Clinical picture and treatment of bullous cystitis

Infectious and inflammatory lesions of the bladder (cystitis) dominate in its manifestation among a huge number of urological pathologies. The disease is characterized by the development of inflammatory reactions in the mucous membrane of the urinary tract, causing structural and functional disorders.

According to morphological changes in the structural tissues of the urinary-vesical walls, cystitis can manifest itself in various types and forms. One of which is bullous cystitis (BC).

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What is the bullous form of cystitis?

This form of MP inflammatory lesion is not considered an independent disease. It manifests itself as a result of the complication of the chronic form of cystitis, as a consequence of untimely examination and late start of treatment.

Prolonged exposure to the inflammatory reaction on the urinary-vesical tissues causes the development of pathological processes, manifested by congestive hyperemia (areas overflowing with blood) and bullous edema – the formation of many cavities filled with blood serum leaking from the capillaries (serous fluid).

Puffiness is manifested by a progressive nature, which leads to a violation of the integrity of the mucous epithelium and deprives the cystic walls of the protective properties, which creates the risk of deep damage to the structural tissues of the MP.

Bullous lesion of the urinary-vesical tissues with the formation of many spherical cavities protruding onto the surface of the mucous membrane of the MP lining is diagnosed in adults and children. The clinical features of the pathological lesion are determined by the gender, age and general condition of the patient.

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The reason for the development of BC

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Features of the development of BC in adults

The genesis of bullous lesion of MP is due to two main factors – the influence of pathogenic flora that penetrated the bladder cavity and the weakening of local immune phagocytosis, due to a number of provocative factors caused by:

  • the presence of renal pathologies of various natures that disrupt the processes of urine excretion,
  • side effects of drugs,
  • the consequences of surgical interventions that disrupt the processes of complete emptying of the MP (strictures, adhesions and scars),
  • lack of blood circulation in the pelvic organs, provoking the development of venous stasis (blood stasis),
  • bacterial, hormonal and endocrine pathologies,
  • poor nutrition and vitamin deficiency,
  • passive lifestyle.

Features of the development of BC in children

Bullous cystitis is most often diagnosed in children 4 and 12 years old – mainly in girls, although up to three years of age, the disease affects both sexes in equal proportions. In infants, this pathology is rare. Diagnosing BC in young children is difficult due to the inability of babies to convey their feelings. It is possible to identify pathology only during an exacerbation of the disease.

The reason for the development of BC in children is due to:

  • The failure of child immunity.
  • High transcapillary metabolism (permeability of the vascular walls), which ensures the free spread of toxic substances into the surrounding tissues.
  • Insufficient activity of the spleen, which performs the function of a filter for foreign “agents” in the body and produces antibodies against them.
  • Accelerated metabolic processes (metabolic processes), which reduce the chance for a quick recovery of the body.

All this explains the fact that the development of the disease in babies begins in the season of colds under the influence of cold. Not fully formed immune phagocytosis (protection) reduces the level of body resistance, which contributes to the free introduction and active influence of bacterial and viral infections on it.

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The signs of BC in adults and children are generally identical. Manifest:

  • severe sharp soreness during miction (urination),
  • painful sensations in the projection area of ​​the MP (lower abdomen),
  • clouding of urine and its pungent odor,
  • imperative urges with minor micrations,
  • fever, malaise and weakness.

In children of ten, twelve years of age, the manifestations of the bullous type of cystitis are most pronounced and painful.


The protocol for the treatment of cystitis with bullous tissue damage provides for an integrated approach to treatment – drug treatment, physiotherapy sessions, diet correction.

