What is Cystitis Cystica and Cystitis Glandularis?
Cystitis cystica is a simple, non-severe condition of the bladder. It occurs when the urinary bladder undergoes an inflammatory reaction, leading to the creation of bubble-like structures, or cysts, just beneath the surface layer. In some instances, this process causes cells to change and become gland-like or secrete mucus, a progression called cystitis glandularis.
These changes typically occur in response to the outgrowth of bladder cells called von Brunn nests. Despite their unusual growth pattern, these projections are harmless and non-cancerous.
Generally, both cystitis cystica and cystitis glandularis are reactions to long-standing irritation or inflammation, and they may occur at the same time. While they typically do not cause symptoms, some individuals might encounter vague signs that warrant careful attention. This is to rule out other diseases that look similar but may be cancerous, like bladder adenocarcinoma.
A condition called nephrogenic adenoma, which is a rare, benign bladder growth, shares visual similarities with cystitis glandularis. This tumor can occur alongside several factors, like bladder stones, bladder trauma, constant bladder infections, radiation therapy, or bladder surgery. It’s worth noting that if this adenoma grows large, it might result in obstructive urinary symptoms or appear in multiple spots.
What Causes Cystitis Cystica and Cystitis Glandularis?
The exact cause of conditions known as cystitis cystica and cystitis glandularis hasn’t been found yet, but many people with these conditions often have ongoing irritation, infection, or inflammation in their bladders. Some potential causes could be: bladder exstrophy, chronic blockage in the bladder, long-term urinary tract infections especially by a bacteria called Escherichia coli, indwelling catheters, mechanical irritation because of foreign objects or bladder stones, and neurogenic bladders.
Besides these reasons, there is a condition known as nephrogenic adenoma which is often seen in people who have had organ transplantation and are on medications that suppress the immune system. Nephrogenic adenoma happens when fallen off cells from the far end of the kidney tubes get implanted anywhere in the urinary tract. Yet, mostly this occurs around the neck of the bladder and the part of the urethra closer to the bladder.
In a study of 21 people with nephrogenic adenoma, most of them had a history of bladder augmentation surgery, which often leads to repeat bladder infections and bladder stones. This condition has also been linked to instillations of Bacillus Calmette-Guérin and mitomycin-C into the bladder. Other ideas propose that the adenoma could be a lesion transforming its cells, a leftover tissue from embryonic kidney development, or the result of damage to the bladder cells in a bladder that has undergone surgery in the past or is chronically inflamed. Interestingly, in kidney transplant patients, nephrogenic adenomas seem to arise from the implanted kidney tubular cells and not from the recipient’s bladder tissue.
Risk Factors and Frequency for Cystitis Cystica and Cystitis Glandularis
Cystitis cystica is a condition that isn’t well understood due to difficulties in diagnosing it. Both men and women, regardless of age, may develop cystitis cystica, though it’s slightly more common in men. It can often be identified unexpectedly during biopsies or cystoscopies done for other reasons, and is discovered in about 60% of autopsies, suggesting it might be a normal variant of urothelial mucosa.
- The condition is typically found in the bladder, neck, and trigone but less commonly in the ureters and renal pelvis.
- A different condition, cystitis glandularis, is either diffuse or local and affects about 2% of the population. It usually appears in people during their fifties and sixties.
- Nephrogenic adenomas are more common in men, with a ratio of 2-to-1 with women, and its occurrence is probably underestimated.
- Nephrogenic adenomas are also found in children, accounting for around 10% of cases.
Signs and Symptoms of Cystitis Cystica and Cystitis Glandularis
Cystitis cystica and similar conditions do not have specific symptoms, making it difficult to diagnose as they resemble a host of other urinary diseases. Some people may experience:
- Blood in the urine
- Lower urinary tract symptoms such as frequent urination, feeling the need to urinate urgently, not being able to empty the bladder fully, and blood in the urine
- Blockage-like urinary symptoms
- Pain in the lower belly or around the anus
- Rarely, inability to pass urine and swollen kidneys
- Symptoms similar to a urinary tract infection
When taking a patient’s history, healthcare providers will look at other possible diagnoses. They will evaluate details including the patient’s medical history, lifestyle, sexual history, and family history, as well as conduct a specific examination of the reproductive and urinary systems.
Testing for Cystitis Cystica and Cystitis Glandularis
To correctly diagnose cystitis cystica and similar conditions, a step-by-step approach is mostly adopted. This usually involves conducting tests using a device called a cystoscope and taking a sample of bladder tissue for further examination.
