Tests for cystitis: what tests should be taken?

Inflammatory diseases of internal organs are pathologies, the diagnosis of which is based on the results of tests and instrumental studies, allowing you to see what is inaccessible to the naked eye. When it comes to the urinary system, in particular the inflammatory process in the tissues of the bladder, laboratory tests come to the fore. Tests for cystitis allow you not only to diagnose inflammation in some part of the body and determine its pathogen, but also to assess the condition of other organs associated with the bladder, because the infection tends to spread inside the body.

A little about cystitis

Among various pathologies of the genitourinary system, cystitis is considered one of the most popular diseases. The inflammatory process localized on the walls of the bladder (and this is what doctors mean when they diagnose "cystitis") is associated with the entry of a bacterial infection into the system responsible for the production and excretion of urine.

Causes of bladder infection may include:

• Insufficient hygiene of the genitals, because the perineum and genitals in this case become a real breeding ground for infection, which can rise up the urethral canal to the bladder.
• Infectious and inflammatory diseases of other organs of the urinary system, most often the kidneys (in this case, the bacteria only have to go down with the urine).
• Chronic or latent infectious pathologies of other organs and systems (if an infection has entered the body and is actively multiplying, it can easily move with the bloodstream to any internal organ supplied with blood vessels, discovering new places of deployment, one of which may be the bladder).
• Failure to regularly visit the toilet when necessary to relieve oneself (rare acts of urination provoke stagnation in the bladder, and overstraining the organ negatively affects the condition of its tissues, which subsequently results in inflammation).
• Congenital anomalies of the bladder and urethral canal that disrupt the normal outflow of urine and lead to fluid retention, inflammation of the bladder, and stone formation.
• Urolithiasis and kidney stones, tumor processes in the bladder and near the ureters (urine outflow may also be disrupted, and concentrated sediment will irritate the walls of the bladder and provoke their inflammation).
• Viral pathologies, including HIV infection, and decreased immunity lead to the fact that opportunistic microorganisms, which are considered safe against the background of normal functioning of the immune system, begin to parasitize the body. The reproduction of such microorganisms is accompanied by intoxication and the development of an inflammatory process in the tissues of the organ where bacteria operate.
• Hypothermia of the pelvic area contributes to a decrease in local immunity, which also provides opportunities for the reproduction and parasitism of opportunistic microflora, which is always present on our body.
• In women, even pregnancy can provoke cystitis, which, due to hormonal changes in the body, is a strong blow to the immune system. In addition, in the later stages, the bladder is constantly under pressure from the uterus, which increases in size every day, which disrupts its normal functioning and can lead to tissue inflammation.
• Infectious and inflammatory diseases of the genital organs, including STDs, are a source of pathogenic microflora, which can leak through the urethra into the bladder, which often happens in the weaker sex. In men, the source of infection can be an inflamed prostate gland (prostatitis), which has a common outlet with the bladder into the urethra.
• Less often, the cause of inflammation is drug therapy. It, like hard stones in the bladder (mineral salts), scratching and irritating its walls when urine moves, leads to the development of a non-infectious form of cystitis.

The impact of the above factors can lead to the fact that at one not very wonderful moment a person will be forced to seek help from doctors with complaints of discomfort and pain in the lower abdomen, burning and stinging when urinating, frequent urges to urinate, a feeling of heaviness in the bladder despite the fact that little urine may be released.

Moreover, in the acute phase of the process, the temperature may even rise, and blood may be found in the urine, which is a dangerous sign indicating either severe inflammation with the appearance of erosions on the walls of the bladder, or the presence of stones inside the organ.

Acute cystitis usually occurs with pronounced unpleasant symptoms that significantly reduce a person's quality of life. However, timely diagnosis and effective treatment help to get rid of such an unpleasant disease quite quickly. If the disease is neglected, it becomes chronic, and although the symptoms in this case are barely noticeable and practically do not interfere with a person's normal life and work during periods of calm (remission), there is a high risk of developing various complications that are more dangerous than cystitis itself.

