Hemorrhagic cystitis in women: diagnostic features and treatment

Introduction. Treatment of urinary tract infections (UTI) is a complex thing to do, due to the difficulties in diagnosing the causes of UTI and identifying risk factors for recurrence of the disease. Objective. To study the causes of hemorrhagic cystitis, develop an algorithm for examining these patients, and select a rational therapy. Materials and methods. A complex examination and treatment of275 patients with a clinical picture of hemorrhagic cystitis was performed. Patients with the absence of leukocyturia and bacteriuria additionally performed рolymerase chain reaction (PCR) of the first portion of urine (scraping from the urethra) for the presence of herpes simplex viruses of the 1 and 2 types (HSV of the 1 and 2 types), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human papillomavirus of high oncogenic risk (HPV)) in acute period, ELISA with determination of immunoglobulins G and M for HSV types 1 and 2, CMV and EBV, examination of vagina flora pathogens and sensitivity to antibiotics with essential indication of the number of lactobacilli. Results. There is an increase level of hemorrhagic cystitis in young patients, while in 64% of cases, the bacterial agent was not detected. An algorithm for the diagnosis of hemorrhagic cystitis of viral etiology has been developed, including examination of this category of patients for the presence of viral agents. In 37% of cases, the presence of chronic herpes and papillomavirus infection was proven. The use of antiviral therapy significantly reduced the number of recurrent UTI in this category of patients. Conclusions. Examination of patients with recurrent urinary tract infections should include the methods which confirm the viral nature of the disease.