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Kranz J, Bartoletti R, Bruyère F, et al. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol. 2024 Jul;86(1):27-41. doi: 10.1016/j.eururo.2024.03.035. Epub 2024 May 6. PMID: 38714379.
Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68(10):e83-e110. doi: 10.1093/cid/ciy1121. PMID: 30895288.
Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. doi: 10.1093/cid/ciq257. Review. PMID: 21292654.
Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010 Mar 1;50(5):625-63. PMID: 20175247.
Definition, Etiology, PathogenesisTop
Nonbacterial cystitis refers to a range of signs and symptoms typical for infectious cystitis, which affect women of childbearing age. Routine microbiologic studies do not reveal the presence of any uropathogens. Some cases of nonbacterial cystitis are caused by viruses (herpes simplex virus type 1 or type 2, BK polyomavirus, cytomegalovirus, and adenovirus), chlamydia (Chlamydia trachomatis), fungal infection (see Candiduria), or mycobacteria. Cystitis may also be a complication of prior pelvic irradiation or cancer chemotherapy or a manifestation of autoimmune diseases. In the remaining cases, the etiology remains unknown, and such patients are usually diagnosed with interstitial cystitis on the basis of cystoscopy and urodynamic tests. Spontaneous resolution of signs and symptoms over time is frequently observed.
TreatmentTop
1. Infectious etiology: Appropriate antimicrobial treatment based on microbiologic testing, including polymerase chain reaction (PCR) for viruses and chlamydial infection.
2. Noninfectious etiology: Treat the underlying disease (eg, autoimmune disease), consider symptomatic treatment, or both. Symptomatic treatment: oral pentosan polysulfate sodium 100 mg tid, oral oxybutynin 5 mg bid or tid, oral hydroxyzine 10 to 50 mg/d, oral amitriptyline 25 mg bid or tid, and behavioral therapy. A recent trial among women with moderate to severe refractory interstitial cystitis/bladder pain syndrome suggested a benefit of certolizumab pegol, an anti–tumor necrosis factor (TNF)-alpha agent used in the treatment of rheumatoid diseases; such treatment may be tried in selected patients in a specialized setting.Evidence 1Moderate Quality of Evidence (moderate confidence that we know true effects of the intervention). Quality of Evidence lowered due to a short follow-up and imprecision (small number of patients). Bosch PC. A Randomized, Double-blind, Placebo-controlled Trial of Certolizumab Pegol in Women with Refractory Interstitial Cystitis/Bladder Pain Syndrome. Eur Urol. 2018 Nov;74(5):623-630. doi: 10.1016/j.eururo.2018.07.026. Epub 2018 Jul 30. PMID: 30072210.
