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UROLOGICAL IMAGES
Year : 2016  |  Volume : 32  |  Issue : 4  |  Page : 329-330
 

Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication


1 Department of Paediatric Surgery, Dr. B. C. Roy PGIPS, Kolkata, West Bengal, India
2 Department of Anesthesiology, Dr. B. C. Roy PGIPS, Kolkata, West Bengal, India

Date of Web Publication28-Sep-2016

Correspondence Address:
Dr. Pankaj Halder
Saroda Palli, Panchanon Tala, Baruipur, Kolkata - 700 144, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.189718

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   Abstract 

Cystitis cystica (CC) is aproliferative disorder of bladder urothelium and usually subsides with medical therapy. However, this is not true for severe CC where surgical intervention is required to control breakthrough urinary tract infection (UTI). It may be mistaken as bladder neoplasm or posterior urethral valve, especially in children. Here, we report a case of CC in a 2-year-old boy where we had to excise the large pedunculated intravesical lesion to control breakthrough UTI and ongoing renal damage.


Keywords: Bladder outlet obstruction, cystitis cystica, cystitis glandularis, metaplasia, urinary tract infection


How to cite this article:
Halder P, Mandal KC, Mukherjee S. Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication. Indian J Urol 2016;32:329-30

How to cite this URL:
Halder P, Mandal KC, Mukherjee S. Prolapsing cystitis cystica causing bladder outlet obstruction: An unusual complication. Indian J Urol [serial online] 2016 [cited 2019 Nov 12];32:329-30. Available from: http://www.indianjurol.com/text.asp?2016/32/4/329/189718



   Introduction Top


Cystitis cystica (CC) is a histopathological term of hyperproliferative bladder urothelium. Recurrent urinary tract infection (UTI) acts as a most potential stimulus for CC. Moreover, it has a positive feedback loop over the disease process. [1] About 22% of UTIs are complicated as CC in children. Long-term chemoprophylaxis, chlorhexidine instillation in the bladder, and transurethral resection are the recommended treatment methods for CC. [2] Surgical intervention in the form of excision of the lesion, resection of bladder, and supravesical diversion of urine are needed in cases which failed with all other lesser invasive procedure.


   Case report Top


A 2-year-old boy was referred to us as a case of bladder outlet obstruction with suspected posterior urethral valves (PUV). He had a history of difficulty in micturition, recurrent UTI, and hematuria for which he was being treated elsewhere. Ultrasonography (USG) showed an echogenic and irregular intravesical lesion (30 mm × 20 mm). Micturating cystourethrogram (MCU) suggested bilateral vesicoureteral reflux (VUR) and persistent filling defect in the bladder, as well as in the dilated and elongated posterior urethra [Figure 1]. In accordance with the reports, we inferred it may be a case of PUV. On cystoscopy, there was a fleshy mass in the posterior urethra and bladder but no evidence of PUV. The biopsy from the mass reported as CC.{Figure 1}

Intravenous antibiotic failed to control the symptom (acute retention of urine and breakthrough UTI) and a urethral catheter was kept in situ for a long time. Subsequently, surgical intervention was planned.

On exploration, a pedunculated lesion was found in the bladder. It had a narrow base and thus, could be excised completely without compromising the bladder wall and urothelium [Figure 2]. Initially, there was dribbling of urine which dramatically improved with voiding management. A repeat MCU after 6 months showed an insignificant postvoid residual urine and no VUR. There was no evidence of recurrence and patient was doing well in 2 years follow-up.{Figure 2}


   Discussion Top


Microscopically, CC looks like miliary cystic structures lined by cuboidal or columnar epithelium. With time, the lining epithelium differentiates into intestinal columnar mucin-secreting glands (goblet cells), termed as cystitis glandularis. [3] The clinical behavior of CC may be indistinguishable from PUV and bladder neoplasm because of (i) similar presenting symptoms, (ii) comparable intravesical specific mass lesion in USG, (iii) corresponding intravesical filling defect in intravenous urogram or MCU, and (iv) common complications. Apart from PUV, the other possibilities of dilated and elongated posterior urethra are prolapsing bladder mass, congenital urethral stricture, foreign body in the urethra, and prolapsing lesion of CC. The specific surgical approach for CC is not clearly defined in literature. Each of the recommended surgical options needs to be selected carefully considering the lesion (size, origin, and severity), patient's profile, and renal functional status. [4] Zaharani and Pandyan performed supravesical diversion of urine in a complicated case of CC with compromised renal function. [5] They also suggested prompt surgical intervention in cases which failed with all other lesser invasive procedure.

Acknowledgments

The authors would like to thank Prof. Bidyut Debnath, Head of the Department, Pediatric Surgery, PGIPS, Kolkata, and Prof. Madhumita Mukhopadhyay (MD), Department of Pathology, IPGMR, Kolkata.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Vrljicak K, Turudic D, Bambir I, Gradiski IP, Spajic B, Batinic D, et al. Positive feedback loop for cystitis cystica: The effect of recurrent urinary tract infection on the number of bladder wall mucosa nodules. Acta Clin Croat 2013;52:444-7.  Back to cited text no. 1
    
2.
Varo Solís C, Bachiller Burgos J, Báez JM, Estudillo F, González Moreno D, Alvarez-Ossorio Fernández JL, et al. Glandular cystic cystitis. Actas Urol Esp 2000;24:594-8.  Back to cited text no. 2
    
3.
Milosevic D, Batinic D, Tesovic G, Konjevoda P, Kniewald H, Subat-Dezulovic M, et al. Cystitis cystica and recurrent urinary tract infections in children. Coll Antropol 2010;34:893-7.  Back to cited text no. 3
    
4.
Waites KB, Canupp KC, Roper JF, Camp SM, Chen Y. Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder. J Spinal Cord Med 2006;29:217-26.  Back to cited text no. 4
    
5.
Zaharani AB, Pandyan GV. An unusual case of obstructive uropathy: Cystitis cystica with ureteritis cystica. Indian J Surg 2005;67:210-2.  Back to cited text no. 5
    


    Figures

  [Figure 1]IndianJUrol_2016_32_4_329_189718_f1.jpg, [Figure 2]IndianJUrol_2016_32_4_329_189718_f2.jpg



 

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