Ureteritis cystica or pyeloureteritis cystica is a benign condition of the ureters representing multiple small submucosal cysts.
Typically, this condition is seen in diabetics with recurrent urinary tract infections. As such, it is most frequently seen in older patients and is more common in women.
Ureteritis cystica results from chronic urinary tract irritation due to stones and/or infection. Organisms frequently involved include:
- E. coli (most common)
- M. tuberculosis
- Proteus spp.
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.
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, 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 occurs bilaterally in up to 50% of cases 4.
Treatment and prognosis
Usually, no treatment is required for ureteritis cystica 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 an increased incidence of formation of transitional cell carcinoma (TCC) 5, although this may relate to the common underlying cause of chronic inflammation rather than the disease itself 6,8.
History and etymology
The first to report of this entity was Morgagni in the late 18th century 7. The first to describe it were Richmond and Robb 5.
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
- 5. Richmond HG, Robb WA. Adenocarcinoma of the ureter secondary to ureteritis cystica. Br J Urol. 1967;39 (3): 359-63. Pubmed citation
- 6. Kilic S, Sargin SY, Gunes A, Ipek D, Baydinc C, Altinok MT. A rare condition: The ureteritis cystica. A report of two cases and review of literature. Inonu Universitesi Tip Fakultesi Dergisi. 2003;10:87–9
- 7. Morgagni JB. London: William Cooke Translation; 1822. De sedibus et causis morborum per anatomen indagatis libri quinque; pp. 316–411.
- 8. Mahboubi S, Duckett JN, Spackman TJ. Ureteritis cystica after treatment of cyclophosphamide-induced hemorrhagic cystitis. Urology. 1976;7 (5): 521-3. Pubmed citation