Cystitis cystica is a common, non-cancerous condition of the urinary bladder. It involves the formation of small, fluid-filled sacs or nodules on the bladder’s inner surface, resulting from reactive inflammatory changes.
What is Cystitis Cystica?
Cystitis cystica involves the development of small, fluid-filled sacs or nodules on the bladder’s inner lining. These formations arise as a response to chronic inflammation or irritation within the bladder. The condition occurs when cells in the urothelium, the bladder’s lining, invaginate into the underlying connective tissue, forming structures known as von Brunn nests.
These von Brunn nests can then degenerate, leading to fluid-filled cystic changes. Lesions may appear as small, translucent submucosal cysts, generally less than 5 mm in size, or sometimes as an irregular, shaggy, or fuzzy lesion. They can also present as elevated lesions with multiple rounded lumps. The lesions can be sessile (flat) or pedunculated (stalk-like).
Causes and Risk Factors
Cystitis cystica develops in response to persistent irritation or inflammation of the bladder lining. One common trigger is recurrent urinary tract infections (UTIs), particularly those caused by Escherichia coli. The chronic presence of bacteria can lead to ongoing bladder irritation, promoting these changes.
Other factors that contribute to chronic irritation include bladder stones or kidney stones, which can cause mechanical irritation. Prolonged use of indwelling catheters can also introduce bacteria and cause tissue damage. Conditions that obstruct the flow of urine, such as an enlarged prostate or bladder outlet obstruction, can lead to urine retention. Systemic conditions like diabetes or a weakened immune system can also increase susceptibility.
Symptoms and Diagnosis
Cystitis cystica often presents with symptoms related to the underlying bladder irritation, though it can sometimes be asymptomatic. Common symptoms include frequent urination, a strong urge to urinate, and pain or a burning sensation during urination, known as dysuria. Patients may also experience lower abdominal discomfort, cloudy urine, or blood in the urine (hematuria). In rare instances, mucus may be present in the urine.
Diagnosis typically begins with a physical examination and a review of the patient’s medical history. A urine test is usually performed to check for signs of infection or blood. Imaging studies, such as ultrasonography, CT urogram, or MRI, can visualize bladder lesions and assess bladder wall thickness.
Cystoscopy is considered the definitive diagnostic tool. During this procedure, a thin tube with a camera (cystoscope) is inserted through the urethra to visualize the bladder lining. The doctor looks for the characteristic cobblestone appearance of the bladder mucosa, which indicates the presence of the cysts. A biopsy may be performed during cystoscopy to confirm the diagnosis and rule out other conditions, such as bladder cancer.
Treatment and Outlook
Treatment for cystitis cystica primarily focuses on addressing the underlying cause of bladder inflammation. If a urinary tract infection is present, antibiotics are typically prescribed. For cases involving bladder stones or kidney stones, their removal is recommended. When bladder outlet obstruction is a factor, interventions to clear the obstruction are pursued.
Symptomatic management can be employed if the cysts cause discomfort. This may include pain relief medications or other treatments to alleviate symptoms like frequent urination or urgency. In situations where conservative treatments are insufficient, or if the lesions cause significant issues like obstruction of the urinary tract or recurrent bleeding, transurethral resection of the lesions may be considered.
Cystitis cystica is a benign condition and does not typically progress to cancer. The outlook is generally favorable, and the lesions may improve or resolve over time, especially once the underlying cause of irritation is managed. Close surveillance may be warranted in some cases, particularly if symptoms persist.