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Cystitis cystica

Cystitis cystica is the same condition as ureteritis cystica and closely related to cystitis glandularis. It is a relatively common chronic reactive inflammatory disorders that occur in the setting of chronic irritation of the bladder mucosa.

Epidemiology

Cystitis cystica is seen in a variety of patients, who all have chronic bladder inflammation as a uniting features. The underlying causes include: 

Pathology

Chronic irritation from infection, calculi or even tumours results in metaplasia of the urothelium, which proliferates into buds, which grow down into the connective tissue beneath the epithelium in the lamina propria. In the case of cystitis cystica, the buds then differentiate into cystic deposits  (whereas in cystitis glandularis it they differentiate into goblet cells). Indeed, in most cases examples of both conditions can be identified histologically. 

Radiographic features

 Whether imaged with conventional intravenous excretory urography or more recently with a CT urogram,  the appearance is that of multiple small 2 - 5mm smooth walled rounded lucent filling defects projecting into the lumen. Rarely they can be up to 2-3 cm in size 2-3.

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. An association with adenocarcinoma of the bladder has been described, and thus these patients should be monitored.

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