Author: Dr. Aleksandar Bocevski, Urologist at Hill Clinic
Dr. Bocevski, what are chronic and recurrent cystitis?
In everyday clinical practice, we often encounter patients whose complaints go beyond the definition of a “simple infection.” When burning, frequent urination, and pelvic pain become persistent, the focus of treatment must shift from temporarily suppressing bacterial growth to restoring the structural integrity of the bladder. Patients often do not distinguish between the different conditions, but for us as specialists, this distinction is crucial. Acute cystitis is a single episode, usually of bacterial origin, that responds quickly to standard treatment. Recurrent cystitis involves repeated episodes of inflammation (several times a year), requiring attention to the immune system and local defense mechanisms. When symptoms persist despite antibiotic treatment, a deeper cause must be sought—usually damage to the tissue itself.
Which symptoms most often indicate a chronic condition?
The complaints patients report are often underestimated or treated only symptomatically, but they are a clear signal of chronicity:
- Strong and persistent urge to urinate
- Very frequent urination (pollakiuria), including at night (nocturia)
- Burning and pain deep in the bladder
- Sensation of incomplete bladder emptying
- Constant discomfort in the pelvic area
What is interstitial cystitis (IC)?
Interstitial cystitis is a chronic inflammatory condition often mistaken for a common infection, but antibiotics do not provide lasting relief. Patients experience severe pain and pressure, and their quality of life is significantly impaired. In Bulgaria, we already have access to innovative instillation therapy recommended by leading specialists for managing this condition.
How does OAB differ from cystitis and how is it recognized?
It is important to distinguish cystitis from OAB (overactive bladder). In OAB, urges are sudden and urgent, sometimes accompanied by incontinence, but infection or pain is not necessarily present. However, the two conditions may coexist, requiring precise diagnosis and a different therapeutic approach by the urologist.
What should patients know after radiotherapy?
Patients who have undergone radiotherapy in the pelvic area should be aware that they may develop radiation cystitis. This is not an infection, but a structural damage to the mucosa, manifested by pain, frequent urges, and sometimes blood in the urine. In such cases, restoring the protective layer is critically important.
Why do infections recur?
The causes of chronic recurrent infections are usually related to a disrupted protective barrier (GAG layer). The mucosa becomes an “open door” to the aggressive components of urine. Another reason is incomplete recovery, as tissues fail to fully regenerate between episodes. Unfortunately, self-treatment also leads to the risk of frequent or improper antibiotic use, which in turn causes resistance. Recurrence is a signal for the need of a specialized approach and restoration of the GAG layer.
Gepan® instill contains chondroitin sulfate—a natural building block of the protective layer. By direct instillation into the bladder, the solution temporarily replaces the missing barrier, allowing the inflamed tissue to recover. This is an effective solution for chronic and interstitial cystitis, as well as radiation-induced damage.
In which other situations do you recommend Gepan?
Urothelial protection is also indispensable in male urology, especially in cases requiring preoperative preparation for laser surgery (HoLEP). It stabilizes the mucosa and reduces irritative symptoms after surgery.
Another group of patients who may benefit are those with long-term catheter use, often due to BPH. It helps manage inflammation and trauma caused by prolonged catheterization in cases of enlarged prostate.
When should you consult a urologist?
Consultation is essential when symptoms do not respond to standard treatment, when there are frequent recurrences (more than twice within 6 months), or when persistent pelvic pain is present.
Patients usually seek help when their quality of life is impaired due to inflammation. It is important to understand that chronic cystitis is a complex condition requiring precise differential diagnosis and an individualized treatment plan. At Hill Clinic, we apply multidisciplinary and combined treatment approaches, along with long-term follow-up. Our main goal is not just temporary suppression of inflammation, but comprehensive symptom control and long-term improvement in our patients’ quality of life.