Lab tests are essential in this process. These may involve a complete blood count, tests to look for signs of inflammation, urinalysis, and a kidney function test. Urinalysis is particularly crucial as it can identify whether there is blood in the urine or a urinary tract infection. It is generally carried out before antibiotics are prescribed. If an infection is detected, a further test called a culture and sensitivity test is performed to determine the best treatment approach.
Cystoscopy, an examination using a thin camera inserted into the bladder, is used to check for certain conditions:
In cystitis cystica, the bladder might appear completely normal or could look like it contains a large cyst or mass. Most commonly, multiple small see-through cysts are seen in the bladder. Other changes in the bladder’s lining may be present, such as thickening or the appearance of multiple nodules, which are growths or lumps in the body. It is standard to sample both the cyst and the surrounding bladder lining because the changes seen on cystoscopy and imaging might not confirm the diagnosis.
Cystitis glandularis might appear as an irregular, rough lump, often located in the top part of the bladder. There may be clear boundaries between normal and abnormal bladder lining. The lumps may be attached to a stem (pedunculated) or sit directly on the lining (sessile) and can sometimes be mistaken for bladder cancer on the cystoscopy. After diagnosis, patients with cystitis glandularis are usually checked regularly with cystoscopy and other tests.
Nephrogenic adenoma is another condition which is rarely associated with blood in the urine, but may cause symptoms such as an irritated bladder. The bladder’s inner surface may have a velvety appearance, and lumps may be present.
Various imaging methods can be used to examine the bladder and urinary tract further:
Ultrasonography (US) is a non-invasive and reliable way to diagnose cystitis cystica. It’s especially useful in cases of repeated urinary tract infections as it can measure the thickness of the bladder wall. If the wall is more than 3mm thick, this suggests cystitis cystica. The bladder’s condition and the kidneys can also be assessed using this method.
A plain x-ray of the kidneys, ureters, and bladder (KUB) can be used to spot any calcified stones.
Computerized tomography (CT) scanning, with or without intravenous contrast media (a type of dye), allows for a full assessment of the genitourinary system. In cystitis cystica, CT scanning may reveal small defects in the bladder wall. In rare cases, a large tumor-like mass may be visible. Magnetic resonance imaging (MRI) offers more detailed images and can rule out other pelvic abnormalities.
Finally, cystograms provide a detailed image of the bladder and are especially useful in children. They can help identify if vesicoureteral reflux (the backward flow of urine from the bladder into the ureters) is present, which can coexist with or mimic the symptoms of cystitis cystica.
Treatment Options for Cystitis Cystica and Cystitis Glandularis
Cystitis cystica, a condition linked with recurrent urinary infections, can be hard to treat as the exact cause can be hard to identify. Treatment typically involves several steps. First, any sources of irritation or infection need to be removed, followed by antibiotic treatment and measures to relieve symptoms. In cases where these methods don’t work, surgical intervention may be required.
One popular initial treatment involves using antibiotics to handle any existing urinary infection, followed by a long-term, low-dose prophylactic treatment, or a preventative measure to avoid future infection. A variety of antibiotics can be used depending on the severity of the individual’s case. Some patients may also benefit from local administration of antibiotics through regular intravesical instillations – a type of treatment where the medication is inserted into the bladder.
Cranberry products are known for providing some relief from recurring urinary infections, but aren’t generally effective for treating cystitis cystica. It’s important to prevent recurrent urinary infections for long-term recovery, as this can help reduce bladder inflammation and potentially reverse the changes caused by cystitis cystica.
D-mannose, a type of sugar that can be excreted in urine, has shown potential as a supplement helping to prevent urinary tract infections. However, more research is needed before this can be a standard recommendation.
There are also some other medications that can help manage this condition. Corticosteroids, for example, can be beneficial in severe or treatment-resistant cases. There are also medications designed to reduce inflammation and improve the integrity of the bladder lining, which can help manage some of the symptoms of cystitis cystica.
Physical therapy, pelvic floor exercises, and other forms of symptom management can also be beneficial in managing cystitis cystica.
If medications are unsuccessful at managing the condition, surgical options might be considered. These can range from simpler procedures, like the removal of lesions or cysts within the bladder, to more extensive surgeries, like partial or total bladder removal, in more severe cases. Surgical treatment for nephrogenic adenoma, a condition often associated with cystitis cystica, can also involve removing lesions, with continued antibiotic treatment and anti-inflammatory drugs as supportive therapy.