Symptoms of cystitis cannot be called specific, since similar sensations in the form of nagging pain in the lower abdomen and pain when urinating are also experienced by patients with sexually transmitted diseases. This similarity of symptoms often becomes the reason that men and women begin to feel embarrassed about their problem, taking it for an STI, and instead of seeing a doctor, they self-medicate, which only worsens the situation.

You should not try on the role of a urologist or venereologist, because the disease, no matter what kind it is, is considered a pathology and requires special treatment. But even a doctor has the right to prescribe such treatment only after an accurate diagnosis has been established.

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Diagnosis of cystitis

You shouldn't play with your health, especially since diagnosing cystitis is not that difficult. The patient can contact his general practitioner with the existing complaints, and he will make a preliminary diagnosis based on the anamnesis and laboratory tests and decide which other doctor the patient should visit: a urologist, nephrologist, gynecologist, venereologist, etc.

This course of action is considered more effective than going straight to a specialist. Firstly, the patient himself may be mistaken with the diagnosis, and the doctor's verdict (even a general practitioner) will be closer to reality than the opinion of a non-specialist, which most of us are.

Secondly, it is often not so easy to get an appointment with a specialist. The appointment may not be daily, it may be strictly limited in time, etc. All these nuances can significantly delay the moment of the first appointment. And this is not only lost time, but also lost opportunities, because in these days and hours of waiting it would be possible to take some general tests, which in case of cystitis a therapist can safely prescribe.

In this case, the patient will turn to a specialist for subsequent diagnostics and treatment, fully armed, because even the results of general blood and urine tests can tell a lot about the state of the genitourinary system.

Based on the results of general tests and the patient's medical history, a urologist or other doctor will be able to immediately make a preliminary diagnosis and prescribe more detailed studies that will help determine not only the localization of the inflammatory process and the degree of organ damage, but also the cause of the disease.

If a full laboratory examination gives controversial results and does not allow an accurate diagnosis, they resort to instrumental diagnostic methods, such as ultrasound of the pelvic organs and kidneys. Additionally, cystoscopy and a smear for microflora can be prescribed to detect sexually transmitted infections. The fact is that cystitis is often diagnosed in combination with other diseases of the genitourinary system, being their complication or, less often, the cause.

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Indications for the procedure for cystitis.

Laboratory tests for cystitis diagnostics are prescribed regardless of the form of the disease. But what exactly can tell the doctor that the patient has cystitis?

Inflammation of the bladder very rarely occurs practically asymptomatically, especially when it comes to the acute form of the disease, which is characterized by the following points:

• The sudden appearance of symptoms indicating pathology already in the first days of the disease.
• Symptoms appear almost immediately after exposure to provoking factors, which include stress, hypothermia, active sex, a sharp decrease in immunity, which usually occurs against the background of viral pathologies, etc.
• A notable symptom of the disease is frequent painful urination, the need to empty the bladder more often than usual, despite the fact that the portions of urine are small (it is incredibly difficult for patients to retain urine in the bladder for more than 3-4 hours).
• Patients with acute cystitis suffer from quite severe nagging pain in the lower abdomen and between urinations. The pain may also spread to the perineum.
• Often, blood is found in the urine of patients with cystitis. At the same time, the urine itself becomes more cloudy and dark.
• Complicated cystitis caused by pathogenic microorganisms, as well as the spread of inflammation to the kidney area, can be accompanied by hyperthermia and chills.

If acute cystitis is neglected, the infectious and inflammatory process can quickly affect not only the bladder, but also nearby organs associated with it: kidneys (pyelonephritis) or urethra (urethritis). If the disease is not fully treated, there is a high risk of its transition to a chronic form, which will worsen with each decrease in immunity, exposure to cold, etc., and, in the end, can again cause diseases of other organs, because the bladder will remain a source of infection for the entire body.

