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A case of cystitis glandularis occurring concurrently with a neurilemmoma of low malignant potential in a patient with neurofibromatosis is presented. The co-existence of these two conditions made it difficult to distinguish between local recurrence of the neurilemmoma and malignant change in the cystitis glandularis. Repeated biopsies were required to solve this problem. The pathological and radiological features are described.
A case of eosinophilic cystitis complicated with transient vesicoureteral reflux in an 11-year-old girl with allergic disorders is reported. She was suffering from pollakisuria, painful urination, vesical irritability, and gross hematuria for about 2 months. Urinalysis showed aseptic pyuria. White blood cell count was 9,700/mm3 with eosinophils of 10%. Eosinophils were also found on urine cytology. Intravenous pyelography revealed bilateral hydronephrosis and apparently contracted bladder. Tumorous lesion and edematous mucosa were observed in the retrotrigonal region on cystoscopy. The multiple bladder biopsy uniformly revealed eosinophilic cystitis. Following antiallergic treatment, practically all symptoms subsided in steps, and normal cystoscopic appearance and histological structure were restored in 3 months. The vesicoureteral reflux markedly diminished in 10 months.
Eosinophilic cystitis appears to have an allergic origin to different substances causing an immunological reaction. Up to now it was unknown that Mitomycin-C could cause this reaction. We present 6 cases of eosinophilic cystitis induced by Mitomycin-C analysing their clinical and pathological characteristics.
A case of cystitis glandularis is reported. A 70-year-old male was admitted to our hospital with the complaint of urinary frequency and gross hematuria. A bladder tumor was suspected by ultrasonography. Cystoscopy revealed multiple cystic lesions arising from the bladder neck and trigone. Transurethral biopsy of the bladder wall lesion revealed cystitis glandularis. Transurethral resection was performed. His postoperative course was uneventful.
Forty-six young women had unusual and presumably noninfectious disorders of unknown etiology involving tissues derived from the embryonic urogenital sinus (urogenital sinus syndromes). Ten women had interstitial cystitis, and 25 had focal vulvitis. Eleven women had both interstitial cystitis and focal vulvitis. The affected groups were similar in demographic and other characteristics. Most were white and in their mid-20s. Both unusual conditions occurred in the same woman more often than could be expected by chance. This observation suggests that some common, perhaps autoimmune mechanism may be involved in the etiology of these syndromes.
Polypoid cystitis, pyelonephritis, and obstructive uropathy was found in a cow with hematuria, dysuria, and colic. The cow was treated with penicillin, multiple B vitamin supplementation, and isotonic sodium chloride. Polypoid cystitis, diagnosed in this cow by use of endoscopic examination, is a common response to chronic inflammation of the bladder and can lead to obstructive uropathy. Although endoscopic confirmation of this diagnosis may not always be feasible, recognition of corresponding clinical signs can allow timely, appropriate treatment.
A 33-year-old woman presented with chronic diarrhea, vomiting and anasarca due to systemic lupus erythematosus with protein-losing enteropathy, interstitial cystitis and glomerulonephritis. Methylprednisolone could not prevent aggravation of diarrhea, obstructive uropathy, and nephrotic syndrome, and prolonged intestinal ileus developed. Because of this steroid-resistance, bolus injections of cyclophosphamide (1 g i.v. monthly) were decided. Protein-losing enteropathy and ileus both disappeared rapidly following the first injection. Protein-losing enteropathy, intestinal ileus and interstitial cystitis are exceptional manifestations of systemic lupus erythematosus; steroid-resistance of the digestive manifestations has only been reported in one case and our observation is the first reporting the efficacy of cyclophosphamide.
In an open randomized study pivmecillinam (Selexid; CAS 32886-97-8) was studied by general practitioners in 345 female patients with uncomplicated acute cystitis. Out of the bacteriologically evaluated 299 patients 151 patients were treated for three days with two tablets of pivmecillinam 200 mg t.i.d. and 148 patients for seven days with one tablet t.i.d. There were no significant differences in the bacteriological effect between the two regimens. In the 3-day group 91% and 88% were cured at the first and the second control; in the 7-day group 94% and 95%, respectively. There was no significant difference in the total clinical effect, either. Adverse reactions, usually gastrointestinal disturbances, occurred in 10% of the 3-day group and in 11% of the 7-day group (N.S.). Pivmecillinam treatment in acute cystitis in women was equally effective whether given for three or seven days, with the same total frequency of adverse reactions for the two regimens.
Cystitis cystica (CC) and cystitis glandularis (CG) are common in the urothelium lining the bladder neck and trigone. Because some cases of CG show histologic features strikingly similar to prostatic acini, we hypothesized that some such foci may represent prostatelike metaplasia in the urinary bladder. Forty surgical and autopsy bladder specimens (23 males, 17 females) showing CC or CG were studied using anti-prostate specific antigen and anti-prostate specific acid phosphatase antibodies. Fourteen (35%) of these 40 cases showed positive staining for prostate specific antigen or prostate specific acid phosphatase or both in CC or CG foci. Among these were five female patients. The findings indicate that bladder epithelium is capable of undergoing prostatelike metaplasia and lend support to the hypothesis that the adult bladder stroma closest to the prostate may exert inductive influences on the overlying epithelium to show prostatelike metaplasia.
We encountered 8 cases of cystitis probably caused by Tranilast. Bladder biopsy performed on 6 of the 8 cases revealed eosinophilic cystitis in 3 cases. In the lymphocyte stimulation test using Tranilast as an antigen, a positive and false positive reaction was seen in one case each. This disease seemed to occur as a result of allergy of the bladder specific to Tranilast.
