Cystitis cystica

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

Epidemiology

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

• chronic bladder outlet obstruction
  • pelvic lipomatosis
  • benign prostatic hypertrophy
  • bladder TCC
• chronic infection
• bladder calculi

Pathology

Chronic irritation from infection, calculi, or even presence of tumors, result 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, both conditions can be shown to coexist histologically.

Radiographic features

Whether imaged with conventional intravenous excretory urography or, more recently, with a CT urogram, the appearance is that of multiple, small (2-5 mm) smooth walled, rounded, lucent filling defects projecting into the lumen. Rarely, they can reach 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, in rare severe cases, cystectomy. An association with adenocarcinoma of the bladder has been described; thus, these patients should be monitored.