What happens to the mucous membrane
Normally, the inside of the bladder is lined with urothelium - a special epithelium that withstands contact with urine and protects the underlying tissue. With prolonged irritation or chronic inflammation, part of the urothelium is rebuilt and turns into squamous epithelium, similar to the skin, sometimes with the formation of the stratum corneum.
Such epithelium is not adapted to contact with urine. The protective barrier is broken, the components of urine penetrate deeper and irritate the nerve endings - cramps, frequent urges and pain occur, indistinguishable from cystitis. But there may be no bacteria.
Most often, the changes are located in the area of the triangle and the neck of the bladder - the most sensitive area, which explains the severity of symptoms with a relatively small area of damage.
Reasons
- Chronic and often recurrent urinary tract infections
- Past sexually transmitted infections: chlamydia, mycoplasma, trichomonas, gonococcus
- Hormonal changes, estrogen deficiency
- Long-term catheterization and endoscopic interventions
- Bladder stones
- Smoking
- Chemical and radiation exposure
- Chronic stagnation of urine and disruption of its outflow
Symptoms
- Frequent urination in small portions
- Cutting and burning sensation when urinating, especially at the end
- Pain and discomfort above the pubis
- Feeling of incomplete emptying
- Night rises
- Pain during intercourse
- Constant or wave-like course with short periods of relief
- Sterile urine cultures for severe complaints
- Short-term effect of antibiotics with rapid return of symptoms
Diagnostics
- Urinalysis and repeat cultures to assess for infection
- PCR for sexually transmitted infections
- Ultrasound of the kidneys and bladder with determination of residual urine
- Cystoscopy - visualization of whitish plaques on the mucosa; main detection method
- Bladder biopsy with histological examination is the only way to confirm the diagnosis and exclude a tumor
- Urine cytology
- Gynecological examination in women
- Urinary Diary
A biopsy is fundamentally important for another reason: similar-looking changes may turn out to be squamous metaplasia with keratinization, which requires closer monitoring, or concomitant pathology, requiring other treatment.
Treatment
- Elimination of the cause: treatment of the identified infection by culture and PCR, sanitation of foci of inflammation
- Correction of hormonal levels in menopausal women - local estrogen therapy as prescribed by a gynecologist
- Instillation of drugs into the bladder that restore the protective layer of the mucous membrane
- TUR of leukoplakia of the bladder - removal of altered areas of the mucosa; performed endoscopically, without incisions
- Laser ablation of altered areas
- Treatment of associated conditions: stones, urinary stagnation, bladder dysfunction
- Quitting smoking
- Correction of drinking regime and exclusion of irritating foods
Observation
- Control cystoscopy at the time prescribed by the doctor
- Periodic urine tests
- Immediate treatment if blood appears in urine
- Prevention of urinary tract infections: drinking regime, regular urination, urination after sexual intercourse
- Observation by a gynecologist in menopausal women
- Refusal of uncontrolled use of antibiotics when symptoms return - culture first
Where they are examined and treated in Tashkent
Diagnosis requires cystoscopy with the ability to take a biopsy and a histological laboratory, and treatment requires an endoscopic operating room.
In Tashkent, such examination and treatment, including TUR of leukoplakia of the bladder, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If “cystitis” does not go away for more than six months, and the cultures are sterile, discuss cystoscopy with a urologist: without it, it is impossible to diagnose leukoplakia, and blind treatment only prolongs the problem. Clinic contacts are below.
