Diagnostic Approach for Cystitis and Fistulization

Cystitis Diagnostic Testing

The European Urology guidelines recommend that diagnosis of uncomplicated cystitis can be made with high probability based on a focused history of lower urinary tract symptoms and absence of vaginal discharge 1
In patients with typical symptoms of uncomplicated cystitis, urine analysis provides minimal increase in diagnostic accuracy but can help when diagnosis is unclear, according to the European Urology guidelines 1
Urine culture is recommended by the European Urology guidelines only in specific situations, such as suspected acute pyelonephritis, symptoms that do not resolve or recur within 4 weeks after treatment completion, women presenting with atypical symptoms, and pregnant women 1
For women whose symptoms don't resolve by end of treatment or recur within 2 weeks, the European Urology guidelines recommend urine culture and antimicrobial susceptibility testing 1
The European Urology guidelines suggest that failure to obtain urine culture in patients with recurrent or complicated UTIs is a common pitfall to avoid 1

The Journal of the American College of Radiology recommends CT cystography for diagnosing bladder fistulas and leaks, which has supplanted fluoroscopic cystogram 2
Colovesical fistula can usually be diagnosed with contrast-enhanced CT based on enhancing tract(s) with or without gas extending from colon to bladder wall, associated focal bladder wall thickening, and presence of pneumaturia or fecaluria in clinical history, according to the Journal of the American College of Radiology 3
CT with rectal contrast or oral contrast with delayed scanning is useful to detect enterovesical fistulas and infected fistulous tracts, as recommended by the Journal of the American College of Radiology 2
The Journal of the American College of Radiology suggests that CT cystography can provide additional information regarding size and location of colovesical fistula in presurgical planning 3
MRI is equally sensitive to CT for evaluating vesicovaginal and enterovesicular fistulae with excellent soft-tissue contrast, according to the Journal of the American College of Radiology 4
The Journal of the American College of Radiology recommends considering MRI when soft tissue detail is critical, and notes that missing fistulas by not using appropriate contrast techniques during CT imaging is a common pitfall to avoid 2