Xanthogranulomatous cystitis and bilateral ureteral reflux due to bladder neck obstruction: a case report.

Xanthogranulomatous cystitis (XC) is a rare benign disease of chronic granulomatous inflammation. We report a 23-year-old woman with xanthogranulomatous cystitis. She was referred to our hospital with the chief complaint of a 1-year history of frequent, urgent dysuria with recurrent fever. An imaging examination showed bilateral ureteral reflux and a normal bladder. Urodynamic findings suggested bladder outlet obstruction and increased post-void residual urine. Finally, the patient underwent endoscopy, and bladder neck obstruction was confirmed. Additionally, we found multiple granulomatous masses in the bladder. Therefore, we performed transurethral resection of the tumor and bladder neck. A histopathological examination of resected tumor tissue showed xanthogranulomatous cystitis, and the patient received anti-infective therapy. Follow-up cystourethroscopic results and urination symptoms returned to normal, and the bilateral ureteral reflux was gradually reduced.

Two Cases of Intractable Radiation-Induced Hemorrhagic Cystitis Treated with Transcatheter Embolization.

Radiation-induced hemorrhagic cystitis is a late complication of radiotherapy, and in rare cases, refractory. Refractory bleeding may not be resolved by transurethral electrocoagulation (TUEC) or hyperbaric oxygen (HBO) therapy and requires transcatheter arterial embolization (TAE) or urinary diversion. Here, we report two cases of radiation-induced hemorrhagic cystitis successfully treated with TAE. Case 1 was a 61-yearold man who underwent total prostatectomy for prostate cancer followed by salvage radiation therapy. The patient developed radiation-induced hemorrhagic cystitis 2 years and 3 months after radiotherapy. After no improvement with TUEC and HBO, TAE was performed. Case 2 was a 78-year-old man who underwent total prostatectomy followed by salvage radiation therapy and developed radiation-induced hemorrhagic cystitis 12 years later. TAE was performed after no improvement with HBO. TAE proved successful in both patients, and there was no relapse. TAE is a potential treatment option for refractory radiation-induced hemorrhagic cystitis.

Photocoagulation with GREENLIGHT© laser in radiation-induced haemorrhagic cystitis: Results of a single-center series.

INTRODUCTION: Radiation-induced haemorrhagic cystitis (RIHC) is one complication of the pelvic radiotherapy. The GREENLIGHT© laser (GL) has been barely studied in the treatment of radiation cystitis. The primary objective was to evaluate the efficacy of GL in refractory RIHC patients (RRC) in a single-centre series. MATERIALS AND METHODS: Twenty-nine patients were treated by GL bladder photocoagulation (GLBP). These patients showed signs of refractory haematuria in the context of RIHC. The primary endpoint was the absence of haematuria that would require a subsequent surgical intervention. Secondary endpoints were postoperative hospitalization length of stay, the occurrence of complications according to the Clavien-Dindo classification, the occurrence of functional urinary disorders and the number of cystectomies. RESULTS: After a median follow-up of 30 months, 24 (82.7%) patients had no recurrence of haematuria. No postoperative complications were reported. A disabling overactive bladder secondary to the procedure occurred in 9 patients (31.0%). Two patients needed a cystectomy at 1 and 11 months. CONCLUSION: GLBP may constitute an efficient line of treatment for RIHC. Despite overactive bladder it allowed to avoid or delay cystectomy.

Does renal failure worsen radiation cystitis following radical prostatectomy?

