CHRONIC CYSTITIS – DIAGNOSIS

DIAGNOSING CHRONIC CYSTITIS

In addition to the symptoms of chronic cystitis mentioned in a the respective section of this page, the doctor needs to perform a number of laboratory tests to further investigate and objectively evaluate the condition.

Laboratory tests

Tests with urinalysis films: In some cases only, qualitative analyzes using 10 simple urinalysis parameters strips in recent urine, may show signs of blood and inflammation.

Urinalysis: Not usually chronic inflammations particular value, but sometimes useful conclusions can be drawn from coexisting diseases or any complications.

Urine crops: there are few cases, perhaps not more than 20%, where the microbial agent can emerge, and this usually happens when moderate or severe urinary symptoms coexist. In cases of random urine sample used for the crops (when there are vaginitis and we want to see whether the infection exists or has diffused into the bladder), there can rarely microbes be found  no matter the degree of presence of chronic inflammation in the bladder. In this case  we need to resort to another test, which is performed by the urologist which is the ourithrokysteoskopisi..

Vaginal fluid crops: the vagina is a rather easy environment for microbial colonization, which depending on the virulence properties they have, apart from easily causing a local inflammation they can enter the urethra and the bladder. Finding the bacteria in the vagina, often leads to the determination of the causative agent of chronic cystitis. It should be emphasized that the vaginal fluid’s crops are specialized and their specific evaluation protocol must be kept by the microbiologist, because of what I’ve seen in my experience is that their results in many cases are  from partly to completely untrue.

Period tissue culture:  it is a very important and necessary test to show whether microbes have entered the endometrium, especially when the vaginal fluid culture shows quite intense inflammation, except of finding microbial agent, the number of pyosfairion is great.From my own experience a severe inflammation of the vagina, possibly indicates simultaneous existance of microbial agents in more than 30% in the endometrium or even at the fallopian tubes. This situation requires in most cases, except of the standard oral treatment, special medical treatment (in many cases intravenous delivery of the drugs). The situation mandates the eradication of the microbial agent from the endometrium, because it is a severe reason for an early termination of the pregnancy, especially in the first month.Ultrasonic testing: For those who know exactly what they should assess of the urogenital system, is a valuable tool because it shows many elements that coexist or are side effects of this chronic disease (cystitis). Through this test, the functional bladder capacity or malfunctions of the urination mechanism caused by the inflammation or other complications, the existence of potential intramural lesions (e.g. tumor) and the existence of possible gritty, is evaluated.

Radiological control: Necessary in some cases where it requires differential diagnosis of the problem mainly by the use of intravenous pyelography with cystography. Also in a few cases using the CT scan is considered necessary for differential diagnosis in either intramural or exocystic problems that can coexist.

Figures 1 & 2: Intravenous pyelography with cystography in lateral and upright receiving, showing contrast filling shortage in the base and a deformation of the shape of the bladder, with a”pear” display type, which proved to be glandular cystitis with a concomitant pelvis lipomatosis.

Urometric test: In several cases it shows problems that are causes or complications of the disease (chronic cystitis) and it certainly is a helpful examination. There are more than a few cases where postinflammatory urethral stricture, maintain and increase the frequency of relapses.

Uretrhrocystoscopy: It consists the main examination in diseases of the urinary bladder, since you can directly visually and in magnification come in contact with the problem and you can diagnose the type of the disease, the extent of the inflamed area, the chronicity of the problem and to evaluate the type of treatment which must be applied and for how long.

Figure 3: Input of the cystoscope into the bladder.

Cystoscopy, is a painless examination that is done using a local anesthetic (gel) applied to the urethra. Then the cystoscope is inserted, which consists of a thin metal tube, through which the magnifying lens pasees, which is connected to a specific source light beam emission, so that the optical image obtained is clear and detailed. The equipment of the cystoscopes and the special high technology light beam sources, create the conditions necessary for proper evaluation.

The experience of the urologist is a prerequisite for the proper evaluation of the inflammation. The lesions may be either limited or cover almost the entire cystic wall and in some cases they require a differential diagnosis, since other malignant lesions may be concealed. If during the examination there are  differential diagnosis problems highlighted, at the same time there is tissue sampling made from the suspicious areas, in order to histologically make the diagnosis.

Here are some forms of chronic cystitis according to the cystoscopic appearance such as:

Figure 4: Various forms of chronic cystitis with cystoscopic similar appearance as membranous kystitida- trigonitis, cystic cystitis, glandular cystitis, erythematous crystalline calcifications, gnarly cystitis, lupus cystitis.

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