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Cystitis Cystica

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.


Presentation

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 [1]. 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 [2].

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 [3] [4] [5] [6] [7].

Fecal Incontinence
  • Edited and authored by some of the most respected figures in the field, this newly revised book is your comprehensive guide to all areas of urogynecology, including urinary and fecal incontinence, urodynamic testing, management of genuine stress incontinence[books.google.com]
Dysuria
  • 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.[symptoma.com]
  • .  Irritative voiding symptoms:  Frequency  Dysuria  Urgency  Bacteruria  Gross hematuria  Chronic UTI  They may complain of voiding mucus  Less frequently: ureteral obstruction and subsequently hydronephrosis. 12.[slideshare.net]
  • The main symptoms of cystitis are: Discomfort when urine is passed an a stinging/burning pain in the urethra (‘dysuria’) Frequency of urination and an urgent need to go, often only passing small amounts Urgency even when the bladder is empty Dark or cloudy[bladder-help.com]
  • Nine months following transurethral fulguration, 8/11 (72.7%) patients were in complete remission and 1/11 (9.1%) complained of urgency and dysuria; two patients were lost to follow‑up.[spandidos-publications.com]

Workup

The differential diagnoses of cystitis cystica include intestinal metaplasia, the nested variant of urothelial carcinoma and adenocarcinoma [8] [9].

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 [3] [10] [11] [12].

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 [4] [13]. 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 [7] [14].

Prostatic Lesion
  • I was intrigued by the appearance of this small bubble close to the upper surface of the prostate and was confused if this was a prostatic lesion or a bladder pathology. Much research on the net confirmed that this was indeed cystitis cystica.[ultrasound-videos.blogspot.com]
Lymphocytic Infiltrate
  • Several abnormal features were observed in the adjacent urothelium, including large intracellular vacuoles (4 patients), Brunn's nest (5), lymphocyte infiltration (10) and generally disorganised urothelial architecture (10).[ncbi.nlm.nih.gov]

Treatment

  • Conservative treatment and TUR of the lesions had no effect on the symptoms.[ncbi.nlm.nih.gov]
  • Patients with cystitis cystica are a hard core group requiring long-term treatment and follow-up. Different therapeutic methods are discussed and our experience with chlorhexidine bladder instillation is mentioned.[ncbi.nlm.nih.gov]
  • Infection was controlled equally with both drugs but, despite adequate control, 24% had evidence of cystic changes upon completion of the treatment period. An additional 44% became reinfected during the 1-year followup with no drugs.[ncbi.nlm.nih.gov]
  • Contains a new section on painful and irritative voiding disorders, including a discussion of overactive bladder and the latest treatment options available.[books.google.com]
  • Treatment of Cystitis Cystica If present, treatment of urinary tract infection. Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z References Deutsche Version: Zystitis cystica[urology-textbook.com]

Prognosis

  • Cystitis cystica is a derivative of the focal epithelial proliferation, the associated tumors tend to be non-infiltrating papillary and the prognosis is good.[ncbi.nlm.nih.gov]
  • Factors 7-49 82 Genetic Predisposition and Syndromic Associations 8-1 83 Clinical Features and Natural History of Bladder Cancer 8-2 84 Morphologic Characteristics of Invasive Urothelial Carcinoma 8-10 85 Urothelial Carcinoma in Young Adults 8-14 86 Prognosis[books.google.com]
  • Treatment and prognosis Treatment consists of removing the source of irritation and surgical excision of the area of inflammation or cystectomy in rare severe cases.[radiopaedia.org]
  • CLINICAL ISSUES Presentation Usually incidental finding When florid, small raised lesion with intact urothelium may be seen Rare cases with intestinal metaplasia and extensive mucin extravasation may form large mass lesion that can mimic malignancy Prognosis[basicmedicalkey.com]
  • If a patient is diagnosed with cystitis cystica, the doctor can provide information about the available treatment options and the prognosis with different choices.[wisegeekhealth.com]

Etiology

  • Cystitis cystica: benign inflammatory reaction of the urothelium to infection or mechanical irritation Etiology and Pathology of Cystitis Cystica Cystitis cystica is an inflammatory reaction of the urothelium to infection or mechanical irritation.[urology-textbook.com]
  • […] columnar luminal cells are present Cystitis glandularis Cystitis cystica with luminal cuboidal or columnar lining cells Cystitis glandularis with intestinal metaplasia (intestinal type) Cystitis glandularis with at least focal intestinal-type goblet cells ETIOLOGY[basicmedicalkey.com]
  • Granulomatous cystitis The histologic features of granulomatous cystitis depend on the etiology. Infection with tuberculosis presents as caseating granulomas with Langerhans giant cells predominantly in the lamina propria.[emedicine.medscape.com]
  • Immunohistochemical evaluation of its etiology and differentiation from prostatic adenocarcinoma. Arch Pathol Lab Med 2006; 130 :805–810. 14. Tong GX, Weeden EM, Hamele-Bena D, et al.[nature.com]
  • "Etiology, pathogenesis, and diagnosis of interstitial cystitis". Rev Urol. 4 Suppl 1: S9–S15. PMC 1476007. PMID 16986036. Kind T, Cho E, Park TD, Deng N, Liu Z, Lee T; et al. (2016).[wikidoc.org]