OBJECTIVE: To investigate the impact of renal function on the risk, severity, and management of radiation cystitis in patients who underwent postoperative radiation therapy for prostate cancer. METHODS: Retrospective data was assessed from patients treated with adjuvant/salvage radiation therapy at a single academic institution between 2006 and 2020. The incidence, severity, and management of radiation cystitis were compared between three groups: CKD 0-2, CKD 3-4, and CKD 5. Associations of clinicopathologic factors with radiation cystitis were assessed in univariate and multivariate Cox regression models. RESULTS: A total of 110 patients who underwent radiation therapy following robot-assisted laparoscopic radical prostatectomy were included. The incidence of radiation cystitis following postoperative radiation therapy was 17% with a median presentation time of 34 months (interquartile range 16-65 months). The incidence of radiation cystitis was 100% in CKD 5 patients compared to 15% in CKD 0-2 and 17% in CKD 3-4 patients (p < 0.001). CKD 5 patients required more treatments, emergency department visits, and longer hospitalization times than CKD 0-4 patients (all p < 0.001). Multivariate analyses identified CKD 5 as the only significant factor associated with radiation cystitis (HR = 10.39, p = 0.026). CONCLUSION: End-stage renal failure is associated with the risk and severity of radiation cystitis in patients receiving postoperative radiation therapy. Knowledge of the potential morbidity of this complication in this population could guide physicians and patients as they evaluate risks and benefits prior to selecting adjuvant or salvage radiation therapy.

Safety and efficacy of percutaneous electrocoagulation haemostasis in the treatment of grade IV haemorrhagic cystitis after allogeneic haematopoietic stem cell transplantation in children: a retrospective analysis.

BACKGROUND: To investigate the efficacy and safety of endoscopic electrocoagulation haemostasis via a percutaneous transhepatic approach for the treatment of grade IV haemorrhagic cystitis (HC) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in children. METHODS: The clinical data of 14 children with severe HC, who were admitted to Hebei Yanda Hospital between July 2017 and January 2020, were analysed retrospectively. There were nine males and five females, with an average age of 8.6 years (range: 3 to 13 years). After an average of 39.6 (7 to 96) days of conservative treatment in the hospital's haematology department, the bladders of all patients were filled with blood clots. A small 2-cm incision was made in the suprapubic area to enter the bladder and quickly clear the blood clots, and a percutaneous transhepatic approach to electrocoagulation and haemostasis was performed. RESULTS: In the 14 children, a total of 16 operations were performed, with an average operation time of 97.1 (31 to 150) min, an average blood clot of 128.1 (80 to 460) mL and an average intraoperative blood loss of 31.9 (20 to 50) mL. There were three cases of postoperative bladder spasm remission after conservative treatment. During the follow-up period of 1 to 31 months, one patient improved after one operation, 11 patients were cured after one operation, and two patients were cured after recurrent haemostasis by secondary electrocoagulation, four of whom died of postoperative non-surgical blood-related diseases and severe lung infections. CONCLUSION: Percutaneous electrocoagulation haemostasis can quickly remove blood clots in the bladders of children after allo-HSCT with grade IV HC. It is a safe and effective minimally invasive treatment.

Cumulative Incidence and Clinical Risk Factors of Radiation Cystitis after Radiotherapy for Prostate Cancer.

OBJECTIVES: This study aimed to evaluate the cumulative incidence of overall and severe radiation cystitis following external beam radiation therapy for prostate cancer and investigate the clinical factors predictive of radiation cystitis. METHODS: This retrospective study comprised 246 patients who received external beam radiation therapy for localized or locally advanced prostate cancer between 2013 and 2016 in our institution. Of these, 189 received primary radiation therapy and 57 received adjuvant/salvage radiation therapy. Radiation cystitis was recorded using the Common Terminology Criteria for Adverse Events version 5.0 definition, and severe radiation cystitis was defined as grade 3 or higher. All medical records were reviewed to calculate the cumulative incidence of radiation cystitis. Univariate and multivariate Cox regression analyses were used to evaluate its association with clinicopathologic features. RESULTS: The median follow-up period after radiation therapy was 56 months (range 5-81). The 5-year cumulative incidence of radiation cystitis and severe radiation cystitis was 16.2% and 3.0%, respectively. Multivariate analyses identified radiation therapy in the adjuvant/salvage setting was the sole risk factor associated with the development of radiation cystitis (hazard ratio: 2.75, p = 0.02). CONCLUSIONS: Radiation therapy in the post-prostatectomy setting was associated with increased risk of radiation cystitis compared with radiotherapy as the primary treatment.

Systematic review and meta-analysis of ketamine-associated uropathy.

