Emphysematous cystitis

Background

Microbiology

• Escherichia coli (most common)
• Klebsiella pneumonia
• Also Proteus, Enterococcus, Pseudomonas, Clostridium, and rarely Candida

Risk Factors

• Diabetes mellitus (60-70% of patients)
• Urinary tract obstruction
• Women

Clinical Manifestations

• Mostly in older women with diabetes
• Abdominal pain is most common symptom
• About half have classic signs of cystitis
• May have pneumaturia after bladder catheterization
• Urinalysis shows pyuria and hematuria with positive cultures

Differential Diagnosis

• Air within the bladder wall may occur from gastrointestinal fistulas

Diagnosis

• Usually made radiographically on X-ray or CT

Management

• Often managed medically with antibiotics
• Duration depends on clinical response, but usually 7 to 14 days
• May need bladder irrigation if blood clots, or catheterization if difficulty voiding
• Rarely needs surgical intervention for debridement or cystectomy