An identical situation is observed with self-medication or an incorrect approach to choosing medications for cystitis (for example, when infectious cystitis is treated without the use of antibiotics and antifungal agents or these drugs are inactive against the pathogen). The latter often occurs when bacteriological tests for cystitis are refused, which allow determining the sensitivity of the infection to the drugs used.

Some people, having dealt with the symptoms of acute cystitis on their own, believe that they have defeated the disease, and are very surprised if the symptoms reappear after a while. But now we are talking about chronic cystitis, the symptoms of which will remind us of themselves again and again.

The following complaints are characteristic of this form of pathology:

• Unpleasant sensations in the lower abdomen, which intensify during a relapse of the disease.
• More frequent urge to urinate than before, because the inflammation in the bladder tissues, although becoming less, does not disappear completely.
• The act of urination may be accompanied by slight pain and discomfort. As the disease worsens, this symptom intensifies.
• Over time, symptoms of intoxication of the body appear (frequent headaches, nausea, etc.).

Complaints about the appearance of symptoms of acute or chronic cystitis are the basis for prescribing tests. However, in some cases, the inflammatory process in the bladder is detected accidentally when taking general urine and blood tests during a medical examination or visiting a doctor about another disease. So tests can be of good service even in the absence of obvious symptoms of the disease.

Among other things, the doctor may prescribe tests during treatment of cystitis, which will help evaluate the effectiveness of the treatment and, if necessary, revise the prescriptions.

Laboratory diagnostics

Cystitis is a disease whose diagnosis relies on laboratory tests more than other diseases. Doctors prescribe many different tests to reconstruct the full picture of the disease so that its treatment is as effective as possible.

Tests prescribed for cystitis can be divided into general and special. The first can be prescribed by a therapist, a urologist or another specialist with sufficient knowledge to solve this problem. Special tests are the prerogative of specialists. But since both types of tests are important in diagnosing cystitis, we will mention all types of tests, starting with the simplest ones.

So, what tests are usually taken for cystitis?

A general blood test, although not particularly indicative in diagnosing cystitis, cannot be done without it. The inflammatory process in any organ necessarily affects the condition of the blood, in which an increased number of leukocytes and high erythrocyte sedimentation rate (ESR) are found.

But a general or clinical blood test (CBC) only helps to determine the presence or absence of an inflammatory process in the body without indicating its location and the cause of tissue inflammation. In addition, at an early stage of the disease or in its mild form, a noticeable increase in leukocytes may not occur, which means that other research methods will be required that provide more useful information.

A general urine analysis (GUA) is considered a more informative test. Like a CUA, it can detect a high level of leukocytes, but since the test concerns urine, it indicates an inflammatory process in the urinary system (kidneys, bladder, urinary tract). In this case, protein and epithelial cells rejected as a result of inflammation can be detected in the biomaterial.

In case of severe acute inflammation of the urinary system organs and formation of stones in the urine, erythrocytes (blood in the urine) may also be detected. Since cystitis is considered an infectious disease, the results of the OAM will include data on a bacterial or fungal infection.

But, despite all the important information that the OAM provides, the study does not allow us to accurately determine the localization of the inflammation and understand whether this process has affected the bladder or whether the kidneys are the cause of the “abnormal” tests (although it is possible that both organs are involved in the process).

Urine analysis according to Nechiporenko is considered a popular special method of diagnosing diseases of the urinary system. Such analysis is of great value if the results of previous studies were insufficient for making a final diagnosis. Studying morning urine by this method allows determining the exact number of leukocytes, erythrocytes and cylinders.

Urine analysis by the Addis-Kakovsky method is not a very popular special study. However, its results can be useful in differential diagnostics, as they allow identifying a specific symptom of cystitis (frequent urge to urinate is based on the fact that the inflamed organ has difficulty holding a large amount of urine for a long period of time).

Zimnitsky's urine analysis is necessary if the doctor suspects an inflammatory process in the kidneys, which can be detected as a separate disease or accompany cystitis. This analysis requires not one, but several portions of urine collected during the day to determine the total amount of urine and the specific gravity of each portion.

