BMJ 1996;313:1079 (26 October)

Letters

Should be managed in urological units

EDITOR,--We take issue with several points in Linda Cardozo's editorial on postmenopausal cystitis.1 The comment that "for those women in whom oestrogen therapy is ineffective or inappropriate, it is important to exclude underlying pathology" is misleading as it implies that oestrogen should be given before adequate assessment and investigation. The author should have mentioned that urothelial carcinoma should be excluded by microscopical examination of urine for red cells, followed if indicated by cytological examination of urine and flexible cystourethroscopy, before oestrogen is started after antibiotic treatment for bacterial cystitis.2

The coexistence of vaginal and urethral stenosis with atrophic vaginitis is well known and is best treated with a combination of urethral dilatation and intravaginal oestrogen for long term success.3

Bacterial cystitis can be difficult to distinguish from bladder carcinoma, especially carcinoma in situ. Interstitial cystitis has clearly defined diagnostic criteria,4 including a particular symptom complex, a systemic response to endoscopic . . . [Full text of this article]


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Relevant Article

Postmenopausal cystitis
Linda Cardozo
BMJ 1996 313: 129. [Extract] [Full Text]

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