Hypothesis / aims of study
Encrusted cystitis is a rare but severe form of chronic bladder mucosal inflammation caused by Corynebacterium urealyticum, a urease-producing microorganism. The disease is characterized by the deposition of salts (struvite, calcium, magnesium, and ammonium phosphates) and persistent alkaline urinary pH, which contribute to the maintenance of inflammation and biofilm formation.
Risk factors include prolonged catheterization, invasive urological procedures, diabetes mellitus, immunodeficiency states, and chronic urinary tract infections. The rising number of diagnosed cases in recent years is likely associated with increased urological interventions, immunosuppressive therapy, and improved microbiological identification.
Study design, materials and methods
From 2010 to 2024, 54 patients (aged 34 to 78 years) with confirmed encrusted cystitis were treated. The main complaints included dysuria, suprapubic pain, hematuria, and lack of response to outpatient antibiotic therapy. Most patients had a history of long-term bladder catheterization, transurethral or open surgery in anamnesis.
Diagnostics included clinical history, urinalysis and urine culture, ultrasound of the urinary tract, urethrocystoscopy, and, when necessary, CT scan. All patients presented with alkaline urine (pH 7–9), persistent leukocyturia, and mucosal encrustations ranging from 1.0 to 40 cm². The most frequently isolated pathogens were E. coli, Klebsiella spp., Pseudomonas spp., and mixed flora.
Results
Additionally, we analyzed the relationship between treatment outcomes and the extent of mucosal involvement. Among the 42 patients included in the study, 28 (66.7%) showed no recurrence. In this group, the area of encrustation was less than 10 cm². All patients underwent transurethral resection (TUR), followed by a 14-day course of bladder instillations. No relapses were observed.
Fourteen patients (33.3%) experienced recurrence. Of these, 9 patients had lesions ranging from 10 to 40 cm². They underwent repeat TUR and percutaneous cystostomy. Bladder instillations were administered for 30 days through the cystostomy, which was then removed. No further recurrences occurred in this subgroup.
In 5 patients with extensive encrustation exceeding 40 cm², cystostomy alone proved ineffective. These patients underwent three TUR procedures, followed by percutaneous nephrostomy and a 30-day course of local intrabladder instillations. This approach resulted in remission even in severe cases.
Medical Therapy was administrated to all patients after transurethral resection. Antibiotic therapy based on bacteriological urine culture (most often antibiotic-resistant flora) - protected cephalosporins. For reduction of urinary pH - methionine 250 mg - up to 3000 mg per day. Bladder instillation was performed every other day: Syntomycin emulsion 10% diluted with Novocaine 0.25% to 100.0 ml; Chlorhexidine solution diluted 1:10 for 30 days.
The average duration of drainage (cystostomy or nephrostomy) was 37-78 days.
Histological examination in all cases revealed inflammatory-infiltrative and fibrosclerotic changes.
Interpretation of results
The findings confirm that TUR is a fundamental treatment method. However, in cases of recurrence and extensive encrustation, effective treatment requires the addition of urinary diversion, prolonged local antiseptic therapy and reduction the measures of urine pH.
For lesions smaller than 10 cm², TUR alone was sufficient. In cases with 10–40 cm² of mucosal involvement, cystostomy combined with TUR was necessary. In severe forms exceeding 40 cm² or in patients with frequent relapses, nephrostomy followed by staged therapy was the only effective strategy.
Treatment success correlated with both subjective clinical improvement and objective data from ultrasound, cystoscopy, laboratory analysis, and CT imaging.