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.
Cystitis cystica is seen in a variety of patients, who all have chronic bladder inflammation as a uniting features. The underlying causes include:
- chronic bladder outlet obstruction
- chronic infection
- bladder calculi
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 they differentiate into goblet cells). Indeed, in most cases examples of both conditions can be identified histologically.
Whether imaged with conventional intravenous excretory urography or more recently with a CT urogram, the appearance is that of multiple small 2-5 mm 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.
- 1. Wong-you-cheong JJ, Woodward PJ, Manning MA et-al. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics. 26 (6): 1847-68. doi:10.1148/rg.266065126 - Pubmed citation
- 2. Provenzale JM, Nelson RC, Radiology DU. Duke radiology case review, imaging, differential diagnosis, and discussion. Lippincott Williams & Wilkins. (1997) ISBN:0397516134. Read it at Google Books - Find it at Amazon
- 3. Joffre F, Otal P, Soulie M. Radiological imaging of the ureter. Springer Verlag. (2003) ISBN:3540655212. Read it at Google Books - Find it at Amazon