INTRODUCTION: This systematic review and meta-analysis focused on the literature regarding ketamine-associated uropathy to summarise its clinical manifestations, the results of urological assessments, and current management. METHODS: A literature search was conducted using keywords and MeSH terms related to ketamine abuse, urinary tracts, and urological examinations. Databases including Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched up to 26 June 2020. RESULTS: In total, 1365 articles were retrieved; 45 articles (4921 patients) were included in the analysis of patient demographics, clinical manifestations, examination results, and treatments. Frequency was the most common manifestation (pooled prevalence 77.1%, 95% confidence interval [CI]=56.9%-92.2%), followed by urgency (69.9%, 95% CI=48.8%-87.3%) and suprapubic pain (60.4%, 95% CI=35.3%-82.9%). Upper urinary tract involvement was less common; the pooled prevalence of hydronephrosis was 30.2% (95% CI=22.0%-39.2%). Further workup revealed a pooled functional bladder capacity of 95.23 mL (95% CI=63.57-126.88 mL), pooled voided volume of 113.31 mL (95% CI=59.44- 167.19 mL), and pooled maximum urine flow rate of 8.69 mL/s (95% CI=5.54-11.83 mL/s). Cystoscopic examinations and bladder biopsy revealed frequent urothelial denudation, inflammatory changes, and inflammatory cell infiltration. Treatments included oral medications for symptomatic relief, intravesical therapy, and surgery (eg, hydrodistension and bladder reconstruction), but ketamine abstinence was necessary for improvement. CONCLUSION: Ketamine-associated uropathy frequently involves frequency, urgency, and suprapubic pain; upper urinary tract involvement is less common. Affected patients showed reductions in bladder capacity and urine flow rate. Endoscopic and histological analyses often revealed cystitis. Despite variations in treatment, ketamine abstinence is important for all patients with ketamine-associated uropathy.

Evaluation of hymenal adhesions resection in the treatment of recurrent post-coital cystitis.

OBJECTIVE: To describe and evaluate the technique of hymenal adhesions resection in the treatment of recurrent post-coital cystitis. MATERIALS AND METHODS: Monocentric retrospective observational study including patients operated for hymenal adhesions resection between 2013 and 2020. The indication was based on the association of 4 conditions: at least 3 episodes of documented cystitis per year, a post-coital rhythm, a failure of preventing hygienic and dietary rules, a negative etiological assessment except for the existence of hymenal adhesions. RESULTS: Twenty-three patients were included. The procedures were performed on an outpatient basis. With a mean follow-up of 36.5 months (standard deviation: 22.3), 21 patients (91%) reported a correction of recurrent post-coital cystitis, 16 (70%) had 1 to 2 annual episodes of cystitis, 19 (83%) reported improvement with surgery and satisfaction was rated on average at 8.5/10 (standard deviation: 2.15). None of the 23 patients had persistent documented recurrent cystitis after surgery, 12 (52%) had 1 to 2 documented episodes annually, and 11 (48%) had no documented recurrence. Three cases of postoperative complications were observed: vulvovaginitis, delayed healing, and pyelonephritis. No cases of dyspareunia were reported during the follow-up. CONCLUSION: In case of post-coital cystitis, accompanied by hymenal adhesions, and without any other identified cause, the removal of hymenal adhesions could be an alternative to iterative antibiotic therapy.

Clinical Outcomes following Percutaneous Urinary Diversion for Hemorrhagic Cystitis.

Hemorrhagic cystitis (HC) can lead to severe morbidity in treatment-refractory cases. Percutaneous nephrostomy (PCN) drainage was first described in 1993 as a safe, nonoperative procedure to achieve supravesical urinary diversion and treat severe HC. Despite its early success, subsequent studies in the adult population have been limited. This retrospective case series describes long-term outcomes following PCN placement in 24 patients with refractory HC. The overall technical success of the procedure was 100%. Seventeen of 24 (71%) patients experienced resolution of hematuria. The median time for hematuria resolution after the procedure was 12 days (interquartile range, 7-28 days). Postprocedural HC severity grade significantly decreased from a median Grade 3 to Grade 1 (P < .01). The complications included catheter obstruction, dislodgement, and associated urinary tract infections occurring at rates of 1.0, 1.6, and 1.7 per 1,000 catheter days, respectively. This study of PCN placement demonstrated and further confirmed the effectiveness of urinary diversion in treating refractory HC.

