Definition, Etiology, PathogenesisTop
Nonbacterial cystitis refers to a range of signs and symptoms typical for infectious cystitis, which affect women of childbearing age. Routine microbiological 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.
1. Infectious etiology: Appropriate antimicrobial treatment based on microbiological 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 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 Jul 30. pii: S0302-2838(18)30548-7. doi: 10.1016/j.eururo.2018.07.026. [Epub ahead of print] PubMed PMID: 30072210.