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Acute urinary retention in a patient with extended cystitis glandularis.

Michajłowski J, Matuszewski M, Kłącz J, Gibas A, Biernat W, Krajka K - Cent European J Urol (2011)

Bottom Line: We present a case of 45-year-old man with an extensive CG causing acute urinary retention.Immediately after surgery the patient noticed significant improvement in urine passing.During the 2-month follow-up there was no relapse.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medical University of Gdańsk, Poland.

ABSTRACT
Cystitis glandularis (CG) is defined as glandular metaplasia of bladder urothelium. In most cases the course of CG is asymptomatic. However, some patients complain of hematuria and lower urinary tract symptoms (LUTS) of varying degrees. We present a case of 45-year-old man with an extensive CG causing acute urinary retention. Although it was initially treated as an infection, prompt ultrasound and cystoscopy helped to establish the diagnosis. Transurethral resection of the cyst with biopsy of the bladder mucosa was then performed. Immediately after surgery the patient noticed significant improvement in urine passing. During the 2-month follow-up there was no relapse.

No MeSH data available.


Related in: MedlinePlus

Pathological picture: cystitis glandularis of the typical type. A. The lesion is well circumscribed in the edematous and inflamed vesical mucosa and contains some cystically dilated structures. B. Larger magnification shows columnar lining cells devoid of mucus and goblet cells.
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Figure 0005: Pathological picture: cystitis glandularis of the typical type. A. The lesion is well circumscribed in the edematous and inflamed vesical mucosa and contains some cystically dilated structures. B. Larger magnification shows columnar lining cells devoid of mucus and goblet cells.

Mentions: A 45-year-old male came to the Regional Urological Clinic with a diagnosis of “recurrent cystitis”. He complained of severe LUTS – pollakiuria, urgency (every 20 minutes), nocturia (every hour), feeling of incomplete emptying of the bladder, and a significant decreasing in urine flow. Previously, the patient received a 7-day course of oral antibiotic therapy (Ciprofloxacin 2 x 500 mg) with no improvement. The symptoms gradually increased over three weeks. Ultrasonography showed extensive irregular thickening of the bladder walls, up to 20 mm in greatest dimension, with the presence of two cystic lesions (32 mm and 21 mm) with anechoic content and a thin hyperechogenic wall (Fig. 1). They were localized in the bladder neck on the anterosuperior wall. Distal parts of the ureters were dilated without dilation of pyelocaliceal system. Residual urine volume was about 300 ml. Urine examination showed only erythrocyturia (up to 15 RBC/hpf). Urine culture was sterile. The level of creatinine was 1.04 mg/dl. Urography showed a normal course of both ureters with moderate dilation in the distal part (Fig. 2). During the cystoscopy two cystic changes were found in the neck of the bladder on the anterosuperior wall. The first with a diameter of about 30 mm and the second with a diameter of about 15 mm. The larger one almost completely closed the internal orifice of the urethra (Fig. 3). Mucosa throughout the bladder was significantly swollen, hemorrhagic, and particularly irregular within the trigone of the bladder (Fig. 4). During cystoscopy, biopsy of the bladder mucosa was performed. During waiting for pathological results, a significant increase of LUTS and acute urinary retention occurred. Urinary catheter was inserted and the patient was referred to the department of urology. Transurethral resection of all exophytic cystic lesions with biopsy of the bladder mucosa was performed. The bladder neck was also found to be affected by the disease. The postoperative period was uneventful. The catheter was removed on the third day after surgery. Pathological examination of both specimens (cyst and bladder mucosa) showed cystitis cystica glandularis (Fig. 5). Two weeks after surgery the patient noticed significant improvement in urinary flow without feeling of incomplete emptying of the bladder. Pollakiuria and urgency were less frequent. Maximum urinary flow in uroflowmetry performed 6-weeks after surgery was 34.8 ml/s (VV = 142 ml) and residual urine volume was about 15 ml. Bladder ultrasound showed persistent thickening of the walls up to 15 mm, without cystic changes.


