Main Difference – Cystitis vs Pyelonephritis
Urology is a branch of medicine which studies about disease conditions related to the urinary system-kidneys, ureters, bladder and urethra. Cystitis and Pyelonephritis are two common urological conditions, and the usage of these terms can be quite confusing without an exact diagnosis since their presentation in patients shares a lot of common features. The main difference between cystitis and pyelonephritis is that cystitis is an infection of the bladder or urethra, most commonly due to a bacterial etiology whereas pyelonephritis is a complication of it, caused when the damage extends up to the kidney through ureters.
This article explains,
1. What is Cystitis
– Signs and Symptoms, Cause, Risk Factors, Diagnosis and Treatment
2. What is Pyelonephritis
– Signs and Symptoms, Cause, Risk Factors, Diagnosis and Treatment
3. Difference between Cystitis and Pyelonephritis
What is Cystitis
Cystitis is defined as an infection of the bladder or urethra, most commonly due to a bacterial etiology. Cystitis affects both males and females, but accounts for a significant female predominance possibly due to the short urethra present in females,
Bacteria, especially Escherichia coli type, which is a part of the normal flora in the body, sometimes becomes highly virulent, especially in immune-comprised states and invades the walls of the bladder and urethra. They will then get attached to the walls using their pili and multiply, resulting in inflammation and irritation of the wall lining.
Cause and Risk Factors of Cystitis
The major cause of cystitis is known to be ascending infections where virulent bacteria enters the target organ, through external genitalia.
Major risk factors include,
- Usage of tampons
- Urinary catheterization
- Pregnant women whose bladder is not emptied completely, most of the time
- Sexually active women
- Urinary tract obstruction
- Usage of diaphragms in women as a method of contraception
- Frequent or vigorous sexual activities
Signs and Symptoms of Cystitis
Most patients with Cystitis may present with signs and symptoms including,
- Blood mixed urine
- Dark or cloudy urine
- Smelly urine
- Pain above the pubic bone, lower back or abdomen
- Difficulty in passing urine
- Burning sensation on urination
- High fever (100.4F)
- Loss of appetite
However, some patients may only complain of generalised bodily symptoms such as fatigue, lethargy, nausea, vomiting and feverishness without any of the features mentioned above.
Diagnosis and Treatment for Cystitis
Your doctor will take a complete history from you about the onset of symptoms and how severely they affect your day to day activities along with a thorough abdominal and genital examination which will give important clues towards confirming the diagnosis. However, investigations such as full blood count, urine full report and urine culture are mandatory to confirm the diagnosis.
It is also highly necessary to exclude other conditions which might mimic cystitis including, urethritis, sexually transmitted infections, bladder pain syndrome, prostatitis, benign prostatic hyperplasia in men and lower urinary tract infections.
The majority of the patients with this condition will recover on their own within 4 days. However, if your illness is lasting more than 4 days, it is highly advisable to seek medical advice, without delaying further.
Antibiotics, depending on the organism, is the treatment of choice for Cystitis, and until the responsible organism is confirmed with the help of a urine culture, empirical antibiotic therapy will be carried out, covering up all possible bacteria.
Commonly used antibiotics for Cystitis include Nitrofurantoin, Trimethoprim-Sulfamethoxazole, Amoxicillin, Cephalosporins, Ciprofloxacin, and Levofloxacin.
It is important to stay appropriately hydrated, so drinking plenty of water is highly encouraged.
Prevention of Cystitis
However, since prevention is always better than cure, it is important to practice safety methods as much as possible to prevent from Cystitis, which significantly includes,
- Avoid using perfumed soap, cream or talc powder around the genitals.
- Complete emptying of the bladder when passing urine.
- Maintain a perfect hydration by drinking plenty of fluids
- Always wiping your bottom from front to back when you go to the toilet
- Emptying the bladder after having sexual intercourse
- Avoid using Diaphragms as a method of contraception
What is Pyelonephritis?
Most urinary tract infections involve the bladder and urethra, and an infection whose damage extends up to the ureters and kidneys is known as Pyelonephritis.
Causes of Pyelonephritis
Generally, a majority of pyelonephritis cases take place as a result of a complication of bladder or urethral infection (E. coli or klebsiella) and can end up in contaminating blood giving rise to fatal scenarios.
This condition can also occur due to a urinary tract obstruction possibly seen in benign prostatic hypertrophy (BPH), abdominal or pelvic masses and bladder, ureteric or renal calculi.
Signs and Symptoms of Pyelonephritis
There are 2 types of Pyelonephritis:
Acute – Sudden and self-limiting type which is effectively treated with antibiotics, and rarely cause any long lasting damage to the kidneys.
Chronic – A rare type which is usually caused by birth defects in the kidney and present as recurrent urinary tract infections particularly in children. This will also result in progressive scarring of the kidneys.
Patients with Pyelonephritis usually experience,
Fever with chills and rigours, back pain or flank pain, malaise, lethargy, nausea, vomiting and confusion with signs associated with cystitis including, blood in urine, dark or cloudy urine, pain on micturition, increased frequency and urgency of urination.
Diagnosis and Treatment of Pyelonephritis
A GP will diagnose Pyelonephritis with the help of a complete history from the patient followed by an abdominal and pelvic examination. Investigations such as urine full report (to see increased white blood cells and the presence of red blood cells) and urine culture are mandatory to establish the exact diagnosis. Also, it is important to find the etiology of the condition and therefore, imaging studies like X-ray, Ultrasound scan of the pelvis and abdomen (to identify and abscesses, calculi and obstruction), CT and MRI may be useful. A blood culture can be useful to identify any possible contamination of blood with the causative bacteria.
It is always advisable to treat Pyelonephritis shortly and promptly after making the diagnosis since there can be an immense number of complications if the treatment is delayed or if left untreated. Whether to admit the patient or carry out treatments at home will depend on the severity of the condition and the treatment of choice for Pyelonephritis is Antibiotics, covering the responsible bacteria.
Difference Between Cystitis and Pyelonephritis
Cystitis is defined as an infection of the bladder or urethra, most commonly due to a bacterial etiology.
Pyelonephritis is a complication of it, caused when the damage extends up to the kidney through ureters.
Signs and Symptoms
Signs and symptoms of Cystitis and Pyelonephritis are quite similar to each other, but patients with the latter are usually severely ill, requiring hospital admission most of the time.
Both Cystitis and Pyelonephritis are treated effectively with specific antibiotics, targeting the causative organism.
“Urinary system” By Jordi March i Nogué  – Own work (CC BY-SA 3.0) via Commons Wikimedia