Emphysematous Cystitis (EC): Symptoms & Treatment

Instructor: Artem Cheprasov
Emphysematous cystitis is a rare and serious urinary tract condition. You'll learn what it is, what it's caused by, whom it is most likely to affect, and the signs, symptoms, and treatment options for it as well.

What is Emphysematous Cystitis?

Do you know what a mural is? It's a painting, but with a wall as its canvas so to speak. So when we say something is intramural, we mean it occurs within ('intra-') a wall. This will help you better understand the definition of emphysematous cystitis, an infection of the bladder by gas producing microorganisms (namely bacteria) that is characterized by the presence of intramural gas. That is to say, gas within the bladder wall.

Emphysema refers to the pathologic (abnormal) accumulation of gas in an organ or tissue. 'Cyst-' means bladder and '-itis' refers to inflammation.

Let's learn about this condition's signs, symptoms and potential treatment options.

Signs & Symptoms

Among other potential signs, especially in severe cases, a person with emphysematous cystitis may have any of the following signs and symptoms alone or in combination:

  • Pyrexia, or fever. Chills are possible as well.
  • Dysuria, difficult or painful urination, where 'dys-' refers to something difficult or bad. People might describe a burning sensation while urinating.
  • Increased urinary frequency/urgency
  • Gross hematuria, blood ('hemato-') in the urine that is visible to the naked eye
  • Abdominal pain

The problem is, all of the above are not by themselves diagnostic or specifically indicative of emphysematous cystitis. So the most important sign that can be gleaned in this condition comes from radiographic studies, like x-rays or a CT scan. These will reveal:

  • Intraluminal gas. Gas in the bladder wall.
  • Sometimes (not always), intraluminal gas. This is gas within the lumen of the bladder. The lumen is the empty space where urine accumulates in the bladder. It's like the empty space enclosed by a balloon.

The gas may appear curvilinear, mottled, like bubbles/cobblestones, or like a beaded necklace on radiographic imaging.

The bladder is centrally located in this image. Not the black mottled appearance indicating gas.
b

Treatment

The most common infectious agent responsible for emphysematous cystitis is a bacterium known as E. coli. Thus, antibiotics, drugs that kill or prohibit the growth of bacteria must be used to treat this condition. Some possible antibiotics used to treat emphysematous cystitis include:

  • Gentamicin
  • Piperacillin/tazobactam
  • Ciprofloxacin

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