 0.005). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients was1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. Physicians must pay attention to high-risk patients according to clinical clues and arrange imaging studies as soon as possible to confirm the diagnosis of EC. MEDS and REMS are helpful for clinical staff in predicting the clinical outcome of EC patients. If EC patients feature higher scores of MEDS (≥12) and REMS (≥10), they will have higher mortality.

Clinical Outcomes and Risk Factor Analysis of Patients Presenting with Emphysematous Cystitis: A 15-Year Retrospective Multicenter Study.

Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52–100) vs. 70.0 (26.5) years (range: 28–97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251; 95% CI, 2.254–17.250; p < 0.001), CKD (OR, 18.439; 95% CI, 3.421–99.404; p = 0.001), NB (OR, 7.374; 95% CI, 1.993–27.285; p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.

Emphysematous cystitis: review of current literature, diagnosis and management challenges.

Emphysematous cystitis (EC) is a rare disease in human as well as in veterinary medicine; in both it is defined as an uncommon form of complicated urinary tract infection (UTI), characterized by the presence of gas within the bladder wall and lumen. While female dogs are at increased risk of developing an UTI, patients with EC are not subject to gender or age predisposition and may present with variable clinical manifestations. Diabetes mellitus (DM) appears as the most common risk factor for the development of EC, but many other underlying conditions have been mentioned in literature and should be taken into consideration. In case of EC, Escherichia coli appears to be the most common pathogen isolated from urine cultures. A conclusive diagnosis of EC requires necessarily the recourse to imaging methods, such as abdominal radiography and ultrasonography. An early diagnosis and appropriate medical therapy, consisting in protracted antibiotic treatment associated with control over underlying diseases, could lead to avoid surgical intervention.

Clinical, Laboratory and Ultrasonographic Findings of Diabetic Dog with Emphysematous Cystitis

Background: Emphysematous cystitis is a rare inflammatory disease of the lower urinary tract characterized by the accumulation of gas within the wall and lumen of the urinary bladder. The clinical manifestations of emphysematous cystitis resemble those of bacterial cystitis, often hindering the differentiation between the two. In this work, we report a case of emphysematous cystitis in a diabetic dog. The diagnosis of cystitis was followed by ultrasonography for the early detection of emphysematous cystitis, which showed the presence of multifocal and irregular hyperechoic interfaces forming a distal reverberation artifact. Case: A 9-year-old female dog was referred to VETCLINIC Veterinary Hospital 24 hours with a history of urinary incontinence, polydipsia, polyuria, and diabetes mellitus. At first, the blood glucose was measured and found to be 376 mg/dL. Blood count, biochemical measurements of alkaline phosphatase (AF), urea, creatinine, and alanine aminotransferase (AAT), urinalysis, urine culture with antimicrobial susceptibility testing, and abdominal ultrasonography were performed. The hematological exams showed that the serum was lipemic and with hemolysis; the values of AAT, AF, and total plasma proteins were above the reference values; hematocrit was below the normal level; erythrocyte rouleaux and thrombocytosis with platelet aggregates were present. Urinalysis showed the presence of traces of proteins, glucose, and occult blood as well as granular and hyaline cylinders and transitional epithelial cells. In urine culture, growth of the aerobic bacteria Klebsiella pneumoniae was observed, being sensitive to most of the antimicrobials. Ultrasonography showed the presence of gas in the wall of the urinary bladder, besides a discrete thickening of the wall, compatible with the diagnosis of emphysematous cystitis. Discussion: The first report of emphysematous cystitis in dogs was made in 1926 in a diabetic dog. Emphysematous cystitis is complicated, characterized by the presence of gas in the wall and lumen of the urinary bladder. It is usually reported in patients with diabetes mellitus. The patient presented with a very high glycemic index (376 mg/dL), in addition to having a history of urinary obstruction and presence of bladder stones, which may have acted as predisposing factors for the onset of emphysematous cystitis. In the present case, ultrasonography was the examination of choice. Hyperechoic reverberation-forming lines, identified as gas present in the topography of the urinary bladder, were easily visualized, as described in the literature. For the treatment of this condition, adequate management of the diet and the correct use of antimicrobials are of fundamental importance since the presence of diabetes mellitus in this patient can present serious complications in the future. This report shows the importance of the use of a combination of diagnostic tools to arrive at the correct diagnosis of the patient.

