Medication: in order to follow an organized medication which usually includes combinations of therapeutic substances, taking into account everything mentioned in the previous sections (i.e. Condition & Symptoms) is necessary:

• Germs that have been reported but also potential infectious microorganisms that may exist, but which could not be identified in urine and vaginal fluid crops.

• The severity of lesions detected in the urethra, bladder, vagina, cervix and uterus.

• The existence of complications accompanying the inflammations (urethral stricture or malfunctions in the urination mechanism).

• The chronicity of the inflammations depending on the patient’s history.

The conservative medication’s  duration can last from 1 to 3 months, without excluding the need for further treatment (up to 9 months). In addition to the antimicrobial therapy to combat chronic cystitis, there can be used medicines that are related to the reduction of some intensive discomfort such as frequent and urgent urination or intrusive actions associated with the treatment of some complications such as the narrowing of the urethra.

Georgiadis Protocol (Chronic Cystitis)

Intravesical Instillations Therapy:  Intravesical instillations are a necessity in most cases of chronic cystitis, since the cystic lesions are chronic and highly resistant to treatment with oral medications. As such, the use of specific medicinal substances in mixtures at appropriate concentrations have proven to have extremely good therapeutic effects.  This approach significantly improves or even completely cures in many cases, even the most difficult situations of persistent and extremely annoying for the everyday life symptoms.

Figure 1: Chronic membranous cystitis in resolution after a series of intravesical infusions.

The intravesical therapy is an easy and painless method which is achieved by the input of a narrow band disposable catheter into the bladder, through which the pharmaceutical mixture is injected. The drugs should remain in the bladder for about two (2) hours and then be removed naturally by urinating. The results of the intravesical therapy are considered absolutely positive in percentage more than 92% of all patients. Their application frequency varies according to the intravesical lesions and usually comprises a basic stage with a greater or lesser number of continuous infusions every second day followed by the stages of monthly circles, usually completed in three to six therapy circles.

Intravaginal treatment: the coexistence of a microbial infection in the vagina is very common (rates exceeding 70%) and should be treated simultaneously. In case it doesn’t recede with the normal oral  antifungal medication, intravaginal ointments are applied. These are made with mixtures of appropriate antimicrobials in vaginal creams, in order to achieve increased concentrations of drug in the vaginal area and uterus, especially in cases where the germs have penetrated there too.

Urethral Dilations: Are performed in the cases of coexistant urethral stricture as functional side effect or organic complication of the chronic inflammation of the urethra and bladder. The stricture after its formation, makes the disease very difficult to cure, if it is not recognized and treated on time. The urethral dilations are a conservative surgical intervention using local anesthesia and are very well tolerated by patients with chronic cystitis.

Transurethral endoscopic electrocautery: In a few but very difficult cases (a rate not exceeding 20%) with a history of many years and with lesions highly resistant to the aforementioned confrontation (with intravesical infusions), we recourse to the cauterization of the lesions, simultaneously with the antimicrobial treatment. This is accomplished by using either the transurethral electrocautery device  or sometimes as an alternative solution the neodymium (Nd): YAG laser side emission, with healing results at a rate of almost 96% of all patients suffering from chronic cystitis, about three months later from the surgery.

Immunoprophylaxis: Using antimicrobial vaccines, there are a small number of patients with moderate improvement in 2 main parts. Specifically there was a slight decrease in the power of the ailments, as well as an increase of the interval of the recessionary phases of the disease. However, the patients did not  appear to be very satisfied since the symptoms remain in a significantly disturbing extent, even after the continuous intake of the pharmaceutical preparation for a long time. Thus it can be used or suggested by some gynecologists or urologists, but the results do not seem to justify their use.

Chemoprevention: Taking antimicrobial drugs in small doses for very long periods of time, in order to maintain a state of remission or low intensity symptoms (in order to prevent the frequent occurrence of periods of exacerbation of the disease), does not seem to produce the expected results in the infection. In most cases, especially in patients with an extended history (at least over 2-3 years), the appearance of the infection (chronic cystitis) does not bring any practical effect. Instead I would say that it probably results in negative effects after having partially cover the symptoms without inhibiting the development and progressive burden of inflammation, both in the expansion of damage and its complications and also generates reactive resistance mechanisms to infectious organisms, making it persistent to even the most powerful antibiotics. It is something I have come through in a significant number of patients, which had received for several years – possibly over 6-10 years – different treatments either of chemoprevention or treatments with powerful antibiotics, in order to cope with recurrent acute inflammatory conditions (recurrent symptoms of chronic cystitis after full clinical resolution  of a previous episode and despite the appropriate treatment) with intense discomfort in the bladder. This way several highly virulent microorganisms such as Enterococci, Staphylococci but mainly Chlamydia became very resistant even to the most powerful antibiotics and much more time was needed, with all that this implies in a psychological burden, until their final recovery.

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