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Urology

Pyocystis

Pyocystis is a severe form of lower urinary tract infection that results from the collection of purulent debris within the bladder. Pyocystis is sometimes referred to in the literature as ‘empyema cystis’ and ‘vesical empyema.’ Pyocystis is an uncommon condition that occurs exclusively in the defunctionalized bladder. It can cause a severe systemic infection and result in prolonged hospital stays, surgery, and death. To optimize outcomes and reduce morbidity, early identification and treatment m

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • It can cause a severe systemic infection and result in prolonged hospital stays, surgery, and death.
  • Pyocytis will typically present with suprapubic pain, malodorous discharge from the urethra, and fevers for several days prior to admission.
  • In more severe cases, there may also be other systemic signs of infection, such as loss of appetite, nausea, and vomiting.
  • The clinician may find tachycardia, hypotension, and pyrexia when taking basic vital signs.
  • In patients displaying signs of urosepsis, initial treatment should include fluid resuscitation and administration of broad-spectrum IV antibiotics.
  • Sepsis and the corresponding complication can also occur in patients with pyocystis and can result in death.
  • Blood tests often show leukocytosis and a raised C-reactive protein (CRP).
  • Blood cultures should be taken; however, these often do not isolate an organism.
  • All patients with a differential of pyocytis should be catheterized.
  • A sample of the bladder contents should be taken for microbiology, cultures, and sensitivities.
  • The diagnosis of pyocytis can be aided by using computed tomography (CT) and ultrasound.
  • CT scanning with IV contrast is preferred for investigation.
  • Investigation and diagnosis of pyocytis may also include cystoscopy to aid bladder access, evacuate toxic collections, and biopsy thick-walled bladder to exclude malignancy.
  • In patients displaying signs of urosepsis, initial treatment should include fluid resuscitation and administration of broad-spectrum IV antibiotics.
  • Immediate catheterization of the patient is important in patients with suspected pyocystis.
  • Following catheterization, bladder irrigation should be used to prevent the re-accumulation of infected debris and to assist in clearing the initial collection.
  • This can be continuous irrigation using a three-way catheter or can be done using frequent bladder washouts.
  • Intra-vesical antibiotics have been used to treat pyocytis, typically gentamycin or neomycin.
  • Normal saline is also an option.
Normal saline
Intra-vesical
Adult
Not specified in source
Renal
Not specified in source
Duration
Not specified in source
  • a cystectomy may be necessary in cases with resistant infection.
  • Alternatively, in sexually inactive females, the Spence-Allen procedure can be considered to prevent the development of pyocytis.
  • This involves the creation of a vesicovaginal fistula to allow continuous drainage of bladder contents through the vagina.
  • Cystectomy may be necessary for patients not responding to IV antibiotics and irrigation.
  • Severe non-resolving infections require surgical management with either the Spence-Allen procedure or total cystectomy.
  • Irrigation should be continued in the community for up to 3 months, several times a week, to attempt to eradicate any infection.
  • Complications of pyocytis include the need for surgical management, including the need for a total cystectomy.
  • Sepsis and the corresponding complication can also occur in patients with pyocystis and can result in death.
  • Delayed intervention may result in the need for surgical intervention and a poorer prognosis.
  • All team members must engage in open communication and meticulous record keeping of each patient encounter and report to other team members if there are any patient status changes or concerns.
  • review
    Pyocystis. StatPearls [Internet] — Holly C. Brownlee, James Richards, Neil D. Trent — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov