Cystitis Cystica in Children

Infections of the urinary tract are the second frequent among all bacterial infections in the pediatric population.

Recurrent infections lead to chronic inflammatory changes. If the symptoms of cystitis last for more than 2-3 weeks or recurrences appear after a short period of remission, chronic cystitis may be assumed. The most common form of chronic inflammation in children is cystitis cystica, diagnosed in approximately 10% of patients with urinary tract infections, with a definite female predominance (80%).

Macroscopically, in the endoscopic examination small cysts of pearl, pink, brown or yellow color are found. The lesions are usually located in the area of the bladder triangle, neck and around the ureteral mouth, but they can occupy the entire surface of the bladder, and are rarely described in the ureter and pelvis. The bladder wall trabeculation, swelling and congestion of the mucous membrane, incorrect location and widening of the the ureters orifices are often found.

The pathogenesis of the disease is unclear.

The most frequently isolated inflammatory agent is E.coli, and other Gram-negative bacteria: Pseudomonas, Klebsiella, Enterobacter and others.

According to some authors, cystitis cystica is considered a precancerous condition.

Clinically, the inflammation may be asymptomatic or proceed in the form of active infection. Chronic inflammation can lead to urinary incontinence, urgency, pollakiuria, dysuria and even urinary retention.

In urodynamic studies, a decrease in the volume of urine given per portion in relation to the expected values, irregular curves of tubular flows, their flatness, residual urine after micturition, are observed, which is the cause of subsequent infections.

Treatment of cystitis cystitis is difficult and long-lasting. A multi-month alternation treatment with furazidine and trimethoprim with sulphamethoxazole administered orally and intravesical instillations of antibiotics (gentamicin) and corticosteroids (prednisone) are applied. The results of treatment depend on the severity of changes in the bladder, and full recovery is obtained only in the case of lesions of low and medium intensity.

The authors present their own experience regarding the diagnosis and treatment of patients with cystitis cystica.