Cystitis disorders

Urinary tract infection (UTI) is an infection caused by pathogenic microorganisms of one or more structures of the urinary tract. The most common structure affected is the bladder, with the urethra, prostate, and kidney also affected (see Pig. 47-1). Display 47-1 identifies the disorder most frequently associated with each of these structures within the urinary system. Clinical manifestations of a UTI of the bladder (cystitis) include urgency, frequency, burning and pain on urination, and pain caused by spasm in the region of the bladder and the suprapubic area. 

Glucocorticoids are also used in the treatment of a number of HIV-related disorders, including Pneumocystis carinii pneumonia, demyelinating peripheral neuropathies, tuberculous meningitis, and nephropathy. Glucocorticoids are used as adjunctive therapy in Pneumo cystitis carinii pneumonia to decrease the inflammatory response and allow time for antimicrobial agents to exert their effects. In patients who are immunocompromised because of HIV infection, adjunctive steroids may be less beneficial in promoting survival. 

Atropine and other antimuscarinic drugs have been used to provide symptomatic relief in the treatment of urinary urgency caused by minor inflammatory bladder disorders (Table 8-3). However, specific antimicrobial therapy is essential in bacterial cystitis. In the human urinary bladder, M2 and M3 receptors are expressed predominantly with the M3 subtype mediating direct activation of contraction. As in intestinal smooth muscle, the M2 subtype appears to act indirectly by inhibiting relaxation by norepinephrine and epinephrine. 

Saw palmetto is known to have diuretic, urinary antiseptic, endocrinological, and anabolic properties. Traditionally, it is used for chronic or subacute cystitis, catarrh of the genitourinary tract, testicular atrophy, sex hormone disorders, and specifically for prostatic enlargement. 

Atropine and other antimuscarinic drugs have been used to provide symptomatic relief in the treatment of urinary urgency caused by minor inflammatory bladder disorders (Table 8-3). However, specific antimicrobial therapy is essential in bacterial cystitis. 

Upper renal tract disorders with ureteric reflux and bilateral hydronephrosis has been briefly reported in a patient with a history of cyclophosphamide-induced cystitis (SEDA-22, 410 11). 

A 33-year-old man developed myalgia and rhabdomyo-lysis while taking norfloxacin for cystitis. He complained of general muscle fatigue, tendon disorders, and articular pain. When norfloxacin was withdrawn, his symptoms abated, with persistence of shght myalgia for 10 days. 

If this complication occurs, the drug should be withdrawn immediately (7). A report has given some data on the frequency with which tiaprofenic acid cystitis-related disorders were reported to the UK s Committee on Safety of Medicines. Between 1981 and 1996, 770 adverse drug reactions involving 221 patients were reported. A peak in the reporting of cystitis was noted in 1994, when tiaprofenic acid product information was changed and advice was sent to UK doctors warning about cystitis-related... 

Included in the FDA Inactive Ingredients Guide (IV infusions, SC implants, and topical preparations). Available in the USA as a 50% solution for irrigation in the treatment of interstitial cystitis. Also available in Canada as a 70% solution for use as a topical antifibrotic and in Germany as a topical gel containing 10% dimethyl sulfoxide for the treatment of musculoskeletal and joint disorders. Included in topical formulations of idoxuridine and diclofenac licensed in the UK. 

A 2.16% dimethyl sulfoxide solution in water is iso-osmotic with serum. Dimethyl sulfoxide has been used as a 50% aqueous solution for instillation into the bladder in the treatment of interstitial cystitis it has also been tried clinically for a wide range of indications, including cutaneous and musculoskeletal disorders, but with little evidence of beneficial effects. 

The lower urinary tract consists of the bladder, urethra, urinary or urethral sphincter, and the surrounding musculofascial structures including connective tissue, nerves, and blood vessels. The urinary bladder is a hollow organ composed of smooth muscle and connective tissue located deep in the bony pelvis in men and women. The urethra is a hollow tube that acts as a conduit for urine flow out of the bladder. The interior surface of both the bladder and urethra is lined by an epithelial cell layer termed transitional epithelium, which is in constant contact with urine. Previously considered inert and inactive, transitional epithelium may actually play an active role in the pathophysiology of many lower urinary tract disorders, including interstitial cystitis and UI. The urinary or urethral sphincter is a combination of smooth and striated muscle within and surrounding the most proximal portion of the urethra adjacent to the bladder in both men and women. This is a functional but not anatomic sphincter that includes a portion of the bladder neck or outlet as well as the proximal urethra. 

Cyclophosphamide Myelosuppression, myeloproliferative disorders, malignancy, immunosuppression, hemorrhagic cystitis, secondary infertility CBC and differential and platelet count, urinalysis Symptoms of myelosuppression, hematuria, infertility CBC and urinalysis monthly, urine cytology and Pap test yearly for life... 

Flavoxate is a urinary tract and spasmodic/alicalinizer, which counteracts smooth-muscle spasms of urinary tract. It is indicated in symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency and incontinence associated with cystitis, prostatitis, urethritis, urethrocysti-tis/urethrotrigonitis. Flavoxate, a flavone derivative and urinary tract spasmolytic (100 to 200 mg p.o. t.i.d.), is used in the symptomatic relief of dysuria, frequency, urgency, nocturia, incontinence, and suprapubic pain associated with urologic, disorders. 

CHRONIC HEALTH RISKS secondary anemia hemolysis acute cystitis acute liver disorders kidney damage possibly cancerous. 

Cyclo- phosphamide (e.g., Cytoxan) PRODRUG is converted by liver to an alkylating agent which crosslinks DNA. Proliferation of B-cells is inhibited more than T-cells. May also attack immunocompetent lymphocytes to inhibit established immune respones. Drug of choice for Wegener s granulomatosis. Also used for severe rheumatoid arthritis autoimmune blood disorders. Alopecia, Gl distress, hemorrhagic cystitis of the bladder, bone marrow depression. 

Exposure Routes, Symptoms, Target Oigans (see Table 5) ER Inh, Abs, Ing, Con SY Hema secondary anemia from hemolysis acute cystitis acute liver disorders derm painful, irreg urination [care] TO Bladder, skin, kidneys, liver, blood [liver, kidney bladder cancer] First Aid (see Table 6) Eye Irr immed Skin Soap wash immed Breath Resp support Swallow Medical attention immed ... 

Enveloping, restorative, febrifuge, diuretic, antispasmodic, hypotensive, and uterine contraceptive. Impotence, menstrual disorders, cystitis, enterocolitis, atonic constipation... 

---