Abstract
We report a case of a patient who developed encrusted cystitis following transurethral resection of the prostate. This rare urologic condition is characterized by intramucosal calcifications and is commonly preceded by urologic instrumentation. Urea-splitting bacteria, most commonly Corynebacterium urealyticum, are the causative pathogen. Treatment is a combination of antibiotics, urine acidification and endoscopic removal of encrustations.
Keywords: endoscopy, infectious disease, hematuria, encrusted cystitis
An 81-year-old male presented to our facility after 6 months of recalcitrant gross hematuria and dysuria despite multiple transurethral resections of the prostate. Computed tomography and endoscopy revealed mucosal calcifications and inflammation. (Figures 1&2) Urine cultures revealed Corynebacterium urealyticum. He was treated with vancomycin and laser lithotripsy of calcifications. His hematuria and dysuria resolved following treatment.
Figure 1.
Non-contrast CT of patient’s pelvis, revealing circumferential mucosal encrustations (arrows) throughout the inferior (left) and superior (right) aspects of the bladder
Figure 2.
Left, Mucosal encrustations found on cystoscopy. Right, bladder wall after laser lithotripsy of calcification.
Encrusted cystitis (EC) is a rare condition defined by bladder mucosal struvite calcifications. First reported in 1914, EC is caused by urea-splitting bacteria, often Corynebacterium urealyticum.1 This member of skin flora is present in 12% of the population.2 It is slow-growing and is often missed on rapid urine culturing.3 EC is generally preceded by urologic instrumentation. Treatment involves glycopeptides antibiotics, urine acidification, and removal of calcifications.4 Corynebacterium can form biofilms and may persist if calcifications are not completely removed.
Acknowledgments
The effort of SAS on this paper was supported in part by the Clinical and Translational Science Award (CTSA) Program of the National Center for Research Resources (NCRR) at the National Institutes of Health (NIH), Grant Numbers UL1 RR024992, KL2RR02994.
Footnotes
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