Bacterial urine culture is performed to detect the infectious factor in urine and to identify it, in other words, to identify the pathogen and its quantitative characteristics indicating the severity of the infection.

Cystitis is a pathology without any particular age or gender restrictions. The disease can be found in men or women (in women, the pathology is diagnosed almost a hundred times more often), in adults and children. But the structure of the genitals and urethra in people of different sexes and ages is somewhat different, which is the reason for different approaches to prescribing and taking tests for cystitis.

The urinary bladder is an organ of the genitourinary system, connected via the ureters to the kidneys and opening into the urethra. It performs storage and excretory functions. When the volume of urine in the urinary bladder reaches 200-400 ml, we begin to experience discomfort and the urge to empty the organ (urinate) appears.

The shape, structure and location of the bladder in women and men are practically the same. The differences begin in the urethra, which is 5-6 times longer in men than in women.

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Tests for cystitis in women

Since the female urethra is short (the size of the female urethra is about 3-4 mm), but is wide and close to the genitals and anus, it is not surprising that cystitis has long been considered a female disease. Infection of the bladder is facilitated by natural discharge from the vagina, which may contain bacterial and fungal cells, and the rectum. A short and wide urethra can hardly be considered an obstacle to microorganisms.

Since cystitis in women is most often infectious (an infection can cause the disease or join later due to the proximity of the source of infection and the urethra and favorable conditions for the reproduction of pathogens), in addition to the above laboratory tests, they may be prescribed additional tests:

• Bacteriological research using the polymerase chain reaction (PCR) method. It allows for the most accurate determination of the pathogen and its sensitivity to the prescribed antimicrobial drugs.
• Cytological examination of a smear to determine the composition of the vaginal microflora (often performed when there is a suspicion of a fungal nature of the inflammatory process or the presence of non-specific pathogens).
• Examination of a smear from the urethra (if infectious urethritis is suspected).

An increase in the number of epithelial cells in the urine is characteristic not only of cystitis or urethritis. An identical picture can also be observed with inflammation and dysplastic processes in the uterus and vagina (especially if there was no necessary preparation for the urine test), so the woman should be examined by a gynecologist. If necessary, an ultrasound of the pelvis or individual organs is prescribed (ultrasound of the bladder is performed with a filled organ), cystoscopy, biopsy with subsequent histological examination (if oncology is suspected).

Tests for cystitis in men

The structure of the male body is such that the penis is also the urethra. At the same time, the length of the urethra is large, and the probability of infection penetration into it is lower than in women.

Infection can enter a man's bladder from the anal area (usually due to poor hygiene) or during unprotected sexual intercourse (again, due to failure to observe hygiene requirements after intercourse). Only the long urethra usually takes the brunt, and the infection does not always reach the bladder. This is due to the more modest statistics on cystitis in men.

However, the disease has the same symptoms and causes as in the weaker sex, so the indications for testing are not particularly different. If infectious cystitis or urethritis is suspected, a man may be prescribed a PCR analysis and a smear from the urethra for testing the microflora.

Painful urination and the release of urine in small portions can also be observed with urethral obstruction (narrowing of the organ or blockage with stones), so it is advisable to conduct uroflowmetry. Urodynamic analysis helps to exclude or confirm disorders of the urinary bladder sphincter. If blood is detected in the urine, cystoscopy is indicated (the device for conducting the analysis resembles an endoscope and helps to examine the walls of the urethra and bladder from the inside).

Ultrasound of the bladder and prostate helps to assess the condition of the bladder walls, its size, identify structural abnormalities, formation of stones, etc. Suspicion of tumor processes requires confirmation by biopsy.

Tests for cystitis in a child

In childhood, cystitis is considered the most common urological infection. The disease is most often diagnosed in girls aged 4-12, which is due to the structure of their genitourinary system.

As in adults, the disease can occur together with other pathologies of nearby organs of the urinary system (urethritis and pyelonephritis).

