What is Pyocystis?
Pyocystis is an uncommon yet serious bladder infection that occurs when a buildup of harmful debris gets trapped in the bladder. Some alternative names for this condition are ‘vesical empyema’ and ’empyema cystis.’ The condition typically affects patients who have had a specific kind of procedure. This procedure redirects the flow of urine away from the bladder (known as pre-vesical urinary diversion) followed by bladder removal (cystectomy).
This kind of diversion often happens in patients with bladder cancer, generally followed by cystectomy. However, there are exceptions where the diversion happens without removing the bladder, especially for non-cancerous diseases like difficult to treat blockage of the tube that carries urine from the kidney to the bladder (ureter), nerve-related bladder issues, bladder inflammation due to radiation (radiation cystitis), excessive bladder bleeding (hemorrhagic cystitis), or a long-lasting type of bladder inflammation (interstitial cystitis). Additionally, pyocystis can also occur in patients whose bladders are not functioning correctly due to lack of urine production (anuria), as seen in patients with advanced kidney disease (end-stage renal disease).
For milder cases, pyocystis can be treated with a range of antibiotics and regular washing out of the bladder (intermittent bladder irrigation). Severe cases with persistent infections might need cystectomy. The idea of performing cystectomy at the time of urinary diversion is debated among medical practitioners since pyocystis is quite rare even in high-risk groups. That, plus the potential risks linked with cystectomy, makes it not a currently recommended preventive measure.
However, because pyocytis is a rare condition, there’s not a lot of published data. This limited evidence impacts the statistical reliability of studying how often it occurs and the results of different treatments.
What Causes Pyocystis?
Pyocystis is usually caused when a bladder that’s not working properly fails to get rid of skin cells and fragments that build up without the flow of urine. The condition can also happen because of the pooling of reverse-flow prostatic fluids in men, and the movement of water through osmosis. If this collection of fragments or secretions becomes infected, then pyocystis occurs.
In a normal bladder, the flow of urine keeps debris from collecting and prevents inflammation and infection from happening. The organisms that typically cause pyocystis are the ones that usually cause lower urinary tract infections, such as E.coli and other bacteria that are classified as gram-negative. Other common organisms include bacteria like P. mirabilis, P. aeuginosa, and Enterococcus. These organisms most likely reach the bladder by moving in a reverse direction along the urethra, causing an infection.
The bladder can stop working properly in two main ways, either due to medical interventions or natural physiological reasons. Natural loss of function happens because of anuria, a condition where the kidneys stop producing urine due to end-stage kidney failure. Medical interventions leading to bladder inactivity are caused by the diversion of urine flow above the bladder. Both these situations result in the absence of urine passing through the bladder, putting the patient at a risk of developing pyocystis.
Risk Factors and Frequency for Pyocystis
Pyocystis, a medical condition, became more common after the introduction of procedures called supravesical urinary diversions in the 1960s. Before this, cases of pyocystis were quite rare. It’s unclear how often it occurs in patients with end-stage renal disease, but it is a known problem for these individuals.
It’s more often seen in patients who have undergone bladder defunctioning procedures than in those with end-stage kidney disease. The occurrence rate of pyocystis in patients who have had these urinary diversion procedures can range from 7 to 67%. The condition also appears more frequently in females, thought to be due to the shorter female urethra, similar to why women are at higher risk of urinary tract infections.
- If the bacterium proteus mirabilis was in the urine before the urinary diversion, the chances of developing pyocystis increase.
- Pyocystis generally develops within the first 6 to 12 months after surgery.
- Patients who have had radiation therapy in the pelvic area are at a higher risk of developing pyocystis.
Alternative names for pyocystis include empyema cystis and vesical empyema. However, these terms are seldom used today and are mostly found in older descriptions of the condition. Due to this, these terms’ contribution to current literature and our understanding of the prevalence of the disease is limited.
Signs and Symptoms of Pyocystis
Pyocystis is a condition that usually comes with several symptoms. Common signs include pain in the pubic area above the genitals, unpleasant-smelling discharge from the urinary tube, and feeling feverish for a few days before needing medical attention. In severe cases, there may also be other signs of infection like loss of appetite, nausea, and vomiting.
- Pubic area pain
- Unpleasant-smelling urinary discharge
- Fever lasting several days
- Loss of appetite (in severe cases)
- Nausea (in severe cases)
- Vomiting (in severe cases)
People who show these signs of infection along with certain risk factors should be examined for pyocystis. These risk factors could include having bladder surgery in the past, or failure of the kidneys. On the other hand, patients with pyocystis might only have a mild fever and some discomfort in the belly or pelvic area, but still feel generally OK. The severity and duration of the infection can make the signs vary from case to case.
Physical examination might reveal a tender mass above the pubic area that can be felt, and swollen lymph nodes in the groin. There might also be an unpleasant-smelling discharge or even visible pus coming from the urinary tube. A medical professional may notice a fast heart rate, low blood pressure, and fever when checking basic health signs.
Testing for Pyocystis
If you are suspected of having pyocytis, a condition where pus accumulates in the bladder, your doctor might order several tests. They will likely start with a blood test to check for an increase in white blood cells and a protein called C-reactive protein (CRP), both of which are signs of an infection. They may also take a sample of your blood to grow in a lab (a process known as a blood culture), but this doesn’t always identify the type of bacteria causing the infection.
