Etiología, patogénesis, diagnóstico y tratamiento de la cistitis y pielitis incrustada: Revisión del problema desde una perspectiva histórica
DOI:
https://doi.org/10.48193/epnjed16Palabras clave:
Cistitis, pielitis, incrustaciones, infección., cistitis, pielitis, incrustaciones, infecciónResumen
Introducción: La cistitis incrustada y la pielitis comparten muchas similitudes con respecto a etiología, patogénesis, diagnóstico y tratamiento. Estos procesos suelen ocurrir sobre un tejido urológico previamente lesionado con la participación de una infección por bacterias productoras de ureasa. En el momento actual, Corynebacterium urealyticum, una bacteria altamente resistente a los antibióticos parece ser el patógeno que más a menudo se ve involucrado en estos procesos. En esta revisión analizamos la historia de estas enfermedades remarcando los avances científicos del último siglo. También revisamos el papel de la ureasa y de la infección bacteriana, así como una breve actualización de los aspectos epidemiológicos, histopatológicos, diagnósticos y terapéuticos.
Relevancia: Se desea remarcar la importancia y gravedad de estas patologías que son frecuentemente infradiagnosticadas y que son de difícil tratamiento.
Conclusiones: La historia clínica, datos exploratorios y analíticos en donde destaca una orina alcalina, a veces con olor amoniacal, piuria, hematuria y presencia de cristales de fosfato amónico magnésico debe alertar al urólogo sobre la existencia de una uropatía incrustante. La radiología simple, ecografía, tomografía computarizada y la visualización endoscópica de las lesiones confirman el diagnóstico. El tratamiento generalmente precisa de cirugía, uso de antibióticos, acidificantes urinarios e inhibidores de la ureasa bacteriana.
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