[Pathogenesis and treatment of postcoital cystitis: are our approaches correct?]

AIM: To study the pathogenetic factors in the development of postcoital cystitis and the efficiency of extravaginal transposition of the urethra. MATERIALS AND METHODS: Literature data and our point of view on the causes of postcoital cystitis are described. Case histories of 438 patients aged 18 to 61 (mean 24+/-1.3) were analyzed. The efficiency of extravaginal transposition of the urethra for the prevention of recurrence of postcoital cystitis was evaluated. RESULTS: The long-term results of operations in 315 patients were studied. A positive effect was noted in 297 (94.3%), which means the complete recovery or reduction in the frequency of cystitis to 2 or less times a year, while complete recovery occurred in 214 patients. In 18 (5.7%), the surgical procedure was ineffective, which required repeated interventions. DISCUSSION: According to our observations, the external opening of the urethra is located in patients with postcoital cystitis and in healthy women at the same level - before the introitus. During sexual intercourse, everyone experiences vestibulo-vaginal frictional dislocation of the urethra, however, exacerbations of the inflammatory process in the bladder occur only in some females, which is associated with the multifactorial nature of the disease. CONCLUSION: Postcoital cystitis develops as a result of a complex of factors, the most significant ofwhich are the state of the vaginal microflora, the virulence of uropathogenic bacteria, the anatomical features of the urethra and vagina, its narrowness with a mismatch with the penile size, the intensity and duration of sexual intercourse, severe, complicated childbirth and surgical procedures in this area. Performing extravaginal transposition of the urethra according to Komyakov demonstrated high efficiency in the prevention of recurrence of postcoital cystitis.

Vasovagal reaction secondary to bladder overdistension in a dog undergoing a unique timeline of medical and surgical treatment for Corynebacterium urealyticum encrusting cystitis: a case report.

BACKGROUND: Corynebacterium urealyticum urinary tract infections can result in a rarely reported condition called encrusting cystitis whereby plaque lesions form on and within the urinary bladder mucosa. Chronic lower urinary tract signs manifest subsequent to the infection-induced cystitis and plaque-induced decreased bladder wall distensibility. Because of the organism's multidrug resistance and plaque forming capability, infection eradication can be difficult. While systemic antimicrobial therapy is the mainstay of treatment, adjunctive surgical debridement of plaques has been used with relative paucity in such cases, thereby limiting our understanding of this modality's indications and success rate. Consequently, this report describes the successful eradication of Corynebacterium urealyticum encrusting cystitis utilizing a unique timeline of medical and surgical treatments. Additionally, this represents the first reported veterinary case of a vasovagal reaction due to bladder overdistension. CASE PRESENTATION: A 6-year-old female spayed Miniature Schnauzer was evaluated for lower urinary tract clinical signs and diagnosed with Corynebacterium urealyticum encrusting cystitis. The infection was persistent despite prolonged courses of numerous oral antimicrobials and urinary acidification. A unique treatment timeline of intravenous vancomycin, intravesical gentamicin, and mid-course surgical debridement ultimately resulted in infection resolution. During surgery, while the urinary bladder was copiously flushed and distended with saline, the dog experienced an acute vasovagal reaction from which it fully recovered. CONCLUSIONS: Surgical debridement of bladder wall plaques should be considered a viable adjunctive therapy for Corynebacterium urealyticum encrusting cystitis cases failing to respond to systemic antibiotic therapy. The timing in which surgery was employed in this case, relative to concurrent treatment modalities, may be applicable in future cases of this disease as dictated on a case-by-case basis. If surgery is ultimately pursued, overdistension of the urinary bladder should be avoided, or at least minimized as much as possible, so as to prevent the possibility of a vasovagal reaction.

Incidental diagnosis of nonfunctional bladder paraganglioma: a case report and literature review.

