Chronic Cystitis – Therapy
How to treat Chronic Cystitis?
It is necessary to organise the medication which usually includes combinations of therapeutic substances. We should take into account everything mentioned in the previous sections (i.e. Condition & Symptoms) such us:
- Germs that we have found but also potential infectious microorganisms that may exist. Not all of them could be identified in urine and vaginal fluid cultures.
- 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. Sometimes we can’t exclude the need for further treatment (up to 9 months). In addition to the antimicrobial therapy to combat chronic cystitis, we can use medicines that are related to the reduction of some intensive symptoms. We may decrease 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 Chronic Cystitis Protocol (GCCP)
Intravesical Instillations Therapy
Intravesical instillations are a necessity in most cases of chronic cystitis. The long-standing bladder lesions are highly resistant to treatment with oral medications. 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. It is effective even to 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. Usually comprises a basic stage with a greater or lesser number of continuous infusions. Then we follow monthly therapeutic instillations, usually completed in three to six therapy circles.
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 usual oral medication, intravaginal ointments are applied. We make these with mixtures of appropriate antimicrobials in vaginal creams. Thus, achieve increased concentrations of drug in the vaginal area and uterus, especially in cases where the germs have penetrated there too.
We perform them in the cases of coexistent urethral stricture as functional 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 conservative surgical interventions using local anesthesia and are very well tolerated by patients with chronic cystitis.
Transurethral endoscopic electrocautery
Some very difficult cases (a rate not exceeding 20%) have a history of many years and lesions highly resistant to intravesical infusions. In these cases, we recourse to the cauterization of the lesions, simultaneously with the antimicrobial treatment. This is accomplished by using the transurethral electrocautery device. As an alternative solution we can use the neodymium (Nd): YAG laser side emission. The healing results are very encouraging, especially after an initial treatment with intravesical instillations. The cure rate is almost 96% of all patients suffering from chronic cystitis, about three months after surgery.
Using antimicrobial vaccines, there are a small number of patients with moderate improvement in two 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, the prophylactic outcome remains poor. Thus, it can be used or suggested by some gynecologists or urologists, but the results do not seem to justify their use.
Taking antimicrobial drugs in small doses for very long periods of time,
- in order to maintain a state of remission or
- to lower intensity of the symptoms or
- to prevent the frequent occurrence of periods of exacerbation of the disease,
does not seem to produce the expected results in the infection management. In most cases, especially in patients with an extended history (at least over 2-3 years), 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. They had received for several years – possibly over 6-10 years – different treatments either of chemoprevention or treatments with powerful antibiotics. Their intension was to cope with recurrent acute inflammatory conditions- recurrent symptoms of chronic cystitis- after full clinical resolution of a previous episode. This way led several highly virulent microorganisms such as:
- E coli
- Chlamydia and many others,
to become very resistant even to the most powerful antibiotics and much more time was needed, until their final recovery, with all that this implies in a psychological burden.