The drug therapy regimen includes:

  • Various forms of anti-inflammatory drugs – “Diclofenac”, “Indomethacin” in the form of rectal suppositories, tablets or injections. Concentrating in the lesion focus, they stop unpleasant symptoms.
  • To normalize the processes of micturition and eliminate swelling of mucous tissues, diuretic preparations are prescribed – the most popular is Furosemide.
  • Antibiotic therapy – to eliminate foci of infection. Prescribe drugs of various groups of antibiotics, taking into account the resistance of the identified pathogen. For example – “Nolitsin”, “Amoxicillin”, “Clarithromycin”, antibiotics of the cephalosparin group (selection of drugs, course and dosage are individual).
  • In combination with antibiotics, a long course of natural uroseptics is prescribed. It can be “Fitolysin” or “Kanefron”.
  • Homeopathic remedies are effective for bullous lesions of MP. “Bura” helps in the normalization of urination processes and relieves false tenesmus (urge), “Dulcamara” – relieves pain and accelerates the regeneration of affected tissues (prescribed for signs of bloody inclusions in the urine), “Digitalis” – effective in eliminating painful conditions in the suprapubic region of the abdomen …

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Practice and clinical studies have shown that antibacterial treatment of bullous cystitis is ineffective in 35% of cases. This is due to the fact that with this form of damage to the urinary-vesical tissues, the pathogen is already in the submucous tissues, where antibacterial agents practically do not affect it.

In the process of drug therapy, the processes of disturbance of mictus (dysuria) normalize faster than purulent accumulations in urine (leukocyturia) disappear, which explains the fact that the relief of inflammatory reactions begins from the surface lining of the MP, and then from its deep layers.

All this explains the need to use physiotherapeutic treatment methods for bullous cystitis:

  • Endovesical phonophoresis.
  • CMT (sinusoidal modulated currents), both isolated and in combination with Gangleron, introduced by electrophoresis, which makes it possible to block pathological impulses from the MP. It is used when the signs of acute delay of miction prevail and the presence of hypertonicity of the muscle tissues of the MP (detrusor).
  • Laser therapy, UHF and ultrasound are prescribed during the latent phase of inflammatory processes.
  • For the effectiveness of tissue regeneration, balneotherapy and mud therapy procedures are prescribed.

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Therapeutic therapy of BC in children

BC therapy in children is aimed at relieving pain symptoms, stabilizing the processes of urination, and eliminating the causative agent of the infectious and inflammatory process. The earlier the child is examined and treatment is started, the faster it will be possible to stabilize his condition and eliminate the pathology.

Drug treatment is similar to treatment in adult patients with age-adjusted dosage and taking into account possible side effects and contraindications. In addition to the standard treatment regimen, complex therapy includes:

  • Drip administration of antibiotics (instillation) at the initial stage.
  • Instillation of a solution of nitrogen-silver salt (silver nitrate) with an ascending concentration in the MP, both isolated and in combination with Collargol or Dioxidine, which promotes improved blood circulation in the urinary-vesical tissues.
  • Instillation of 10% liniment Dibunol with Novocaine has an antiseptic effect on inflamed foci.
  • For the treatment of pathology in babies, course schemes of the anti-inflammatory drug “Skin-Cap” in combination with human leukocyte interferon can be used.

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Along with drug treatment, physiotherapy sessions are carried out, which contributes to a quick recovery. Physiotherapy for bullous cystitis in children includes:

  • the method of introducing calcium chloride into the body by electrophoresis, which helps to strengthen the urinary-vesical walls,
  • instillation of “Terrilitin” or “Lidase”, which have a proteolytic property that promotes soft scarring of the affected tissues,
  • simultaneous use of enemas with instillations with alternating use of a solution of chamomile and eucalyptus,
  • local exposure to galvanic currents with electrophoresis eliminates puffiness,
  • galvanic currents in combination with ultrasound, contribute to the therapeutic effect of other procedures,
  • CMT (sinusoidal modulated currents), both in isolation and in combination with electrophoresis with “Furagin” or “Furadonin”,
  • wrapping and applications with esokerite or paraffin.

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As a herbal medicine that has a beneficial effect on the body, decoctions of juniper and lingonberry leaves, cranberry juice and fruit drinks are recommended.

If the body’s response to the treatment is insufficient, it is possible to prescribe vitamin complexes and immunomodulatory drugs.

Bullous cystitis is an extremely rare disease, but it is quite severe and painful.


Due to the real possibility of complete overlap of the urethral lumen, treatment should be prescribed only by a doctor and take place under his control. In order not to provoke the chronization of the process and unwanted complications, a full therapeutic course is needed.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.