BACKGROUND: Nonfunctional bladder paragangliomas is a rare urological disease. It may present clinical, radiology and pathological features similar to bladder cancer, Only scarce reports have been reported. Urologist must identify this generally benign neuroendocrine neoplasm to avoid misdiagnosis. CASE PRESENTATION: A 62-year-old female presented the outpatient department of our hospital with the symptoms of stomachache, frequent micturition, and urination pain for 20 days. Diagnosed with high blood pressure 1 year ago, administered Amlodipine besylate tablets 5 mg po qd occasionally, did not check blood pressure; denied any tumor observation in the family history. Color ultrasound of the urinary system showed a 38 mm × 34 mm hypoechoic mass on the right side of the bladder, CDFI: in the masses, blood supply was sufficient. Cystoscope showed bladder occupying lesion. Biopsy diagnosis: papillary polypoid cystitis was suspected as a malignant change (Fig. 3a). Then, the patient was admitted to our urological department. Further, computer tomography urography considered bladder cancer. Cystoscopy and biopsy failed to define the nature of the lesions in our outpatient department, which prompted a transurethral resection of the bladder tumor. histopathological and immunohistochemical results were diagnosed as bladder paragangliomas. For the reason, the tumor was removed by partial resection of the bladder. The postoperative recovery and follow-up were uneventful. CONCLUSIONS: Nonfunctional bladder paragangliomas are occasionally found on imaging studies with the symptoms of urinary tract infection or/and intermittent painless hematuria. It may present clinical, radiology and pathological features similar to bladder cancer, so knowledge of this generally benign neuroendocrine neoplasm is of great importance to avoid misdiagnosis. It should be accompanied by the clinical and pathological characteristics of the patient and image changes. Partial resection of the bladder can effectively treat this disease.

Smaller bladder capacity and stronger bladder contractility in patients with ketamine cystitis are associated with elevated TRPV1 and TRPV4.

Stronger contractility and smaller bladder capacity are common symptoms in ketamine cystitis (KC). This study investigates the association between expression levels of transient receptor potential cation channel subfamily V (TRPV) proteins and the clinical characteristics of KC. Bladder tissues were obtained from 24 patients with KC and four asymptomatic control subjects. Video urodynamic parameters were obtained before surgical procedures. The TRPV proteins were investigated by immunoblotting, immunofluorescence staining, and immunohistochemistry. The Pearson test was used to associate the expression levels of TRPV proteins with clinical characteristics of KC. The expression level of TRPV1 and TRPV4 was significantly higher in the severe KC bladders than in mild KC or control bladders. The TRPV1 proteins were localized in all urothelial cell layers, and TRPV4 was located in the basal cells and lamina propria. The expression of TRPV1 was negatively associated with maximal bladder capacity (r = - 0.66, P = 0.01). The expression of TRPV4 was positively associated with the velocity of detrusor pressure rise to the maximum flow rate (r = 0.53, P = 0.01). These observations suggest smaller bladder capacity and stronger contractility in KC are associated with an elevated expression of TRPV1 and TRPV4, respectively.

Outcome of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis: a single-center retrospective study.