The cause of the disease may be:

• Violation of urine outflow (many opportunistic microorganisms pass through the urinary system, but with regular urination, the fluid cleanses the bladder from streptococci, staphylococci, E. coli, etc. circulating in it). Any damage to the bladder mucosa, disruption of various components of the system, decreased immunity contribute to the delay and proliferation of infection.
• Viral infections in the child's body, hypothermia of the pelvis, which disrupt immunity and microcirculation in the tissues of the bladder.
• Fungal infections (usually develop against the background of reduced immunity in children with HIV infection, pathologies of the urinary system, after antibiotic therapy).
• Non-specific infections (chlamydia, mycoplasma, ureaplasma, etc.) are rarely detected and are usually associated with poor hygiene and the presence of the same type of infection in parents. Pathogens of gonorrhea and trichomonas in the bladder can be found in adolescents who are sexually active.
• Foreign bodies in the urinary system.

Among other things, the disease can be provoked by some diagnostic procedures (the same cystoscopy), drug treatment with nephrotoxic drugs, dysbacteriosis, helminthiasis, intestinal infections, purulent-inflammatory processes in the body of various localizations. In girls, cystitis is caused by gynecological diseases (for example, vulvovaginitis).

Risk factors include endocrine diseases, hypothermia, changes in urine acidity, and vitamin deficiencies. One should not forget about poor hygiene, which is typical for careless teenagers (in childhood, mothers control this issue).

What symptoms in children can be an indication for laboratory tests, because children cannot always clearly describe their feelings:

• Infants with suspected cystitis become restless (especially when emptying the bladder), may cry and be capricious, refuse to eat. The child may become lethargic or, on the contrary, overly excited. The baby's body temperature will remain within the subfebrile range. A decrease in the number of urinations may be noted.
• Older children may show their parents and the doctor that they have a tummy ache in the suprapubic area. The pain will be stronger when filling the bladder or palpating the abdomen. The child may cry during urination, urinate frequently, and produce little or no urine. Sometimes there is involuntary emptying of the bladder. At the end of urination, drops of blood may sometimes be seen in the urine.

To diagnose cystitis in children, various laboratory diagnostic methods are also used: general blood and urine analysis, blood biochemistry, bacterial culture, urine acidity test, two-glass test, urine tests according to Zimnitsky and Nechiporenko. Urine analysis is usually taken naturally, but in severe cases, a catheter is used.

It is also possible to prescribe an ultrasound, as well as cystoscopy and cytography, which are relevant for chronic cystitis.

When diagnosing acute cystitis, when quick results are needed, express methods can also be used:

• Express test for determining the content of nitrites in urine using an indicator strip (nitrites in urine appear under the influence of pathogenic microflora).
• A rapid test strip that shows the content of leukocytes and protein in urine.
• Leukocyte esterase reaction (esterase accumulates in urine if there is a purulent process in the urinary system).

If cystitis is suspected in a child, parents should pay attention to the appearance of the baby's urine, collecting a small amount of it in a clean transparent container. If the bladder mucosa is inflamed, the urine will be dark and not transparent enough, and light flakes and blood may be found in it.

Preparation

In order for the results of laboratory tests of urine and blood to be reliable, and for the doctor to be able to make an accurate diagnosis, not only the professionalism of the nurse in the manipulation room and the time of the test are important, but also proper preparation for it. Let's consider the question of how to properly prepare for and take blood and urine tests prescribed for cystitis.

A complete blood count is a laboratory test of blood taken from a patient's finger, which in the case of cystitis can show the presence of a moderate inflammatory reaction. Such a test does not require any special preparation. The only thing is that it is recommended to do it in the morning on an empty stomach, at least you can eat a light breakfast an hour before taking the test. During this same hour, doctors ask not to smoke.

As for nutrition 1-2 days before the test, it is better to avoid spicy and fried foods, as well as alcohol and medications. You cannot donate blood after an X-ray or physical therapy.