Epidemiology

  • Considerations 7-3 74 Histopathology and Diagnostic Criteria 7-4 75 Variants of Urothelial Carcinoma in Situ 7-9 76 Differential Diagnosis 7-31 77 Diagnostic and Predictive Biomarkers 7-34 78 Prognosis 7-37 79 Molecular Characteristics 7-40 References 7-42 81 Epidemiology[books.google.com]
  • We report 4 cases of cystitis glandularis, we analyze the epidemiological, clinical, biological, pathological and therapeutic of this affection. In the last 5 years we treated four patients with cystitis glandularis.[webmedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Acute Uncomplicated Cystitis Acute uncomplicated cystitis is an inflammation of the urinary bladder that occurs in the absence of any structural or functional pathology.[wikidoc.org]

Prevention

  • Study results suggested that early control of urinary tract infections by chemoprophylaxis could prevent higher grades of bladder wall mucosal changes and consequently shorten the length of chemoprophylaxis.[ncbi.nlm.nih.gov]
  • Prevention Cystitis is often not preventable, but the following measures may help: practicing good hygiene after sex using neutral, unperfumed soaps around the genitals.[medicalnewstoday.com]
  • This prevents bacteria in the anal region from spreading to the vagina and urethra. Take showers rather than tub baths. If you're susceptible to infections, showering rather than bathing may help prevent them.[mayoclinic.org]
  • Stasis of urine flow allows entry of pathogens into the urinary tract and also hinders the natural preventive mechanism by which urine flushes away the pathogens and prevents colonisation in the urinary tract. [1] [5] [6] [7] Recurrent/Chronic cystitis[wikidoc.org]
  • Stress reduction can benefit the immune system and help to treat and prevent UTIs. [4] Naturopathic Therapies The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal[ndhealthfacts.org]

References

Article

  1. Capozza N, Collura G, Nappo S, de Dominicis M, Francalanci P, Caione P. Cystitis glandularis in children. BJU Int. 2005;95:411–413.
  2. Nariculam J, Patel A, Murphy D, Rane A. Cystitis Cystica Causing Bilateral Ureteric Obstruction. Internet J Urol. 2006;4(3).
  3. Wong-You–Cheong JJ, Woodward PJ, Manning MA, Davis CJ. Inflammatory and Nonneoplastic Bladder Masses: Radiologic-Pathologic Correlation. RadioGraphics 2006;26(6);1847-1868. doi:10.1148/rg.266065126.
  4. Menéndez V, Sala X, Alvarez-Vijande R, Solé M, Rodriguez A, Carretero P. Cystic pyeloureteritis: Review of 34 cases. Radiologic aspects and differential diagnosis. Urology. 1997;50(1):31–37. doi:10.1016/s0090-4295(97)00205-7.
  5. Rothschild JG, Wu G. Ureteritis Cystica: A Radiologic Pathologic Correlation. J Clin Imaging Sci. 2011;1:23.
  6. Vlatković G, Bradić I, Gabrić V, Batinić D. Cystitis cystica: characteristics of the disease in children. Br J Urol. 1977;49(1):57-9.
  7. Raja J, Anson K, Patel U. Cystitis cystica and cystitis glandularisPresentation with acute ureteric obstruction. Clinical Radiology Extra. 2003;58(6):43-4.
  8. Smith AK, Hansel DE, Jones JS. Role of Cystitis Cystica et Glandularis and Intestinal Metaplasia in Development of Bladder Carcinoma. Urology. 2008;71:915–8.
  9. Volmar KE, Chan TY, De Marzo AM, et al. Florid von Brunn nests mimicking urothelial carcinoma: a morphologic and immunohistochemical comparison to the nested variant of urothelial carcinoma. Am J Surg Pathol. 2003;27:1243–52.
  10. J Nariculam, A Patel, D Murphy, A Rane. Cystitis Cystica Causing Bilateral Ureteric Obstruction. Internet J Urol. 2006;4(3).
  11. Hochberg DA, Motta J, Brodherson MS. Cystitis glandularis. Urology. 1998;51:112–113.
  12. Lee G, Tsiriopoulos I, Yajnik K, Smith R, Pancharatnam M. Cystitis glandularis mimics bladder tumour: a case report and diagnostic characteristics. Int Urol Nephrol. 2005;37:713–715.
  13. Argüelles Salido E, Rodríguez Corchero J, López García MA, Pérez Espejo MP, Campoy Martínez P, Pena Outeiriño JM. Cystic ureteritis in a kidney transplantation candidate. Actas Urol Esp. 2005;29:226–9.
  14. Ito N, Hirose M, Shirai T, Tsuda H, Nakanishi K, Fukushima S. Lesions of the urinary bladder epithelium in 125 autopsy cases. Acta Pathol Jpn. 1981;31(4):545-57.

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Last updated: 2018-06-22 07:49