Meria P, Desgrippes A, Arfi C, Le Duc A
Department of Urology, Hôpital Saint-Louis, Paris, France.
J Urol. 1998 Jul;160(1):3-9.
Encrusted cystitis and pyelitis are chronic inflammations of the bladder and collecting system associated with mucosal encrustations induced by urea splitting bacteria. We review these infectious diseases.
A literature search was performed of the MEDLINE database from 1985 to 1997. Additional articles published before 1985 were also selectively included.
Most of the articles were case reports or short series. During the last 10 years increasing numbers of cases have been diagnosed, especially in immunodepressed patients, and particularly in renal transplant recipients. Many bacteria have been demonstrated in this infection but Corynebacterium group D2 is currently the most frequent. The development of encrusted cystitis or pyelitis requires the presence of specific bacteria with an alkaline urine, a preexisting urological procedure and a clinical context predisposing to infection. Clinical diagnosis can be difficult but the presence of alkaline urine containing abundant calcified mucopurulent debris is highly suggestive. Demonstration of the bacteria requires prolonged cultures in enriched media. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The consequences of treatment failure are serious and can result in graft nephrectomy in kidney transplant recipients.
Early clinical and bacterial diagnosis of encrusted cystitis and pyelitis could improve the prognosis of these infectious diseases.
结痂性膀胱炎和肾盂炎是膀胱和集合系统的慢性炎症，与尿素分解菌引起的黏膜结痂有关。我们对这些感染性疾病进行综述。
对1985年至1997年的MEDLINE数据库进行文献检索。还选择性纳入了1985年以前发表的其他文章。
大多数文章为病例报告或短篇系列报道。在过去10年中，诊断出的病例数不断增加，尤其是在免疫抑制患者中，特别是肾移植受者。已在这种感染中证实有多种细菌，但目前最常见的是D2群棒状杆菌。结痂性膀胱炎或肾盂炎的发生需要特定细菌的存在、碱性尿液、既往的泌尿外科手术以及易发生感染的临床背景。临床诊断可能困难，但存在含有大量钙化黏液脓性碎屑的碱性尿液极具提示性。证实细菌需要在富集培养基中进行长时间培养。治疗基于适当的抗生素治疗、尿液酸化以及切除钙化结痂斑块。治疗失败的后果严重，可导致肾移植受者进行移植肾切除术。
结痂性膀胱炎和肾盂炎的早期临床和细菌诊断可改善这些感染性疾病的预后。