Urine analysis for cystitis may have to be taken more than once. This is a very important study that deserves special attention. Submitting urine collected in a jar in the toilet of a medical institution without preliminary preparation is unlikely to contribute to the correct diagnosis, because it may contain additional components that distort the results of the study.

What steps should be taken to prepare for a general urine test, on the basis of which a presumptive diagnosis is made:

• A day or two before taking urine tests, you need to slightly adjust your diet, refusing to eat foods that color your urine. These include: beets, carrots, strawberries, i.e. any fruits and vegetables that have a bright color.
• An important indicator of urine analysis is its acidity. In order for this indicator to remain reliable, acidic drinks, juices, mineral water, and salty foods will have to be excluded from the diet the day before the analysis.
• The smell of urine also plays a role in diagnostics. Some products can enhance it, so a strong ammonia aroma, typical of cystitis, will be felt. In this regard, it is not recommended to eat onions, garlic, asparagus and other products with a strong aroma the day before.
• Before the analysis, you should refrain from taking certain types of medications (diuretics and laxatives (including senna extracts), biseptol, sulfonamides).
• For women, there is a special restriction regarding menstruation. It is better to take the test after it ends, so that blood from menstrual discharge does not get into the urine, because such a situation can be observed with acute cystitis and stones in the urinary system, which will only distort the real diagnosis.

If the analysis is needed urgently, after hygiene procedures you will need to close the entrance to the vagina with a tampon.

• The material for general urine analysis must be fresh, i.e. collected in the morning before delivery. Otherwise, the composition of urine and acidity will change under the influence of air. An alkaline urine environment may indicate inflammation of the bladder and kidneys even in their absence.
• If you need to collect urine from a small child, you should not make the task easier by trying to squeeze the biomaterial out of a diaper or cotton wool placed under the baby, an old potty, or a used diaper (this is not as easy as it seems, and the test result may be questionable). You cannot use unsterilized baby food jars to collect urine. Urine should be collected directly from the source in a sterile container. For infants, use special urine collectors that are attached to the perineum (they can be purchased at a pharmacy).

Now, regarding the rules for taking a urine test, which are noticeably different for men and women. Common to all patients is the preliminary preparation of the container for the test. You can wash and sterilize a jar with a volume of no more than 250 ml, as was done before. But now in pharmacies you can buy a special sterile plastic container, which is designed to collect urine. In private clinics, such containers are issued during the referral for analysis.

How to properly collect urine for women:

• The structure of the female genitals is such that opportunistic microorganisms and physiological vaginal discharge regularly accumulate in the area of the urethra outside, which should not get into the biomaterial being examined. Therefore, it is very important for a woman to perform hygienic procedures before collecting urine, which include thorough cleaning of the external genitals, trying to cover all skin folds and the entrance to the vagina. Hygiene of the genitals is carried out using toilet or baby (not antibacterial) soap and water. It is better to use cotton pads or a clean napkin.
• It is more convenient to carry out hygiene procedures directly on the toilet, having previously washed your hands with soap. The direction of hand movement when washing should be from front to back (i.e. from the urethra to the anus), but not vice versa.
• After the hygiene procedures, we take the prepared container, trying to hold only the outer walls.
• With your free hand, spread your labia and release a few milliliters of urine into the toilet (the first urine will wash away any remaining microbes on the surface of your genitals).
• Still holding the labia, place the container under the urine stream and collect the biomaterial into it (the volume of urine should be within 50-100 ml, no more is needed).
• It is advisable to deliver the tightly closed container to the laboratory within half an hour. Urine retains its properties for 24 hours if it is placed in a closed container in the refrigerator in case it is not possible to deliver the material on time.

Preparation for a urine test for men is simpler, but still, a few recommendations can be given:

• Urine collection should be done with hands that are thoroughly washed with toilet soap. It is also advisable to wash the penis with warm water.
• We take the penis in our hand and pull back the foreskin (this is not relevant for circumcised men, for whom hygiene procedures are sufficient). We flush a small portion of the first urine into the toilet, and collect the middle portion in a container, directing the stream into it.
• When collecting urine, you should try to ensure that the penis does not touch the walls of the container.
• Next, we proceed in the same way as written in the rules for women.

