Etiology, pathogenesis, diagnosis and treatment of encrusted cystitis and pyelitis: Review of the problem from a historical perspective

Abstract

Introduction: Encrusted cystitis and pyelitis share many similarities regarding etiology, pathogenesis, diagnosis and treatment. These processes usually occur on previously injured urological tissue with the participation of an infection by urease-producing bacteria. At present Corynebacterium urealyticum, a highly antibiotic-resistant bacteria, appears to be the pathogen most often involved in these processes. In this review we analyze the history of these diseases with special emphasis on the scientific advances of the last century. We also review the role of urease and bacterial infection as well as a brief update on the epidemiological, histopathological, diagnostic and therapeutic aspects. Relevance: The importance and severity of these pathologies that are frequently underdiagnosed and difficult to treat are stressed. Conclusions: The clinical history, exploratory and analytical data, which highlight alkaline urine, sometimes with an ammoniacal odor, pyuria, hematuria and the presence of magnesium ammonium phosphate crystals, should alert the urologist to the existence of an encrusting uropathy. Simple radiology, ultrasound, computed tomography and endoscopic visualization of the lesions confirm the diagnosis. Treatment generally requires surgery, use of antibiotics, urinary acidifiers and bacterial urease inhibitors. Keywords: cystitis, pyelitis, encrustations, infection