Cystitis cystica is defined as a benign, proliferative disorder of the bladder, resulting from hyperplasia of the submucosa, typically as a response to infection or irritation. The condition may lead to bladder adenocarcinoma.
Cystitis cystica usually develops in the elderly and occasionally in children, a prevalence of 2.4% has been reported in children with urinary tract infections . It has the same clinical presentation as cystitis, but on cystoscopy it can be mistaken for a malignant lesion. Cystitis cystica is considered a premalignant condition and may progress to adenocarcinoma of the bladder .
Frequently no specific symptoms can be attributed to the disease and it is mostly detected incidentally by ureteroscopy or radiography for other complaints. However, in symptomatic cases, painless hematuria and various other symptoms such as dysuria, urinary frequency and urgency occur. Mucus may rarely be secreted in the urine. Cystitis cystica affecting the orifices of ureters in the bladder can contribute to reflux. The bladder neck involvement may result in vesical outlet obstruction     .
On cystoscopy, nodules are often found in the bladder neck and trigone region and the mucosa has a cobblestone pattern. The muscular layer should be unaffected, which is considered a feature that can distinguish cystitis cystica from urothelial carcinoma. A young age of a patient should raise the suspicion that the lesion is benign, but a cystoscopic biopsy is required to make a definitive diagnosis. Histological evaluation reveals nests of columnar epithelial cells in the submucosa that surround a central region of liquefied columnar degeneration    .
Earlier the preferred diagnostic tools for cystitis cystica were intravenous pyelography (IVP) and retrograde urography. However, magnetic resonance tomography and computed tomography have become more accurate and available. Despite these technical advances, imaging studies can be inadequate to diagnose some patients in which case a cystoscopy is the definite approach used for diagnosis  . Using imaging modalities, cystitis cystica generally appears as discrete and multiple masses that elevate the urothelium. However, the radiological appearances are non-specific and may be mistaken for a malignancy  .