Cystitis and metaplasia

Cystitis and metaplasia 

Updated: 02/01/2022

© Jun Wang, MD, PhD

General features
  • Inflammation of bladder
  • Urinary symptoms: Dysuria, urinary urgency and frequency, hematuria, etc
  • More common in women, except polypoid cystitis
Acute cystitis
  • Clinical diagnosis
  • More common in women of reproductive age
  • Usually bacterial infection, most common E. coli, proteus, etc
  • May spread to kidney, causing pyelonephritis
  • Pyuria, positive microbiology studies
  • Treatment: antibiotics
Chronic cystitis
  • Chronic bladder inflammation
  • Refractory to treatment or surgical correction
  • Recurrence common
Interstitial cystitis
  • Definition
    • Unpleasant sensation: pain, pressure, etc
    • Related to urinary bladder
    • Urinary tract symptoms
    • > 6 months duration
    • No evidence of infection or other irritations
  • Unclear etiology
  • Cystoscopic findings
    • Mucosal fissures
    • Petechia
  • Pathological findings
  • Diagnosis of exclusion 
  • Treatment: Behavioral therapy, pain management, etc
Polypoid/papillary cystitis
Cystitis glandularis and cystitis cystica
  • Commonly incidental findings
  • Referred to together as cystitis cystica et glandularis
  • Associated with chronic mucosal irritation
  • More common in neck and trigone
  • Cystitis glandularis:  Glands in lamina propria lined by columnar or cuboidal epithelium
  • Cystitis cystica: Urothelium lining slit-like or cystic spaces with fluid
  • Treatment: Removal of source of irritation; antibiotic therapy; surgery if not respond to conservative therapies
Hemorrhagic cystitis
  • Gross hematuria
  • Irritative bladder symptoms
  • Associated with drug treatment (cyclophosphamide, etc), radiation therapy, viral infection (herpes, etc)
Follicular cystitis
Eosinophilic cystitis
Metaplasia
  • Replacement of urothelium by other benign epithelium
  • Intestinal
Replacement by colonic type mucosa or isolated/clusters of goblet cells in Brunn’s nests
Incidence increases with age
Risk for adenocarcinoma
  • Squamous
Replacement by stratified squamous epithelium
Normal in women in trigonal area
Associated with chronic infection/irritation
May transform to squamous dysplasia/carcinoma
  • Nephrogenic
AKA nephrogenic adenoma
Papillary or cystic structures of small hollow tubules similar to mesonephric tubules
More common if immunosuppression
May mimic cancer due to infiltrating pattern


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