Encrusting cystitis caused by Corynebacterium urealyticum: literature review

Encrusting cystitis represents an exceptionally rare form of chronic bladder inflammation, characterized by bladder wall calcification. The predominant causative agent is Corynebacterium urealyticum, a gram-positive multidrugresistant bacillus. The pathogenic potential of C. urealyticum is attributed to its elevated urease activity, which initiates a cascade of urea decomposition into carbon dioxide and ammonia. This process results in hyperammoniuria and urine alkalization within the initial 24-hour period. The most significant predisposing factors for encrusting cystitis development include the presence of foreign bodies within the urinary system, such as urethral catheters, nephrostomy tubes, and internal ureteral stents, as well as a history of endoscopic urinary system interventions. Diagnostic suspicion of C. urealyticum presence in urine should be raised in cases of sterile urine according to standard microbiological examination results, elevated urine pH (typically up to 9.0 pH), crystalluria, and the detection of encrustations via imaging diagnostic modalities. Isolation of C. urealyticum necessitates cultivation for 48-72 hours at 370C on a medium enriched with blood or carbon dioxide; however, pathogen detection has been documented only after 90h of cultivation in certain instances. Therapeutic management of encrusting cystitis should encompass three primary components: antibacterial therapy, urinary acidification, and removal of encrustations harboring pathogen biofilms. The systematic review conducted within this study involved the analysis of documented clinical cases of encrusting cystitis, as well as an evaluation of treatment modalities employed by various specialists.