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[Polypoid cystitis, isolated lesion with a unique presentation].

OBJECTIVES: To report on an uncommon case of polypoid cystitis. METHODS/RESULTS: The patient had consulted because urinary stream was suddenly interrupted due to a mass protruding into the urethral meatus. The US, IVP, cystoscopic and pathological findings are documented. The literature on polypoid cystitis is briefly reviewed with special reference to its forms of presentation and the pathological findings which permit making the differential diagnosis from other pathologies, the most important being transitional cell papillary carcinoma. CONCLUSIONS: An uncommon case of cystitis is described, which emphasizes the varied forms of presentation of this condition and the need to distinguish this lesion from other pathologies, particularly bladder carcinoma.

Adult↗

[Cystitis cystica glandularis. A study of 2 cases].

The authors report two cases of cystitis glandularis revealed by hematuria and urinary retention. Cystitis glandularis is a rare disease, caused by metaplasia of the vesical submucosa, probably related to a chronic irritative factor. In its minor form, it has the same clinical features as simple cystitis, but its major pseudoneoplastic form may be mistaken for bladder tumor. The diagnosis is essentially histological. Treatment is usually medical, based on eradication of the irritative factors. Surgery is performed in the case of complications of this disease. The clinical course is unclear, requiring long-term surveillance.

Adult↗

[Eosinophilic cystitis in children. Study of 4 cases].

OBJECTIVE: To present our experience in the diagnosis and treatment of 4 children with eosinophilic cystitis. METHODS: 4 children (3 boys and 1 girl) with eosinophilic cystitis are described. The mean follow-up since diagnosis was 30 months, the mean age was 7 years and the main symptom was hematuria. The clinical features, etiology, course of the disease, pathological findings and diagnostic methods are reviewed. The definitive diagnosis was established by the pathological findings. None of the patients had a recurrence. CONCLUSIONS: The diagnosis of eosinophilic cystitis is exclusively based on the histological findings. There are no clinical or complementary pathognomonic signs. Like most authors, we believe that the immune system plays a decisive role in the appearance of this disease.

Adolescent↗

[Spontaneous bladder perforation due to eosinophilic cystitis: a case report].

We report a case of eosinophilic cystitis the onset of which was characterized by acute peritonitis secondary to a spontaneous intraperitoneal rupture of the vesical cupula. The patient was treated with urgent partial cystectomy in another hospital and 3 months later he underwent endoscopic diathermic coagulation of a residual inflammatory lesion at our institution. After an 18 month endoscopic follow-up no further signs of recurrent eosinophilic cystitis have been pointed out. The non-traumatic bladder perforation and the absence of any other bladder pathology might indicate that eosinophilic cystitis can be responsible for complete bladder rupture.

Aged↗

Augmentation ileocystoplasty in a case of eosinophilic cystitis.

Eosinophilic cystitis (EC) is a rare form of bladder inflammation characterized by massive eosinophilic infiltration of the bladder wall. The most frequent signs and symptoms are pollakiuria, urgency, macroscopic haematuria and hypogastric pain: the involvement of the ureters may cause hydronephrosis and renal failure. Eosinophilia and eosinophiluria are present in 35% and in 50% of the cases respectively. EC may evolve towards sclerosis up to the anatomoclinical picture of small retracted bladder, which requires to be differentiated from tubercular cystitis, interstitial cystitis and cancer. Imaging techniques are not definitely diagnostic. Diagnosis can be reached only by biopsy with the microscopic demonstration of eosinofilic infiltration of the whole bladder wall in the early and acute stages, while fibrosis with poor cellularity predominates in the chronic stages. Etiology is unknown and the hypothesis of an allergic origin is unproved even though remissions or recoveries induced by steroidal therapy have been reported. Surgical therapy of EC, as in our observation, is absolutely required to correct urgency and incontinence and to prevent renal failure when the urinary upper tract has been primarily or secondarily involved.

Aged↗

[Interstitial cystitis in case of primary Sjögren's syndrome].

