Chronic bacterial cystitis often results from the progression or migration of acute upper urinary tract infections or the presence of chronic infections. It may also be triggered by or secondary to certain lower urinary tract conditions, such as benign prostatic hyperplasia, chronic prostatitis, urethral stricture, bladder stones or foreign bodies, urethral hymenal fusion, hymenal hood, or periurethral gland inflammation.
Pathology
The bladder mucosa may appear pale and thinned or thickened and occasionally shows granular or small cyst-like changes, with ulcers observed in rare cases. Microscopically, the lamina propria may exhibit extensive infiltration of plasma cells and lymphocytes along with connective tissue hyperplasia. When the inflammation involves the muscular layer, leading to fibrosis of the detrusor muscle, the bladder capacity may become reduced.
Clinical Manifestations
Symptoms primarily include recurrent or persistent urinary frequency, urgency, and dysuria. Discomfort in the suprapubic bladder region is often present, and pain becomes more pronounced when the bladder is full.
Diagnosis
Diagnosis is generally straightforward based on medical history and clinical presentation, but identifying the underlying cause of recurrent or persistent symptoms is critical for effective treatment. In male patients, a rectal examination may help assess for prostate abnormalities, while examination of the scrotum, penis, and urethral meatus is essential to exclude reproductive, urethral, or stone-related pathologies. In female patients, examination of the external urethral meatus and hymen can help identify abnormalities, and further evaluation may reveal cervicitis, vaginitis, or vestibular gland inflammation. Conditions such as diabetes or immunodeficiency should also be considered.
Urine sediment analysis may reveal a small number of white blood cells, occasionally accompanied by red blood cells. Urine culture may yield positive results. When repeated midstream urine cultures are negative, differentiation from urinary tuberculosis should be considered.
Imaging such as ultrasound, CT scans, or excretory urography may be useful for detecting urinary tract abnormalities, stones, or tumors. During cystoscopy, findings may include pyuria, purulent exudates, or mucosal changes such as congestion or edema. Diverticula, stones, foreign bodies, or tumors may also be observed. Certain conditions, including glandular cystitis, interstitial cystitis, and carcinoma in situ of the bladder, can present with recurrent irritative bladder symptoms and may be difficult to distinguish from chronic cystitis. Cystoscopy and histopathological examination of bladder biopsies greatly aid in making a definitive diagnosis.
Treatment
Antimicrobial therapy is employed, along with ensuring unobstructed urine flow and addressing the underlying causes of urinary tract infections. When necessary, surgical interventions, such as hymenoplasty, may be required to correct contributing factors. Patients with prolonged disease duration or weakened immune systems may benefit from enhanced systemic supportive therapy.