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Cystoprostatectomy with ileal neobladder for treatment of severe cystitis glandularis in an AIDS patient.

Coelho RF, Marchini GS, Dall'oglio MF, Medeiros MT, Nesrallah AJ, Srougi M - Clinics (Sao Paulo) (2008)

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Cystitis glandularis (CG) is a proliferative and metaplastic disorder of the bladder urothelium that usually occurs when the bladder mucosa becomes hyperproliferative in the presence of chronic inflammation and nests of urothelium appear within the lamina propria... CG is rarely reported in children; even in adults, its incidence and clinical significance are not well known... It is generally a microscopic finding subsequent to cystoscopy and biopsy in a patient with irritative bladder symptoms or hematuria. – Most patients do not require more aggressive surgery options, and sparse literature is available regarding the management of severe CG... Microscopic analysis confirmed chronic CG all along the bladder urothelium (Figure 3)... CG is a benign proliferative disease of the bladder mucosa... If an etiology such as chronic infection is identified, it must be appropriately treated... In the reported case, no urinary infection or other causal factors were found... An associated risk of bladder cell carcinoma and adenocarcinoma has been reported– but is still debated... Although most patients with cystitis glandularis will never develop a malignant bladder lesion, it cannot be excluded that the most widely proliferative lesions may have premalignant potential... Intravesical BCG (bacillus Calmette-Guerin) application has been described as an adjuvant therapy after TURB for the treatment of cystitis glandularis... Ureteral obstruction is a rare complication that results from infiltration of the periureteral submucosa... It may be treated with ureteral reimplantation into the dome of the bladder in the presence of a contractile bladder, or may require temporary percutaneous nephrostomy, as was performed in our patient... Cystectomy with continent urinary diversion for cystitis glandularis has been very rarely reported., Obviously, such surgical procedures should be the last resort in these patients... Urinary diversion without cystectomy in such cases is considered to be ill-advised due to the possibility of persistent symptoms and the associated risk of adenocarcinoma.

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Histology showing glandular structures lined with mucus-secreting cubic and columnar cells consistent with cystitis glandularis
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f3-23-0008: Histology showing glandular structures lined with mucus-secreting cubic and columnar cells consistent with cystitis glandularis

Mentions: After treatment, the patient was asymptomatic for two months, after which the irritative voiding symptoms recurred. Another two TURBs were performed, with partial and temporary improvement of the symptoms. Six months after the first TURB, the patient presented anuria and azotemia secondary to bilateral ureteral obstruction. Bilateral percutaneous nephrostomy was performed, with complete recovery of renal function. After considerable counseling, the patient underwent a total cystoprostatectomy with ileal neobladder construction. Microscopic analysis confirmed chronic CG all along the bladder urothelium (Figure 3). The postoperative period was uneventful. At the 6-month follow-up, the patient was voiding well with complete continence; the serum creatinine level was 1.0 mg/dl and intravenous urography showed normal contrast excretion, with markedly reduced ureterohydronephrosis (Figure 4).


Cystoprostatectomy with ileal neobladder for treatment of severe cystitis glandularis in an AIDS patient.

Coelho RF, Marchini GS, Dall'oglio MF, Medeiros MT, Nesrallah AJ, Srougi M - Clinics (Sao Paulo) (2008)

Histology showing glandular structures lined with mucus-secreting cubic and columnar cells consistent with cystitis glandularis
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664733&req=5

f3-23-0008: Histology showing glandular structures lined with mucus-secreting cubic and columnar cells consistent with cystitis glandularis
Mentions: After treatment, the patient was asymptomatic for two months, after which the irritative voiding symptoms recurred. Another two TURBs were performed, with partial and temporary improvement of the symptoms. Six months after the first TURB, the patient presented anuria and azotemia secondary to bilateral ureteral obstruction. Bilateral percutaneous nephrostomy was performed, with complete recovery of renal function. After considerable counseling, the patient underwent a total cystoprostatectomy with ileal neobladder construction. Microscopic analysis confirmed chronic CG all along the bladder urothelium (Figure 3). The postoperative period was uneventful. At the 6-month follow-up, the patient was voiding well with complete continence; the serum creatinine level was 1.0 mg/dl and intravenous urography showed normal contrast excretion, with markedly reduced ureterohydronephrosis (Figure 4).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Cystitis glandularis (CG) is a proliferative and metaplastic disorder of the bladder urothelium that usually occurs when the bladder mucosa becomes hyperproliferative in the presence of chronic inflammation and nests of urothelium appear within the lamina propria... CG is rarely reported in children; even in adults, its incidence and clinical significance are not well known... It is generally a microscopic finding subsequent to cystoscopy and biopsy in a patient with irritative bladder symptoms or hematuria. – Most patients do not require more aggressive surgery options, and sparse literature is available regarding the management of severe CG... Microscopic analysis confirmed chronic CG all along the bladder urothelium (Figure 3)... CG is a benign proliferative disease of the bladder mucosa... If an etiology such as chronic infection is identified, it must be appropriately treated... In the reported case, no urinary infection or other causal factors were found... An associated risk of bladder cell carcinoma and adenocarcinoma has been reported– but is still debated... Although most patients with cystitis glandularis will never develop a malignant bladder lesion, it cannot be excluded that the most widely proliferative lesions may have premalignant potential... Intravesical BCG (bacillus Calmette-Guerin) application has been described as an adjuvant therapy after TURB for the treatment of cystitis glandularis... Ureteral obstruction is a rare complication that results from infiltration of the periureteral submucosa... It may be treated with ureteral reimplantation into the dome of the bladder in the presence of a contractile bladder, or may require temporary percutaneous nephrostomy, as was performed in our patient... Cystectomy with continent urinary diversion for cystitis glandularis has been very rarely reported., Obviously, such surgical procedures should be the last resort in these patients... Urinary diversion without cystectomy in such cases is considered to be ill-advised due to the possibility of persistent symptoms and the associated risk of adenocarcinoma.

Show MeSH
Related in: MedlinePlus