Emphysematous cystitis: a review of 135 cases

Authors


Daniel A. Shoskes, Glickman Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, Ohio 44195, USA.
e-mail: dshoskes@mac.com

Abstract

OBJECTIVE

To review recently published data on emphysematous cystitis (EC), a potentially life-threatening condition characterized by air within the bladder wall, and that most typically affects middle-aged diabetic women.

METHODS

All articles published in English between 1956 and 2006 were identified using a Medline search for keywords ‘emphysematous cystitis’, and ‘cystitis emphysematosa.’ Epidemiological, clinical, diagnostic, pathological and therapeutic data were evaluated, including risk factors such as the presence of diabetes mellitus or other comorbid emphysematous infections of the urinary tract.

RESULTS

In all, 102 published papers, including 135 cases of EC, were reviewed; the median patient age was 66 years, 64% were women and 67% had diabetes mellitus. Most cases were diagnosed using plain films of the abdomen (84%), although more recently, computed tomography was the primary imaging method. Escherichia coli was the most commonly isolated organism. Most patients were treated with medical management alone (90%), while 10% of infections were treated with a combination of medicine and surgery. The overall death rate was 7%.

CONCLUSIONS

EC is the most common and typically the least severe gas-forming infection of the urinary tract. Prompt diagnosis and treatment is warranted to prevent the potential morbidity and mortality of this infectious condition.

Ancillary