If urine is taken from a child for analysis, parents must perform hygiene procedures themselves, because this requirement is mandatory for everyone. Teenagers can perform genital hygiene on their own, and the task of parents is to tell their daughter or son how to do it correctly and how to collect urine for analysis.

If the general urine analysis shows deviations from the norm, the doctor prescribes a urine analysis according to Nechiporenko. The doctor pays attention to the number of leukocytes, erythrocytes and cylinders. The biomaterial is the average portion of morning urine.

On the eve of the test, it is recommended to avoid foods that color urine, antibiotics, anti-inflammatory drugs, diuretics and laxatives. On the eve, you should limit the amount of liquid you drink.

After waking up, we perform hygienic procedures. Then follow the instructions for collecting urine for general analysis. We flush the first portion of urine into the toilet and take 25-50 ml of the middle portion. We finish urinating also into the toilet.

The biomaterial must be in the laboratory within the first two hours. There, a small amount of mixed urine is poured into a test tube and sent to a centrifuge for 3 hours. The sediment formed in this process is subject to examination, placed in the counting chamber of the microscope. The result must be multiplied by the appropriate coefficient at the end.

If kidney inflammation is suspected, a Zimnitsky urine test is performed, which reveals the kidneys' performance at different times. For this, urine is collected at 3-hour intervals throughout the day, including at night. Morning urine, excreted immediately after waking up, is flushed down the toilet.

Urine collection begins at 9 a.m. Collect all urine released during urination. Then collection is carried out at 12, 15, 18, 21, 24, 3 and 6 o'clock, i.e. 8 containers will need to be prepared in advance. The urine collected during the day is stored in the refrigerator and taken to the laboratory in the morning.

Fluid intake during urine collection should be within 1.5-2 liters. The laboratory calculates the total volume and density of urine, the amount of urine excreted at night and during the day.

The biomaterial for urine culture is collected identically to the OAM and Nechiporenko analysis. The first time it is submitted before the start of antibiotic treatment, the second time - after the end of treatment, which allows to evaluate the effectiveness of the treatment.

In order to identify where exactly the infectious process is occurring: in the kidneys or the bladder, a test is performed in Polymyxin (Neomycin can also be used). First, the bladder must be emptied. Then, using a catheter, an antibiotic solution is injected into it. After 10 minutes, a urine sample is taken. The absence of live microbes in the analysis indicates that the process is localized in the bladder.

Urine testing is carried out according to the following scheme:

• First, the urine is examined under a microscope,
• then the urine is directly sown in conditions suitable for the reproduction of bacteria (usually 2-3 media are used),
• When the number of bacteria increases, their properties are studied and the type of pathogen is determined.

The results of this analysis can be obtained after 4-5 days, while modern express methods allow conclusions to be made in just 2 days.

Preparation for urine collection is identical in all cases. But to identify the pathogen, it is especially important not to use antibacterial detergents and medications that distort the results of the tests.

Raising and lowering of values

Any tests prescribed for cystitis are intended to clarify the diagnosis or evaluate the effectiveness of the treatment. For an uninformed person, the appearance and smell of urine can tell little, while for a specialist any changes are significant.

So, what do tests show for cystitis? Let's start with the fact that a healthy person's urine can be light yellow or acquire the color of straw. If there is acute inflammation in the bladder, it becomes darker and acquires an orange or reddish tint, due to the entry of blood into the biomaterial from the organ walls damaged by the disease. The color will vary depending on the amount of blood released.

Normally, erythrocytes (red blood cells) may be present in urine, but no more than 2 units in the field of view. An increase in this indicator indicates an acute inflammatory process with damage to the tissues of the bladder. Usually, blood gets into the urine at the end of urination, so for a general analysis it is better to take the last drops.