Your doctor may also insert a tube into your bladder (a process known as catheterization) both to help diagnose the condition and to provide treatment. They will take a sample from the bladder to check for bacteria and to determine which antibiotics the bacteria is sensitive to. The most commonly found bacteria are E. coli, Pseudomonas aeruginosa, and Enterococcus faecalis, but in people with weakened immune systems, other types of bacteria may be present.
Your doctor may also use imaging tests to help make a diagnosis. These can include a computed tomography (CT) scan, which uses X-rays to create detailed pictures of the inside of your body, or an ultrasound, which uses sound waves to create images. Ultrasounds are beneficial because they can be done right at your bedside. Both of these tests can show if the wall of your bladder is thicker than usual and if there is a collection of different materials inside of it, both of which are possible signs of pyocytis. If you have kidney problems, a type of CT scan that doesn’t use a special dye (a non-contrast CT) can be used instead of the regular kind.
Another way to diagnose and treat pyocytis is through a procedure called cystoscopy. This involves inserting a thin tube with a light and camera into the bladder. This test can help your doctor see inside your bladder, remove any harmful substances, and take a sample of the bladder wall to make sure there aren’t any cancerous cells.
Treatment Options for Pyocystis
If you’re showing symptoms of a severe infection spreading throughout your body, known as urosepsis, the first step in treatment usually involves replenishing your body fluids (fluid resuscitation) and giving you strong intravenous (IV) antibiotics that fight a wide range of bacteria (broad-spectrum). Those who are at a high risk, such as people having dialysis, undergoing chemotherapy, or who have recently left the hospital, may need extra protection with antibiotics that fight off uncommon infections.
For some patients suspecting a condition called pyocystis (where the bladder gets filled with pus), a catheter, which is a thin tube, might be put into the bladder. This serves two purposes: it drains the infected tissue and captures some pus for lab testing. This way, doctors can identify the bacteria responsible for the infection and adjust the antibiotic treatment accordingly.
After the catheter is in place, the doctor may clean out the bladder using a process called irrigation. This means they flush out the bladder to remove infected material and prevent it from building up again. This can be done continuously with a special type of catheter or via regular bladder washouts. You may need to continue this cleaning process at home for up to three months, several times a week, to help get rid of the infection completely. In some cases, antibiotics might be put directly into the bladder to treat the infection, and in other cases, a basic saltwater solution, or normal saline, might be used.
People who have had a urinary procedure and previously tested positive for a type of bacteria called Proteus mirabilis are more likely to develop pyocystis. Some believe that these patients should consider having their bladder removed, a procedure known as a cystectomy. Meanwhile, for sexually inactive women, a method called the Spence-Allen procedure could be an option to prevent pyocystis. This method creates a small hole, or fistula, between the bladder and vagina to allow constant drainage of bladder contents through the vagina.
For those people who aren’t responding to IV antibiotics and bladder irrigation, it might be necessary to remove the bladder, especially in patients with pyocystis. According to some studies, up to 25% of these patients may require a cystectomy.
What else can Pyocystis be?
In women, a condition called pyocytis can cause a discharge from the urethra. This can sometimes be mistaken for a vaginal discharge, which can lead to incorrect diagnoses.
What to expect with Pyocystis
The outcome of pyocystis, a type of bladder infection, depends on how serious the infection is and how much it has affected the body. For less serious cases, it might be possible to treat the infection with antibiotics and occasional bladder rinsing procedures at home. On the other hand, severe infections that do not get better with treatment may need surgery. Surgical options for these severe cases include the Spence-Allen procedure or total cystectomy, which is a surgery to remove all or part of the bladder.
There have been reports that between 18.7% and 25% of patients diagnosed with pyocystis need a cystectomy. It’s important to note, however, that pyocytis is relatively rare, so the number of cases these percentages are based on is low. As such, we would need to analyze a larger group of patients to come up with more accurate numbers.
Possible Complications When Diagnosed with Pyocystis
Complications from pyocystis, a type of infection, may require surgical intervention, even as severe as a total cystectomy, which is the removal of all or part of the bladder. This condition can also lead to sepsis, a life-threatening infection that can spread throughout the body, potentially causing serious complications and even death.
Possible Complications:
- Need for surgical intervention
- Possibility of requiring a total cystectomy
- Development of sepsis
- Serious complications from sepsis
- Possible death due to sepsis
Preventing Pyocystis
Pyocystis is a serious medical issue that can lead to long hospital stays, the need for additional surgeries, and could even be life-threatening. It’s important for patients who are at risk to understand their condition, its symptoms, and ways to manage it. The most common symptoms are lower belly pain, foul-smelling discharge, and fever.
People particularly at risk for pyocystis are those who’ve had surgery to disconnect the bladder or those who are unable to produce urine due to kidney failure. This risk becomes even higher for patients who also undergo dialysis, have weakened immune systems, or have previously been diagnosed with proteus mirabilis, a bacteria that can cause infections.
Managing other pre-existing medical conditions and certain lifestyle factors, like smoking and diabetes, can also help. The quicker pyocystis is recognized and treated, the better the outcome. Delay in treatment could lead to the need for surgery and a higher chance of a less favorable outcome.