In summary, treating cystitis cystica often involves a multifaceted approach including antibiotics, symptom management, and possibly surgical intervention in more severe or resistant cases. This approach can vary depending on the individual’s symptoms, the severity of the cystitis cystica, and their overall health.
What else can Cystitis Cystica and Cystitis Glandularis be?
When trying to diagnose a bladder-related problem, doctors need to identify what exactly is causing the issue. They will consider a list of possible conditions:
- Adenocarcinoma of the bladder
- BCG reactive cystitis
- Benign prostatic hyperplasia, commonly known as an enlarged prostate
- Bladder cancer
- Carcinoma-in-situ of the bladder (a type of non-invasive bladder cancer)
- Catheter cystitis (bladder infection caused by a catheter)
- Chronic cystitis and other urinary tract infections
- Endocervicosis of the urinary bladder (a condition where tissue usually found in the cervix is also found in the bladder)
- Ejaculatory duct cyst
- Fibroepithelial polyp (a benign tumor in the bladder)
- Von Brunn’s nests proliferation
- Inverted papilloma (a type of benign tumor)
- Keratinizing desquamative squamous metaplasia (changes in the type of cells in the bladder)
- Malakoplakia (a rare inflammatory condition)
- Nephrogenic adenoma (a benign growth in the bladder)
- Painful bladder syndrome
- Papillary urothelial carcinoma of the bladder (a type of bladder cancer)
- Polypoidal cystitis (a condition characterized by polyps in the bladder)
- Radiation cystitis (bladder inflammation caused by radiation therapy)
- Schistosomiasis (a type of parasitic infection)
- Squamous metaplasia (a condition where normal bladder cells change to a different type)
In addition, they will consider transitional cell or squamous cell carcinoma of the bladder, vaginitis, trigonitis (inflammation of a specific part of the bladder), vaginal metaplasia, and xanthogranulomatous inflammation of the bladder. By considering these conditions, the doctor can properly identify the problem and provide the correct treatment.
What to expect with Cystitis Cystica and Cystitis Glandularis
The course of cystitis cystica, a bladder condition, is not clearly known. However, it has been observed that removing the source of irritation can cause the inflammation to reduce. Successful treatment and prevention of bladder infections (UTIs) can often cause these mucosal changes to disappear.
There’s ongoing debate about whether cystitis cystica can turn malignant or not. There have been some individual cases reported where cystitis glandularis and nephrogenic adenoma have developed into a type of cancer known as adenocarcinoma.
However, regular check-ups using a cystoscope may only be necessary for a subtype known as ‘cystitis glandularis intestinal type,’ which shows abnormal cell changes when examined under a microscope. For other types of cystitis cystica and cystitis glandularis, regular cystoscopic surveillance may not be required. Nephrogenic adenoma, another type of benign tumor, is known to recur often and therefore, regular follow-up cystoscopies are suggested for this condition.
Possible Complications When Diagnosed with Cystitis Cystica and Cystitis Glandularis
Cystitis cystica, cystitis glandularis, and nephrogenic adenoma are bladder conditions that can lead to several complications. These complications can impact a person’s physical health and emotional wellbeing. Some of these complications include:
- Blockage of bladder outlet
- Bladder pain syndrome
- Kidney swelling also known as hydronephrosis
- Possibility of malignant transformation especially in instances of cystitis glandularis intestinal-type with abnormal cell changes
- Psychological effects from chronic illness and a negative impact on the patient’s quality of life
- Frequent urinary tract infections (this is the most common complication)
- Kidney failure due to blockages in both ureters
- Blockage at the junction where the ureter meets the bladder
- Inability to fully empty the bladder, known as urinary retention
- Frequent urge to urinate, or urinary urgency
- Abnormal backward flow of urine from the bladder to the kidneys, known as vesicoureteral reflux
Preventing Cystitis Cystica and Cystitis Glandularis
The main way to stop cystitis cystica from occurring or getting worse is to identify, avoid and get rid of any factors that might cause it, as much as possible. The best way to prevent it is by regular, long-term protective measures, especially in cases of longstanding or recurring urinary tract infections. Kidney stones should be removed to get rid of a potential inflammation and infection source. Any bladder stones should be treated promptly to prevent ongoing mechanical irritation and inflammation.
Patients should be thoroughly educated on the importance of strictly following prescribed treatments and maintaining good personal cleanliness. It’s crucial that patients keep up with their check-up appointments to monitor their condition and spot any complications early. Patients should also be encouraged to follow general advice to prevent cystitis, such as keeping the genital area clean and drinking plenty of water everyday.