Cloudiness of urine is also caused by an inflammatory process, as a result of which microbes, leukocytes, and epithelial cells enter the urine. Cloudiness of urine in a healthy person is possible only due to lack of hygiene.

The inner surface of the bladder and urethra is lined with epithelial cells, which are periodically renewed. In the urine of a healthy woman, there should be no more than 5-6 such cells in the field of vision (in men, no more than 3). Otherwise, we are talking about an inflammatory process characterized by increased rejection of epithelial cells. This process also causes the presence of mucus in the urine.

The presence of a bacterial infection in urine and its waste products cause the appearance of protein and some other components in the biomaterial, which lead to alkalization of the physiological fluid.

Bacterial components in urine during cystitis can be detected in varying quantities depending on the degree of inflammation.

The level of protein in urine during cystitis changes slightly. It can increase to 1 g per liter. A further increase in protein indicates kidney problems.

An increase in the level of leukocytes once again confirms the diagnosis of inflammation. Normally, a healthy woman should have no more than 6 protective cells in her field of vision, which ensure the fight against infection (in men, this figure is lower - 3-4 units). An increase in the number of leukocytes indicates that the body has become active in the fight against the disease.

If there are a lot of leukocytes and an admixture of pus can be seen in the urine, this indicates pyuria (purulent inflammation), which is considered a particularly serious condition.

In cystitis, the following remain unchanged in the analyses: specific gravity, glucose level, bilirubin, ketone bodies, urobilinogen, mineral composition (its change may indicate urolithiasis), and the number of cylinders.

Urine analysis according to Nechiporenko allows determining not only the diagnosis of inflammation, but also the localization of the disease. When deciphering this urine analysis, attention is paid to the number of leukocytes and erythrocytes (normally the former should be no more than 2000 per ml, and the latter 2 times less), as well as hyaline cylinders, the number of which in cystitis should remain unchanged (20 per ml). An increase in the level of hyaline cylinders and the appearance of other epithelial components not characteristic of the bladder mucosa indicates kidney pathologies.

The bacterial culture results will indicate the types of microorganisms detected, and the quantitative indicators will allow us to assess the quality of the biomaterial. In case of cystitis, the CFU should be within 100 per ml. If this indicator increases, we can suspect incorrect urine collection. If this indicator is 10 thousand or higher, then we are most likely talking about pyelonephritis.

Additionally, an analysis is made for the sensitivity of the identified culture to antibiotics, which is reflected in the results. The optimal drug will be the one that destroys the maximum number of bacterial cells in the study.

Zimnitsky's urine analysis is necessary if there is a suspicion that the inflammatory process has also affected the kidneys. Here, attention is paid to the increase and decrease of values.

For example, the amount of urine excreted per day should be within 1.5-2 liters. If the indicator is higher than 2 liters, this indicates polyuria, which is typical for diabetes of any type and renal failure.

If the amount of urine is less than 1.5 liters with normal drinking regimen, this indicates fluid retention in the body and edema syndrome caused by progressive renal failure.

During the day, more urine should be excreted than at night. Night urine should make up only a third of the total volume. In case of heart failure, the amount of night urine will be greater than daytime or slightly higher than normal. However, approximately equal amounts of urine collected during the day and at night will indicate impaired renal function. In this case, the result indicates a lack of kidney response to changes in the body's activity.

Now, regarding urine density. It should be within 1.012 to 1.025 g/ml, which is due to the difference in the amount of liquid drunk during the day. Reduced urine density may indicate pyelonephritis, chronic renal failure, heart failure, diabetes insipidus. This condition is called hyposthenuria.

Hypersthenuria (increased urine density) is detected in toxicosis of pregnancy, diabetes mellitus, and glomerulonephritis.

Cystitis tests are the most important diagnostic procedure, allowing not only to make an accurate diagnosis, but also to identify concomitant diseases that also require treatment. Such studies are also of great value for assessing the effectiveness of treatment, which makes it possible to avoid chronicity of the infectious and inflammatory process due to an incorrectly developed treatment regimen or inappropriate drugs.

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