The purpose of this study was to evaluate the efficacy of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis (RHC). We conducted a retrospective study of 21 RHC patients treated with a 980-nm diode laser between July 2014 and December 2017 at our institution. Data was collected with regard to age, sex, lower urinary tract symptoms, use of transfusions, a drop in hemoglobin levels, indication of radiotherapy, median time between radiation therapy and presentation, previous treatments, operative time, mean energy used, number of coagulated areas, catheterization time, discharge time after treatment, hospital stay, and surgical outcome. All 21 patients were women with a median age of 52 years (range 36-68 years). Eighteen patients complained of frequency and urgency, four patients had dysuria, and one patient developed urinary retention. Radiation therapy was primarily indicated in the treatment of cervical cancer in 18 patients (85.7%) and endometrial cancer in three patients (14.3%). Nine patients (42.8%) received blood transfusion before surgery and three patients (14.3%) needed blood transfusion after the procedure. The mean decrease in hemoglobin prior to the procedure was 4.08 ± 2.04 g/dL. The median length of time from completion of radiotherapy to the presentation of hematuria was 38 months (range 8-65 months). All patients had failed an adequate trial of conservative treatment which included adequate hydration, hemostatics, continuous bladder irrigation (CBI), and clot evacuation at the bedside. Eleven patients (52.4%) had previously been treated with endoscopic electrocoagulation; the mean number of procedures was 1.73 ± 0.78 (range 1-3 sessions). Six patients (28.6%) underwent HBO, and sodium hyaluronate solution irrigation was administered to 3 patients (14.3%). The mean number of HBO sessions was 26.3 ± 16.8 (range 8-50), and the mean number of sodium hyaluronate solution irrigation procedures was 4.33 ± 1.53 (range 3-6). All operations were successful. The mean operative time was 45.6 ± 12.3 min, the mean number of coagulated areas was 11.7 ± 4.4, the mean energy used was 2.74 ± 1.14 kJ, the mean catheterization time was 6.2 ± 0.9 days, the mean discharge time after treatment was 6.8 ± 1.2 days, and the average length of a hospital stay was 7.4 ± 1.3 days. In 16 patients (76.2%), hematuria was completely resolved after one session of diode laser coagulation. Four patients (19.0%) underwent multiple sessions of laser treatment due to recurrent gross hematuria (three patients required two sessions and one patient required three sessions). Only one patient (4.8%) who had persistent gross hematuria after diode laser treatment (two sessions) underwent a radical cystectomy, which resolved the hematuria. The median hematuria-free interval of patients who had multiple procedures was 9 months (range 1-13 months). In total, 21 patients underwent 27 sessions of diode laser coagulation, and the median hematuria-free interval was 16 months (range 1-45 months) with a median follow-up of 25 months (range 7-48 months). Our study shows promising results for the management of patients with RHC; however, further evaluation with a larger cohort is required to confirm the efficacy of this treatment.

Vesicular Cystitis: A Chronic Cystitis Variant Often Unresponsive to Antibiotics and Electrofulguration.

OBJECTIVE: The aim of the study was to report on the presentation and outcomes of vesicular cystitis (VC), a chronic cystitis exhibiting translucent bladder mucosal vesicles, among women with antibiotic-refractory recurrent urinary tract infections (RUTIs). METHODS: An analysis of our Institutional Review Board-approved series on antibiotic-refractory RUTIs was performed, selecting for documented VC lesions on cystoscopy. All patients had RUTIs defined as ≥3 urinary tract infections/year with positive urine culture. All patients were extensively treated with antibiotics with no resolution of RUTIs and were offered electrofulguration (EF) of VC lesions under anesthesia as a last resort. All patients had a 6-month post-EF office cystoscopy documenting persistence or resolution of the lesions, and a clinical outcome assessment based on RUTI frequency. RESULTS: Of 482 patients, 18 (3.7%) treated during 2011-2017 met the study criteria. VC was most commonly found over the dome/anterior wall (7/18, 38%) and as pancystitis (7/18, 38%). There was often concomitant cystitis cystica of the trigone (8/18, 44%). At post-EF cystoscopy, persistence of VC was noted in 10/18 (56%) patients; 6/18 (33%) underwent repeat EF and an additional 3/18 (17%) were retreated due to new lesions after initial resolution. Two (11%) patients required simple cystectomy and urinary diversion due to RUTIs refractory to all interventions. Within a median follow-up of 2.8 years after EF, clinical cure was observed in 5/18 (28%), improvement in 10/18 (56%), and failure in 3/18 (17%) patients. CONCLUSIONS: Among women with antibiotic-refractory RUTIs, VC is an infrequent and persistent form of cystitis with a predilection for non-trigonal bladder surfaces, whose management is challenging.

Gross hematuria: A rare presentation of disseminated tuberculosis.