We studied a total of 50 recipients who had received allogeneic bone marrow transplantation (BMT) and evaluated both the presence of hemorrhagic cystitis (HC) and the urinary excretion of adenovirus. Twelve recipients developed HC and eight of these 12 patients excreted adenovirus type 11 at the onset of cystitis. Urine for virus isolation was attempted 30, 60 and 100 days after BMT. Among 137 specimens examined, eight were positive for adenovirus type 11. Of these eight samples, six were collected during HC; while in the 129 samples which were negative for adenovirus, only three specimens was collected during HC. Female patients, seropositivity for the antibody to adenovirus prior to BMT and acute graft-versus-host disease (grade 2-4) showed a significant impact on the risk of adenovirus HC. It may be said that adenovirus type 11 is one of the causative agents of HC in BMT recipients.
The presence of type 1 fimbriae, P fimbriae and X adhesins in 30 strains of Escherichia coli producing pyelonephritis, 30 strains producing cystitis, and 30 strains producing recurrent urinary infections are compared. All the strains were collected from adult women without risk factors for infections of the urinary tract. The presence of P fimbriae was 73% in strains producing pyelonephritis, 40% in strains producing cystitis and 20% in strains producing recurrent urinary infections; the presence of X adhesins was 3%, 0, and 17% respectively. There were, in consequence, significant differences between the groups studied; however, such differences were not observed with respect to the presence of type 1 fimbriae, which was 97%, 97% and 90%, respectively. We conclude that P fimbriae act as a factor of greater virulence in the strains of E. coli producing pyelonephritis and X adhesins are found almost exclusively in the strains producing recurrent urinary infections.
A 45 year old female who received radiotherapy for stage II-B uterine cervical cancer four and half years ago, presented with persistent hematuria due to radiation cystitis. 15 (S)-15-methyl prostaglandin F2-alpha (1 mg in 100 ml of normal saline) was instilled into the bladder daily for two days. The severity of bleeding decreased considerably. However, significant hematuria recurred 19 days later which continued despite bladder irrigation with normal saline. 1 mg of 15 (S) 15-Me PGF2 alpha mixed with hydroxyethyl cellulose gel to a volume of 10 ml was then instilled into the urinary bladder daily for three days and macroscopic hematuria ceased. Urinary frequency and urgency were the side effects which lasted for ten days. There has been no recurrence of macroscopic hematuria during the five months follow-up. In conclusion, 15 (S) 15-Me PGF2-alpha may be administered intravesically to control moderate hematuria due to radiation cystitis.
A case of cystitis cystica and glandularis is reported. The patient visited our hospital with the complaint of terminal miction pain. Cystoscopic examination showed a walnut-sized, well-defined mass in the retrotrigone. The surface of the mass was nodular and partially cystic. Computer tomography showed a mass protruding inside and outside of the bladder. Transurethral biopsies of the mass revealed cystitis cystica and glandularis.
Cefixime (CFIX) was administered 200 mg (2 divided doses) per day to 154 female patients with acute uncomplicated cystitis. Ninety four of the 154 patients who satisfied the criteria proposed by the UTI Committee, Japan were examined for the efficacy of the treatment, but 151 of 154 patients were included in the study of the side effects of the drug. The overall clinical efficacy was excellent in 80.8% and moderate in 18.1% of the patients. Ninety five (97.9%) of 97 strains which were isolated from the patients were eradicated in the urinary specimens by the treatment. Subjective side effects were observed in only one (0.7%) of the 151 patients, who complained of a sensation of heaviness in the head. No drug-related aggravation in the laboratory test was observed except for three patients who showed mild elevation glutamic pyruvic transaminase, alkaline phosphatase and blood urea nitrogen. These results showed that the oral administration of CFIX was excellent and satisfactory in the treatment for acute uncomplicated cystitis.
Seventy female patients presenting with frequent (less than or equal to 4 episodes per year) recurrent essential cystitis participated in a comparative, double-blind placebo-controlled study of prophylactic treatment with Pipram. Treatment was administered at the dose of 200 mg in the evening at bedtime for 6 months, followed by a post-treatment phase of 6 months. Four episodes of cystitis occurred during the first 6 months in the Pipram group and 11 in the placebo group; a single episode of infection was observed in the placebo group over the entire observation period (1/2 year). The difference between the two groups, Pipram and placebo, was statistically significant at 6 months and at 1 year. The relative risk of infection in the placebo group was 3.02 at 6 months and 3.56 at 12 months. The bacteria responsible for reinfection during and after treatment were resistant to pipemidic acid in 2 out of 2 cases in the Pipram group and in 2 out of 7 cases in the placebo group. Treatment was well tolerated: 2 discontinuations of treatment because of benign side effects in the Pipram group.
A case of lupus cystitis in a 23-year-old male is reported. The patient began to complain of diarrhea and vomiting in October, 1985. When the diagnosis of systemic lupus erythematosus (SLE) was established at the Department of Internal Medicine in our hospital, he was referred to our clinic for examination of pollakisuria on November 22. DIP revealed a loss of bladder distensibility, and bilateral hydronephrosis and hydroureter. Transurethral cold cup biopsies revealed subcutaneous edema. A diagnosis of lupus cystitis was made and he was treated with steroids, which resulted in symptomatic and radiographic improvement.
Though a hundred years have elapsed since the first presentation of interstitial cystitis as a separate clinical entity, many relating questions have still remained unanswered. Numerous etiological factors such as ischaemia, chronic infection, neurological and recently immunological factors have been connected with the disease as its possible causes. The incidence of the disease is regularly underestimated or overestimated. Sixty-one patients with chronic relapsing cystitis have been evaluated. The parameters which could help in promptly establishing a reliable diagnosis are pointed out in this paper.