Pneumaturia

Aka: Pneumaturia, Pneumatouria, Urine Bubbles, Gas in Urine, Emphysematous Cystitis, Emphysematous Pyelonephritis

1. Definitions
   1. Pneumaturia
      1. Gas passed with urination
   2. Emphysematous Cystitis
      1. Bladder wall infection with gas forming organisms (e.g. Proteus)
   3. Emphysematous Pyelonephritis
      1. Renal parenchymal infection with gas forming organisms (e.g. Proteus)
2. Causes
   1. Bladder instrumentation (cystoscopy)
   2. Fistula from bowel or vagina
      1. Complication from Crohn's Disease, Diverticulitis, cancer, Trauma
   3. Renal tumor infarction
   4. Urinary diversion
   5. Scuba Diving with p-valve (diverts urine outside suit)
   6. Urinary Tract Infection with gas forming organisms that ferment lactate (high risk, see precautions below)
      1. Results in Emphysematous Cystitis or Emphysematous Pyelonephritis
      2. Most common in poorly controlled Diabetes Mellitus
      3. Organisms (may cause staghorn calculi, high Urine pH)
         1. Proteus species
         2. Escherichia coli
         3. KlebsiellaPneumonia
         4. Candida
         5. Clostridium
3. Precautions
   1. Acute infection with Emphysematous Cystitis or Emphysematous Pyelonephritis
      1. Pneumaturia due to gas forming organism infection requires early diagnosis and broad spectrum antibiotics
      2. Delayed diagnosis is associated with high mortality (20%)
      3. Emphysematous Pyelonephritis
4. References
   1. Swadron and Schoenberger in Herbert (2018) EM:Rap 18(6):1
   2. Youssef (2013) Case Reports in Medicine
      1. https://www.hindawi.com/journals/crim/2013/730549/