Single-Incision Plus One Port Laparoscopic Total Pelvic Exenteration After Neoadjuvant Chemotherapy for Advanced Primary Rectal Cancer: A Case Report

Limited data on laparoscopic and robotic total pelvic exenteration (TPE) for gynecologic, urologic, and rectal malignancies have been published in the literature. Single-incision laparoscopic surgery (SILS) has been successfully introduced for colon cancer. Here, we describe our experience of TPE with SILS + 1 port (SILS+1) for advanced rectal cancer. A 64-year-old man was referred to our hospital with anemia. Computed tomography (CT) revealed a rectal tumor that was contiguous with the seminal vesicle and bladder. Rectoscopy revealed an ulcerated, bleeding, and stricturing lesion in the rectum, which was defined as an adenocarcinoma with a moderate degree of differentiation on histologic examination. The patient received neoadjuvant chemotherapy using capecitabine, oxaliplatin, and bevacizumab. After 3 courses of chemotherapy, a rectovesical fistula was suspected from examination of CT images. CT demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. Thus, we constructed a transverse loop colostomy. Two months after the last administration of chemotherapy, we performed SILS+1 TPE. The procedure involved a 35-mm incision in the right side of the umbilicus for the insertion of a single multichannel port, and insertion of a 12-mm port into the right lower quadrant. Total operating time was 751 minutes, and estimated blood loss was 1100 mL (including urine). SILS+1 TPE is a technically promising alternative method for the treatment of selected patients with advanced rectal cancer.

Ultrasound Contribution to the Diagnosis of Emphysematous Cystitis

Emphysematous cystitis is a severe urinary tract infection which threatens patients’ life. Thus, it requires early diagnosis and computed tomography (CT) is the reference medical exam used to address it. However, ultrasound, which is a non-ionizing and very accessible technique, may also contribute to diagnosis. The aim of this study was to illustrate the contribution of ultrasound to the diagnosis of emphysematous cystitis. We report three cases of emphysematous cystitis diagnosed by ultrasound. In all the cases, ultrasound identified basic signs showing presence of gas, including a hyperechoic cystic parietal thickening, repeat echoes and dirty shadow cones of intraluminal focus. Diagnostic confirmation was made in two cases through X-ray and in one case by means of computed tomography. Through simple basic signs, ultrasound directs most usefully towards an emphysematous urinary tract infection. CT enables a more accurate diagnostic work-up of lesions and differential diagnosis with vesico-digestive fistula.

Emphysematous Cystitis and Pyelonephritis in a Nondiabetic Dog and a Diabetic CatS

Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are the result of infection of the urinary bladder and kidneys by gas-producing microorganisms. Those infections are most often reported in diabetic patients and rarely occur concurrently. This article describes two cases of concurrent EC and EPN, one in a nondiabetic dog and the other in a diabetic cat. The use of diagnostic imaging is necessary in the diagnosis of emphysematous infections. Both radiography and ultrasonography were used in the diagnosis of EC and EPN in the patients described in this report.

Emphysematous Cystitis: A Review of the Literature

Emphysematous cystitis (EC) is a rare form of complicated urinary tract infection, its characteristic feature being gas within the bladder wall and lumen. Patients with EC present with variable clinical manifestations ranging from asymptomatic to severe sepsis. EC is typically observed in elderly women with severe diabetes mellitus. Escherichia coli and Klebsiella pneumoniae are often isolated from urine cultures. Imaging methods, such as plain conventional abdominal radiography and computed tomography, are pivotal for obtaining a definitive diagnosis of EC. Most cases can be treated with a combination of antibiotics, bladder drainage and glycemic control. EC is potentially life-threatening, with a mortality rate of 7%. Early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention. In this review, we provide a comprehensive description of the clinical characteristics of EC.