A 53-year-old woman who had xerostomia for ten years was admitted to our hospital because of refractory lower abdominal pain and pollakisuria of five years duration. Although she had undergone surgical treatments including cholecystectomy, ovarian cystectomy and groin hemiorrhaphy, she still suffered from abdominal symptoms. A diagnosis of interstitial cystitis was confirmed by hydraulic distention during a cystoscopic examination and by histopathological examination of the bladder. Her symptoms disappeared soon after the cystoscopic procedure, which also had a therapeutic effect of interstitial cystitis. Laboratory findings revealed hypergammaglobulinemia, a high titer of rheumatoid factor, positive anti-nuclear antibody, and positive anti-SS-A/Ro antibody. She was diagnosed as having primary Sjögren's syndrome based on the results of a gum test (8.5 ml/ 10 min), sialography (Stage II), and a positive minor salivary gland biopsy. Starting one month after the hydraulic distention, her abdominal symptoms gradually reappeared along with elevation of her serum IgG level. These features were markedly improved with 30 mg/day of oral prednisolone, which was then successfully tapered. These results suggested that interstitial cystitis in this case was caused by immunological abnormalities associated with Sjögren's syndrome.

Cystitis, Interstitial↗

Encrusted cystitis and pyelitis.

PURPOSE: Encrusted cystitis and pyelitis are chronic inflammations of the bladder and collecting system associated with mucosal encrustations induced by urea splitting bacteria. We review these infectious diseases. MATERIALS AND METHODS: A literature search was performed of the MEDLINE database from 1985 to 1997. Additional articles published before 1985 were also selectively included. RESULTS: Most of the articles were case reports or short series. During the last 10 years increasing numbers of cases have been diagnosed, especially in immunodepressed patients, and particularly in renal transplant recipients. Many bacteria have been demonstrated in this infection but Corynebacterium group D2 is currently the most frequent. The development of encrusted cystitis or pyelitis requires the presence of specific bacteria with an alkaline urine, a preexisting urological procedure and a clinical context predisposing to infection. Clinical diagnosis can be difficult but the presence of alkaline urine containing abundant calcified mucopurulent debris is highly suggestive. Demonstration of the bacteria requires prolonged cultures in enriched media. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The consequences of treatment failure are serious and can result in graft nephrectomy in kidney transplant recipients. CONCLUSIONS: Early clinical and bacterial diagnosis of encrusted cystitis and pyelitis could improve the prognosis of these infectious diseases.

Calcium↗

[Utilization of a direct sandwich ELISA kit for rapid diagnosis of adenovirus hemorrhagic cystitis in a patient with adult T-cell leukemia].

We report on a case of adenovirus hemorrhagi cystitis that developed in a 49-year-old woman during intensive chemotherapy for adult T-cell leukemia. Although rapid etiologic diagnosis is essential for the effective management of viral hemorrhagic cystitis, the isolation of adenovirus from urine is often too time-cousuming. We detected the adenovirus antigen in the patient's urine using an Adenoclone direct sandwich ELISA kit (Cambridge Bio Science), which is commonly employed for the diagnosis of adenovirus conjunctivitis. Treatment consisted of intravenous vidarabine and bladder irrigation, which resulted in prompt clinical improvement. The Adenoclone kit was useful for the rapid etiologic diagnosis of adenovirus hemmorrhagic cystitis.

Adenoviridae Infections↗

[Interstitial cystitis].

Interstitial cystitis is a particular type of cystitis with clear urine, essentially observed in women. Persistent painful urinary frequency and bladder heaviness are suggestive of the diagnosis. Two different forms have been distinguished according to severity: Hunner's ulcer and small capacity bladder;-bladder distension to 800 ml, followed by haemorrhagic petechiae; with a whole series of intermediate forms. The bladder wall undergoes inflammatory reorganization, without infection, leading to fibrosis. The disease is improved by hydrocortisone instillations. Hunner's ulcer can be treated by partial resection. If the cystitis deteriorates, bladder replacement by detubulized intestinal graft may be required.

Administration, Topical↗

[Eosinophilic cystitis: an incidental diagnosis. An underdiagnosed entity].

The authors report on two cases of eosinophilic cystitis diagnosed by chance, are reported. Both patients had suffered from prostatic and vesical diseases. Since the endoscopic appearance and clinical manifestation of this disease are aspecific, the diagnosis of eosinophilic cystitis is always made on histological specimen. Even if it has been described as a rare entity, personal opinion is that the real incidence of eosinophilic cystitis is underestimated. The main features of pathogenesis and therapy are also described.

Aged↗

A case of lupus cystitis with a history of idiopathic thrombocytopenic purpura.

A 36-year-old Japanese woman who had been diagnosed as having systemic lupus erythematosus (SLE) at the age of 34 began to complain of severe bowel symptoms and developed severe hydroureteronephrosis. She had a history of idiopathic thrombocytopenic purpura. Biopsy specimens from her bladder showed interstitial cystitis. She was diagnosed as having lupus cystitis, and treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone and ureter catheterization. Her urinary and bowel symptoms were alleviated and the level of hydroureteronephrosis improved. We note that cystitis could be a primary manifestation of SLE. Patients not only with SLE but also with some autoimmune diseases require careful urological evaluation when they complain of severe bowel symptoms.