Acute urinary retention in a patient with extended cystitis glandularis.

Michajłowski J, Matuszewski M, Kłącz J, Gibas A, Biernat W, Krajka K - Cent European J Urol (2011)

Pathological picture: cystitis glandularis of the typical type. A. The lesion is well circumscribed in the edematous and inflamed vesical mucosa and contains some cystically dilated structures. B. Larger magnification shows columnar lining cells devoid of mucus and goblet cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921714&req=5

Figure 0005: Pathological picture: cystitis glandularis of the typical type. A. The lesion is well circumscribed in the edematous and inflamed vesical mucosa and contains some cystically dilated structures. B. Larger magnification shows columnar lining cells devoid of mucus and goblet cells.
Mentions: A 45-year-old male came to the Regional Urological Clinic with a diagnosis of “recurrent cystitis”. He complained of severe LUTS – pollakiuria, urgency (every 20 minutes), nocturia (every hour), feeling of incomplete emptying of the bladder, and a significant decreasing in urine flow. Previously, the patient received a 7-day course of oral antibiotic therapy (Ciprofloxacin 2 x 500 mg) with no improvement. The symptoms gradually increased over three weeks. Ultrasonography showed extensive irregular thickening of the bladder walls, up to 20 mm in greatest dimension, with the presence of two cystic lesions (32 mm and 21 mm) with anechoic content and a thin hyperechogenic wall (Fig. 1). They were localized in the bladder neck on the anterosuperior wall. Distal parts of the ureters were dilated without dilation of pyelocaliceal system. Residual urine volume was about 300 ml. Urine examination showed only erythrocyturia (up to 15 RBC/hpf). Urine culture was sterile. The level of creatinine was 1.04 mg/dl. Urography showed a normal course of both ureters with moderate dilation in the distal part (Fig. 2). During the cystoscopy two cystic changes were found in the neck of the bladder on the anterosuperior wall. The first with a diameter of about 30 mm and the second with a diameter of about 15 mm. The larger one almost completely closed the internal orifice of the urethra (Fig. 3). Mucosa throughout the bladder was significantly swollen, hemorrhagic, and particularly irregular within the trigone of the bladder (Fig. 4). During cystoscopy, biopsy of the bladder mucosa was performed. During waiting for pathological results, a significant increase of LUTS and acute urinary retention occurred. Urinary catheter was inserted and the patient was referred to the department of urology. Transurethral resection of all exophytic cystic lesions with biopsy of the bladder mucosa was performed. The bladder neck was also found to be affected by the disease. The postoperative period was uneventful. The catheter was removed on the third day after surgery. Pathological examination of both specimens (cyst and bladder mucosa) showed cystitis cystica glandularis (Fig. 5). Two weeks after surgery the patient noticed significant improvement in urinary flow without feeling of incomplete emptying of the bladder. Pollakiuria and urgency were less frequent. Maximum urinary flow in uroflowmetry performed 6-weeks after surgery was 34.8 ml/s (VV = 142 ml) and residual urine volume was about 15 ml. Bladder ultrasound showed persistent thickening of the walls up to 15 mm, without cystic changes.

Bottom Line: We present a case of 45-year-old man with an extensive CG causing acute urinary retention.Immediately after surgery the patient noticed significant improvement in urine passing.During the 2-month follow-up there was no relapse.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Medical University of Gdańsk, Poland.

ABSTRACT
Cystitis glandularis (CG) is defined as glandular metaplasia of bladder urothelium. In most cases the course of CG is asymptomatic. However, some patients complain of hematuria and lower urinary tract symptoms (LUTS) of varying degrees. We present a case of 45-year-old man with an extensive CG causing acute urinary retention. Although it was initially treated as an infection, prompt ultrasound and cystoscopy helped to establish the diagnosis. Transurethral resection of the cyst with biopsy of the bladder mucosa was then performed. Immediately after surgery the patient noticed significant improvement in urine passing. During the 2-month follow-up there was no relapse.

No MeSH data available.


Related in: MedlinePlus