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Letters to the Editor  |   August 2010
Importance of Obtaining a Detailed Medical History in Diagnosing Emphysematous Cystitis
Author Affiliations
  • Adam W. Ylitalo, DO
    Urological Surgery Resident, Detroit Medical Center, Michigan
Article Information
Urological Disorders
Letters to the Editor   |   August 2010
Importance of Obtaining a Detailed Medical History in Diagnosing Emphysematous Cystitis
The Journal of the American Osteopathic Association, August 2010, Vol. 110, 487. doi:10.7556/jaoa.2010.110.8.487
The Journal of the American Osteopathic Association, August 2010, Vol. 110, 487. doi:10.7556/jaoa.2010.110.8.487
To the Editor:  
In the February case report by Jeremy K. Selley, DO, and colleagues1 regarding emphysematous cystitis, the authors state that pneumaturia is “the characteristic pathognomonic finding in emphysematous cystitis.” However, I would like to point out that pneumaturia is more commonly associated with a colovesical fistula—in 52% to 77% of cases, often a result of Crohn's disease or diverticulitis2—than with emphysematous cystitis. Thus, a finding of pneumaturia in a patient's medical history would not necessarily be indicative of emphysematous cystitis, as Selley et al1 imply. 
Furthermore, the statement by Selley et al1 that emphysematous cystitis has a 20% mortality rate is erroneous, as suggested by the fact that this condition rarely calls for surgical debridement. By contrast, the similarly named but very different entity of emphysematous pyelonephritis, which has a reported mortality rate of 19% to 43%,3 often calls for emergency surgical debridement to save lives. 
Selley JK, Kane BG, Kane KE. Importance of obtaining a detailed medical history in diagnosing emphysematous cystitis. J Am Osteopath Assoc. 2010;110(2):91-94. http://www.jaoa.org/cgi/reprint/110/2/91. Accessed June 14, 2010.
Rovner E. Urinary tract fistula. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier; 2010:2351 .
Schaeffer A, Schaeffer E. Infections of the urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier; 2010: 272.