Journal Article↗

A case of interstitial cystitis accompanying Sjögren's syndrome.

A 51-year-old woman with interstitial cystitis was referred for screening of autoimmune disease. She was positive for results of Schirmer and Saxon tests and for ss/A and ss/B antibodies. Autoantibodies to type 3 muscarinic acetylcholine receptor were detected in the patient's serum by Western blotting. We diagnosed her as having interstitial cystitis accompanying Sjögren's syndrome. To enable early treatment, interstitial cystitis should be considered when patients with Sjögren's syndrome complain of urinary symptoms.

Journal Article↗

Intravesical capsaicin for the treatment of interstitial cystitis: a pilot study.

OBJECTIVES: To study the safety and efficacy of intravesically administered capsaicin, a C-fiber afferent neurotoxin, in patients with interstitial cystitis (IC). METHODS: A pilot study of intravesical capsaicin therapy was performed on 5 female patients diagnosed with IC using NIDDK criteria. Patients were evaluated with cystoscopy and CMG on initial presentation. Bladder capacity, urinary histamine, PGE2 and substance P were measured before and after treatment. A symptom score, visual analogue pain score and frequency/nocturia charts were completed before treatment and weekly thereafter by each patient. Topical anesthesia (30 mls of 0.5% bupivacaine) was instilled intravesically for 30 minutes prior to each treatment with capsaicin. The initial instillation consisted of vehicle (1% ethanol in normal saline) and subsequent weekly instillations of capsaicin in increasing concentrations (10, 50, 100, and 250 uM solutions in 1% ethanol) were given as tolerated by the patient. RESULTS: Four out of 5 of the patients experienced subjective improvement in both symptom and pain score. Bladder capacity improved in 1 patient and symptoms of frequency and nocturia improved in 2 patients. Urinary histamine and PGE2 revealed no trend between before and after treatment; however, 3 out of 5 of the patients did have a trend to decreased substance P. No complications were noted during the course of this study. CONCLUSIONS: Intravesical capsaicin is a safe and promising treatment for interstitial cystitis. A potential mechanism of action is desensitization of bladder C-fiber afferents which presumably initiate painful sensations in IC patients. Low dose intravesical capsaicin therapy represents a potential treatment option for interstitial cystitis.

Journal Article↗

A randomized controlled trial of intravesical bacillus calmette-guerin for treatment refractory interstitial cystitis.

PURPOSE: We compared intravesical bacillus Calmette-Guerin (BCG) to placebo instillations in patients with treatment refractory interstitial cystitis (IC). MATERIALS AND METHODS: Subjects who met the National Institutes of Health-National Institute for Diabetes and Digestive and Kidney Diseases criteria for IC, and reported at least moderate pain and frequency for a minimum of 6 months before study entry, were randomized to 6 weekly double-blinded intravesical instillations of either BCG or placebo, and then followed for a total of 34 weeks. The primary outcome was a patient reported global response assessment at week 34, supplemented with medications for IC during weeks 31 to 34. Secondary outcomes included a 24-hour voiding diary, pain, urgency, validated IC symptom indexes and adverse events. The target sample size was 260 participants, designed to detect a difference in response rates between placebo and BCG of 30% and 50%, respectively. RESULTS: A total of 265 participants were randomized and 17 (6%) patients withdrew from study. The response rates for the primary outcome were 12% for placebo and 21% for BCG (p = 0.062). Small improvements were observed for all secondary outcomes, some more so with BCG, but these differences were of borderline statistical significance. Although a large number of adverse events were reported in the BCG arm, there was no statistically significant difference between the treatment arms in overall adverse event rates. CONCLUSIONS: Although the BCG safety profile was acceptable, the response rate for the primary outcome was low. Effective medical treatment for patients with moderate to severe interstitial cystitis remains elusive.

Administration, Intravesical↗

Lack of effect following repeated in vivo exposure of the rabbit urinary bladder to urine from interstitial cystitis patients at low infusion volumes.

