Dr. P. GEORGIADIS

Surgeon Urologist - Andrologist
Greek English




The symptoms

Clinical signs

 

  • Frequent urination: in most cases is the sole or the predominant symptom hardly recognized by the patient because the increasing frequency of urination rises slowly and gradually, so that it is almost "customary" as a normal condition. Thus, the 3-4 times that are normal to someone urinating throughout the day may become a lot more (eg, 6-9 times daily), without understanding that this is a problem. It sure is an abnormal situation and wants attention. The patient suffering from chronic cystitis is specifically trying to '' get adapted '' to this situation, learning to do certain actions such as,
    - Going to urinate before leaving home to avoid getting forced to desperately look for where to urinate while being outdoors,
    - Looking to find directly where the toilets are when in another room,
    - Sitting in the outer seats in the rows of seats in the theater or cinema in order to have easy access to toilets, or also
    - When traveling trying to make several stops in between to urinate.

     

     

  • Burning urination: (burning sensation during urination) is a symptom that usually refers to what we all call urinary tract infection, but is often transient and perhaps relatively moderate or sometimes appears at times that we have the impression that perhaps a small stone passed or that it is not something to worry about. In the condition downturns it usually doesn't exist. Attention should be paid at this ailment. I have encountered women who had arrived in a state of intense psychosomatic disorders because of the intensity and persistence of this discomfort, especially when they had undergone multiple drug therapies to no avail.

     

     

  • Turbidity urine and repulsive smell: it is a phenomenon which is often mentioned by the patients. The observation of the loss of clarity of the urine with the simultaneous presence of a relatively strong and in many cases repellent odor of urine, are elements which indicate the likelihood of urinary tract infection.

     

     

  • Urgent urination: these are those moments where the patient feels a very strong up to an irresistible urge to urinate without being able to control it, except for a minimum time. At that time she has the feeling that if she doesn't find the toilet in order to urinate immediately, it is possible to even have loss of urine. It does not appear in all cases, but when it exists it denotes the chronicity of the disease and that the bladder wall has suffered severe inflammation and wants the appropriate attention for its identification.

     

     

  • Urgent incontinence: Feeling sometimes very intensely the need to urinate, the patient doesn't have the time to get to the toilet and has loss of a few drops or a much larger quantity of urine. It is a very aggravating symptom for the psychological balance and quality of life of the patient and usually occurs in advanced cases, with great history of urinary infections.

     

     

  • Hematuria: This may be microscopic (ie. Only after urinalysis erythrocytes found) or in other cases, visual, meaning that the color of urine is made by deep dark until light red, usually when we have sharp or acute recurrent infection. It is a symptom (of chronic cystitis) which usually causes extreme anxiety, but in most cases coexists with one or more of the other symptoms and usually shows the area of origin and the cause of the provocation.

     

     

  • Feeling of incomplete emptying: it has to do with the feeling of abidance of urine quantity after the urination. It feels as we are not sure if our bladder is completely emptied. In some cases we feel the need to stick to the bathroom or to go back very quickly in order to empty the remaining urine amount that we feel that remained in the bladder.

     

     

  • Suprapubic pain: is the sensation of pressure or tightness or even pain low in the abdomen, which is usually getting very intense when we feel that we have a lot of urine. The intensity of the pain may go away for a while after urination and after some time appears again, increasing in strength over time until they force us to go back to urinate.

     

     

  • Feeling of Lumbar weight or pain: small or moderate pain which occurs in the region that we believe are the kidneys, accompanied in several situations of chronic cystitis, though usually confused with pain supposedly from the waist (ie. We possibly think that the problem is located in the spine, especially when the pain or the numbness is reflected to the legs) or think there may be something in the kidneys (ie. potentially stones or microcrystals what everyone calls gravel) or a disease of the intestines or the gall bladder. Particular attention to this symptom is needed as there are not a few occasions it requires differential diagnosis

     

     

  • Atypical Gastrointestinal discomfort: more than a few times when a sense of flatulence (bloating) in the abdomen or constipation without clear justification is found, while checking the gastrointestinal system (eg gastroscopy or colonoscopy), due to a disease of the bladder and is many often incorrectly diagnosed as irritable bowel.

     

     

  • Genital system symptoms: genital system is directly related to the urinary in women, that's why infections in the vagina, the cervix and the uterus, most often cause a problem in the urethra and the bladder. Particular attention should be paid to,
    - The recurrent fungal vaginitis, which are generally accompanied by other infections in the vaginal mucosa
    - In any liquid from the vagina more in quantity and of different smell than usual,
    - Itching on the lips of the vulva or inside the vagina
    - Severe pain during menstruation (period)  when taking medication (anticonvulsant or anti-inflammatory) is necessary for the reduction,
    - Pain feeling (dyspareunia) in the genital area during or immediately after sexual intercourse.

     

Generally what you should know is the fact that infections in the genital system, are accompanied by more than 80% of urinary system infections, particularly in the bladder, and they should be treated at the same time in order to be given a definitive solution to the problem.

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 3 and 4. 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 5. 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 :

Membranous cystitis


  • Erythematous crystalline calcifications

  • Glandular cystitis
Cystic cystitis

Gnarly cystitis

Lupus cystitis
 
Figures 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17. Various forms of chronic cystitis with cystoscopic similar appearance as membranous kystitida- trigonitis, cystic cystitis, glandular cystitis, erythematous crystalline calcifications, gnarly cystitis, lupus cystitis.