Ureteritis cystica or pyeloureteritis cystica is a benign condition of the ureters representing multiple small submucosal cysts. It results from chronic urinary tract irritation, due to stones and / or infection.
Typically this condition is seen in diabetics, with recurrent urinary tract infection. As such is is most frequently seen in older patients and is more common in women.
Histologically there are numerous small submucosal epithelial-lined cysts representing cystic degeneration of metaplastic epithelium or submucosal Brunn cell nests 1-3. Their walls are transparent macroscopically, and the fluid contained within is mucoproteinacous. There is often a surrounding infiltrate of lymphocytes 4.
Organisms frequently involved include:
- E. coli : most common
- M. tuberculosis
- Proteus sp.
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, usually of the ureter. Rarely they can be up to 2-3 cm in size 2,4.
They are most common in the proximal ureter, but can be seen anywhere along the urinary tract : bladder (cystitis cystica) or renal pelvis (pyelitis cystica). The condition is demonstrated bilaterally in up to 50% of cases 4.
Treatment and prognosis
Usually no treatment is required for ureteritis cystic per se, but rather the underlying cause of chronic infection may need treatment (e.g. nephrolithiasis). In such cases the condition may resolve. Often, when no treatable underlying condition is present, the appearance remains stable over time 4.
There is perhaps and increased incidence of formation of transitional cell carcinoma (TCC) although this may relate to the common underlying cause of chronic inflammation rather than ureteritis cystica ref needed.
The differential is that of multiple filling defects of the ureter and includes:
- 1. Kawashima A, Vrtiska TJ, Leroy AJ et-al. CT urography. Radiographics. 2004;24 Suppl 1 (suppl 1): S35-54. doi:10.1148/rg.24si045513 - 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. Petersen RO, Sesterhenn IA, Davis CJ. Urologic pathology. Farrar, Straus, and Giroux. (2009) ISBN:0781753430. Read it at Google Books - Find it at Amazon
- 4. 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
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Cystic degeneration of the urethral mucosa||✗|
|Pyelourethral bullous dystrophy||✓|