We reported previously that substances in interstitial cystitis urine, when infused into the rabbit bladder, induce changes that resemble bladders of interstitial cystitis (IC) patients. Here we report our investigation of the effect of additional molecular weight subfractions of IC urine and lower infusion volume in this rabbit bladder bioassay. Urine was pooled from symptomatic IC patients, asymptomatic IC patients (in remission), and normal volunteers. Two fractions of 20x concentrated urine were obtained for each of the 3 groups: a 10-100-kD fraction and a fraction > 100 kD but <0.22 microm. Six rabbits per group were infused twice per week with 6 ml of 1 of these 6 urine fractions or saline as a control. After 6 weeks, each rabbit was cystoscoped before and after hydrodistension, bladder capacity and urea permeability were determined, and the bladder was removed for histologic examination. A questionnaire revealed a significant difference (P < 0.01) regarding voiding symptom severity between symptomatic IC patients and both normal volunteers and IC patients in remission. There was no statistically significant difference among groups of rabbits in cystoscopic bladder appearance, bladder capacity, urea permeability, or bladder histology. If a urine-borne factor is in part responsible for IC symptoms, the rabbit bladder must be filled with urine to near capacity to be able to detect a difference between IC and normal urine in this rabbit bladder bioassay.

Administration, Intravesical↗

Urodynamics in acetone-induced cystitis of anesthetized rats.

We examined the bladder function of cystitis models induced by intravesical acetone instillation in urethane-anesthetized rats. Acetone (0.35 ml) at 10, 30, or 50% concentration or deionized water (sham-treatment) was instilled into the bladder via the cannula which was inserted into the lumen. Acetone was withdrawn 90 sec after instillation and the bladder lumen was washed with saline after 15 min. One hour later, the cystometrogram induced by transvesical infusion of saline (3.3 ml/hr) was measured. During cystometrography of normal (non-treated) or sham-treated group, the time required to cause micturition, reflecting bladder capacity, was 9.6 +/- 0.9 (n = 7) or 10.0 +/- 0.8 min (n = 6), respectively. In the 10% acetone-treated group, the bladder capacity was similar to that in the normal or sham group. In the 30% acetone group, the time to micturition was 4.4 +/- 0.4 min (n = 7), indicating decreased bladder capacity, although the micturition pressure and the threshold pressure were not significantly different from those in the normal or sham group. However, in the 50% acetone group, the micturition reflex disappeared. In isolated rat bladder strips, contractile responses to carbachol or electrical field stimulation in the sham and 30% acetone group were similar. While, both responses in isolated strips from the 50% acetone group were reduced. The degree of damage from degeneration and desquamation of epithelium and hemorrhage in the bladder tissue from the 30% acetone group was less prominent than in the 50% acetone group. Additionally, some tissue from the 50% acetone group showed degeneration of muscle layer. The effects of three drugs were investigated in the 30% acetone group which showed increased urinary frequency. Baclofen (100 microg/kg, i.v.) and morphine (100 microg/kg, i.v.) increased significantly the bladder capacity and the threshold pressure. Atropine (10 microg/kg, i.v.) decreased the micturition pressure. These results suggest that cystitis models induced by intravesical instillation of 30% acetone may be valuable for evaluating drugs for the treatment of urinary frequency.

Acetone↗

Formalin treatment for intractable hemorrhagic cystitis: a review of the literature with 16 additional cases.

Acute, exsanguinating hemorrhagic cystitis secondary to cyclophosphamide therapy, radiation therapy, or an infiltrating bladder tumor may be managed successfully with intravesical Formalin therapy. The indications for its use, the technique, success rates, and complications are discussed. This treatment was effective in 14 of 16 patients in the present series and 79 of 90 cases reported in the literature. Dilutions of 4% or less were as effective as a 10% dilution and were associated with far fewer complications. The early use of Formalin in the treatment of intractable hemorrhagic cystitis is recommended.

Adult↗

Evaluation of carboprost tromethamine in the treatment of cyclophosphamide-induced hemorrhagic cystitis.

The treatment of cyclophosphamide-induced hemorrhagic cystitis has been difficult, with overall poor results using intensive and costly therapy. The authors evaluated the treatment of this problem in four patients with prostaglandin intravesical therapy. Each patient had failed to respond to conservative management. Carboprost tromethamine (Hemabate) was instilled into the bladder, with dwell times ranging from 45 to 60 minutes, three to four times a day for 4 to 5 days. Two of the patients required a second course with carboprost tromethamine at an increased concentration. A third patient's treatment was stopped after the first 5-day course because of intractable bladder spasms and persistent hematuria. In the three patients who completed the full course of therapy the hematuria resolved completely. The only side effect noted was bladder spasms, which were controlled in three of the four patients with oxybutynin chloride. This preliminary evaluation suggests that carboprost tromethamine may be a safe and effective bedside treatment of cyclophosphamide-induced hemorrhagic cystitis.

Adult↗