Snapshot An afebrile 23-year-old woman presents with suprapubic pain, dysuria, and increased frequency of urination. A urinary sediment exam reveals clumps of neutrophils, occasional red blood cells, and rod shaped bacteria. No casts or crystals are found. Introduction An acute inflammation of bladder Most commonly a result of an ascending infection E.coli (MCC) , also adenovirus (hemorrhagic cystitis) , Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Nisseria gonorrhoeae also caused by drugs (cyclophosphamide), parasite infestation (Schistosoma hematobium) May progress to chronic cystitis most commonly seen with recurrent E.coli infections known as malacoplakia Presentation Symptoms urinary frequency dysuria urgency suprapubic pain bedwetting in children gross hematuria Acute cystitis evaluation Urine dipstick increased leukocyte esterase elevated nitrites, elevated pH (Proteus) hematuria Urinary Sediment clumps of neutrophils (pyuria) scattered RBC bacteria without the presence of casts Microscopic analysis > 10 leukocytes/hpf a bacterial pathogen Gold standard is clean catch urine culture with >100,000 bacteria/ml Chronic cystitis evaluation Histology foamy macrophages with laminated mineralized concretions known as Michaelis-Gutmann bodies also see mucosal plaques that are yellow and raised