The initial assessment includes:
- Symptoms and associated disorders
- Relevant past history, medical problems, surgery, trauma, hospitalizations
- Assessment of emotional and psychological status as well as of lifestyle habits
- Focused physical examination
- Frequency/volume chart – daily bladder dairy (3 days)
- Urinalysis and urine culture
- Urine cytology
Urinalysis, urine culture and urine cytology
Urinalysis, urine culture and urine cytology tests are useful to exclude pathological changes: haematuria (red blood cells in the urine), proteinuria (protein detected in the urine), pyuria (white cells present in the urine) etc, to exclude patients with recurrent UTI, and abnormal urinary cytology. In case of pathologic findings the evaluation with appropriate imaging and endoscopic procedures is required.
In more complicated cases, if the diagnosis is in doubt and if clinically indicated, or if the initial oral therapy fails, further evaluation is required.
The following invasive tests are considered:
- Cystoscopy with bladder distention, possible bladder biopsy under general anesthesia
- Pelvic Imaging (Ultrasound, CT, MRI, etc, see below)
The imaging features of cystitis are nonspecific. On imaging only, one form of cystitis cannot be differentiated from another. Bladder tumors may cause mucosal and wall changes that are similar to the changes seen in cystitis, and vice versa. When imaging indicated, ultrasound is the best option.
Ultrasonography is a useful test to provide evaluation of the bladder and bladder wall thickness. It is an accurate method for measurements of bladder capacity, post void residual (PVR) and prostate assessment. US can be used to exclude bladder outlet obstruction and bladder calculi. It is good method in following dilated structures and provides excellent anatomical details at any plane. US also identify other pelvic organs, localise and characterise cystic, solid or complex lesions. The kidneys and ureters could be assessed to exclude associated pathology. Transabdominal US is painless, noninvasive, with no radiation exposure and does not involve contrast material. This method is without side effects and is low cost.
Intravenous Urography ( IVU ) – contrast-enhanced study
IVU provides similar information to ultrasound. This method is good at showing structural abnormalities of the bladder, ureters and kidneys. IVU also can assess the renal function, ureteric reflux and show hydroureteronephrosis.
Computed tomography (CT)
Computed tomography makes pelvic regional anatomy available in the axial and coronal plane with good resolution. CT scans demonstrates bladder calcifications, bladder diverticula, colovesical fistula, perivesical abscess. Blood vessels and masses can be assessed with intravenous contrast.
Magnetic resonance imaging (MRI)
MRI is a useful test to provide assessment of focal or diffuse thickening of the bladder wall in patients with cystitis. This imaging method is best for complicated forms of cystitis such as sinuses or fistula formations.