A case of emphysematous cystitis diagnosed by exploratory laparotomy

Emphysematous cystitis is a rare form of infection. Well known symptoms are: dysuria, urinary frequency and lower abdominal pain. We experienced a case of emphysematous cystitis presented with atypical peritoneal sign and computed tomography findings of massive intra-peritoneal fluid collection and abnormal gas appearance in pelvic space. Due to its presentation as acute abdomen, patient underwent exploratory laparotomy and the diagnosis of emphysematous cystitis was established. As far as we know, our case is the first report of emphysematous cystitis with intra-peritoneal fluid collection.

Computed tomography scan in supine and prone positions: An alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment

To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

Emphysematous Cystitis with Diabetic Neurogenic Bladder

A 62-year-old diabetic woman suffering from high fever was admitted to our hospital. She had a lower abdominal phantom tumor and hyperglycemia. The results of urine analysis showed hematuria and bacteriuria. X-ray and computed tomography revealed gas accumulation in the wall of the bladder. Escherichia coli was identified in urine culture. On the basis of the lack of urine output and the identification of residual urine on catheterization, a diagnosis of emphysematous cystitis with diabetic neurogenic bladder was established. The patient recovered after discontinuation of urinary drainage, intensive insulin therapy, and antibiotic therapy.

Emphysematous cystitis: An unusual disease of the bladder diagnosed on imaging

Emphysematous cystitis (EC) is defined by the presence of gas in the urinary bladder wall. This rare disease entity is caused by gas fermenting bacterial and fungal pathogens. It complicates urinary tract infections especially in diabetic patients but other disabling general medical conditions may be present. Because the clinical symptoms are nonspecific, the diagnosis is often made incidentally on X-rays. Early diagnosis and treatment improve the outcome.We report a case of 83-year-old diabetic female who presented with fever, dysuria and gross hematuria. Ultrasonography and computed tomography revealed gas accumulation in the wall and lumen of the bladder leading to the diagnosis of emphysematous cystitis. She was treated with antibiotics, insulin, rehydratation and a Foley catheter placement.Diabetic patients with urinary tract infections who are severely ill should have radiological investigations to rule out the prsence of emphysematous complications.

Emphysematous cystitis

A 70-year-old poorly-controlled type 2 diabetic male presented with a 48-hour history of dysuria, frequency and frank haematuria. He described a 6-week history of worsening bladder outflow obstructive symptoms with nocturia and hesitancy. On examination he had a temperature of 37.5°C and tenderness in the left iliac fossa. Digital rectal examination revealed a tender, smoothly enlarged prostate gland. Blood glucose measurement was significantly elevated at 17 mmol/litre and serum white cell count was elevated at 19×109/litre, demonstrating a marked neutrophilia. A plain film of the abdomen demonstrated the presence of a well-defined area of lucency in the region of the bladder suggestive of air within the bladder wall. A large lucent area was also noted in the left lower quadrant suggestive of a large bladder diverticulum distended with air (Figure 1). Based on these findings, a diagnosis of emphysematous cystitis was considered likely and the patient was commenced on broad-spectrum intravenous antibiotics, intravenous fluids and subcutaneous insulin sliding scale. Subsequent computed tomography of his abdomen and pelvis with intravenous and oral contrast confirmed the presence of emphysematous cystitis with a markedly abnormal, thick-walled bladder as well as air within the bladder wall (Figure 2). The large lucency seen in the left lower quadrant on plain film was shown on computed tomography to represent a 9.7 cm bladder diverticulum, also containing air within its wall (Figure 3). There was no evidence of a colovesical fistula. Urine culture demonstrated a significant growth of Escherichia coli. His clinical course was uneventful and he was discharged home well 7 days later on oral antibiotics for a total of 14 days. He is due for further investigation of his lower urinary tract symptoms with cystoscopy.