Tuberculosis (TB) is a multi-systemic disease instigated by Mycobacterium tuberculosis that can involve any organ. In any child presenting with clinical features involving multiple organ systems, TB forms an important differential. This holds particularly for endemic countries like India. Genitourinary TB (GUTB) comprises up to 27% of all extrapulmonary TB cases. We present an unusual presentation of disseminated TB involving kidneys and presenting as gross hematuria. 12-year-old girl, presented with recurrent episodes of gross hematuria of one-month duration. She received multiple packed cell transfusions for the same. She had chronic malnutrition. USG KUB with renal doppler was normal. Given persistent hematuria, CT urography was done which showed features suggestive of papillary necrosis with cystitis. Tubercular workup showed multiple opacities predominantly involving perihilar regions bilaterally on chest x-ray along with positive Mantoux test. Sputum for AFB was positive for tubercular bacilli. Urine samples were also sent for CBNAAT which showed TB bacilli sensitive to rifampicin. With a diagnosis of disseminated TB, antitubercular therapy (ATT) was started followed by cystoscopic resection of inflamed bladder wall tissue. Bladder mucosal biopsy confirmed caseating granulomas suggestive of tuberculous cystitis. The patient is doing well and symptom-free after completion of ATT.

Surgical Treatment of Eosinophilic Cystitis in Adults: A Report of Two Cases and a Literature Review.

Eosinophilic cystitis is a rare disease that presents with either urinary frequency, hematuria, suprapubic pain or urinary retention. Although benign, this entity may progress to diffuse bladder involvement with the need for surgical treatment. We report on 2 cases of advanced disease that required cystectomy with very complex lower urinary tract reconstruction, and review the literature of surgically treated cases.

Photoselective Vaporization of the Bladder for the Management of Radiation Cystitis-Technique and Initial Outcomes.

OBJECTIVE: To describe our technique using photoselective vaporization of the bladder (PVB) for the management of hemorrhagic cystitis and initial results of the procedure in 12 patients. MATERIALS AND METHODS: An audit of theater records of a single surgeon was performed to identify patients who had undergone PVB for the management of radiation cystitis. Rigid cystoscopy was performed. Ureteric catheters were placed and active bleeding sites were targeted to optimize vision. Ablation was commenced using the vaporize function. When lasering around delicate structures, the coagulation function was used. Ureteric catheters remained in situ for 24 hours. An 18Fr Foley catheter was placed. When urine output was clear, continuous bladder irrigation was ceased. Both ureteric catheters and the Foley catheter were removed before the 24-hour mark. RESULTS: Twelve patients were identified. Eight patients had previously required blood transfusion secondary to bladder hemorrhage. Nine patients were successfully treated and 2 patients saw improvement in hematuria but required a repeat procedure at 3 weeks postoperatively. Four patients underwent hyperbaric oxygenation as consolidative therapy. One patient was unsuccessfully treated and underwent cystectomy. There were no mortalities. No patients sustained bladder perforation or damage to surrounding structures. CONCLUSION: Radiation cystitis can be life threatening and remains a challenge for the urologist with traditional intravesical treatments, such as aluminum or formalin, having variable results. We present an alternate technique using PVB to ablate the bladder mucosa, with good results. Consolidation with hyperbaric oxygen therapy may be considered. Our study is limited by the small sample size, and the presence of bilateral ureteric catheters leaving the bladder free from urine may impact immediate postoperative outcomes. These initial results are promising; however, further prospective evaluation with a larger cohort and pre- and postoperative cystograms would enable better evaluation of this technique as a definitive management option for hemorrhagic cystitis.

[TYPICAL TYPE CYSTITIS GLANDULARIS PRESENTING URINARY RETENTION IN A YOUNG MAN: ADJUVANT THERAPY USING ORAL CYCLOOXYGENASE-2 INHIBITOR: A CASE REPORT].

A 31-year-old man was referred to our hospital with urinary retention. Cystoscopy revealed multiple edematous papillary tumors on the bladder trigone and neck, which were removed by transurethral resection. The pathological diagnosis was typical type cystitis glandularis. This relapsed six months after surgery and transurethral resection was repeated. Because immunohistochemical findings revealed positive epithelial cyclooxygenase-2 (COX-2) signals, we prescribed an oral COX-2 inhibitor. The tumor revealed shrinkage for six months after medication.