Bladder wall thickening? Pay attention! It may be glandular cystitis

There are many reasons for bladder wall thickening, one of which may be glandular cystitis. Glandular cystitis is a relatively rare non-tumorous inflammatory lesion and a lesion in which epithelial hyperplasia and metaplasia coexist. Today I will talk to you about its clinical manifestations and pathological classification.

Clinical manifestations

Main manifestations: recurrent and intractable frequent urination, urgent urination, dysuria, hematuria, discomfort in the suprapubic area and perineum, distension in the lower abdomen, urinary incontinence, dyspareunia and other symptoms. The most common sites of lesions are the bladder trigone, bladder neck, and around the ureteral orifice, and the neck is more common at 3 to 9 o'clock. The clinical manifestations of glandular cystitis are closely related to the site of the lesion: those with lesions in the trigone mainly show bladder irritation signs; those in the bladder neck often have difficulty urinating, lower abdominal discomfort, and severe cases have dysuria symptoms; those with lesions involving the ureteral opening can cause ureteral dilatation and kidney hydrops and other symptoms of lumbar discomfort; those with a wider range of lesions often have hematuria; those with bladder stones may have symptoms such as interrupted urine flow.

Pathological classification

It is more likely to occur in the bladder trigone, bladder neck and around the ureteral orifice. According to the morphology of lesions under cystoscopic examination, glandular cystitis is divided into four types: papilloma-like type, follicular or villous edema type, chronic inflammatory reaction type and type with no significant changes in the mucosa.

Papillary hyperplasia: The inner wall of the bladder is papillary, polypoid, or villous, with irregular edges, a wide base, and thickened bladder walls. The lesions are more common in the trigone and lateral bladder walls.

Nodular hyperplasia: Localized hyperplasia of the bladder wall in the form of masses or nodular tumor-like hyperplasia with clear boundaries, rough and uneven surface, wide base and clear layered structure, and thickening of the surrounding bladder wall

Diffuse hyperplasia and hypertrophy: The bladder wall is segmental or diffuse hyperplasia and hypertrophy. In mild cases, the bladder wall thickens by only a few millimeters, while in severe cases, the entire bladder wall thickens by several centimeters. The bladder cavity is significantly reduced, the mucosa is rough and not smooth, and there may be scattered small honeycomb-shaped cystic dark areas. The submucosal structure is recognizable, and the bladder compliance is reduced. This type can often lead to bilateral hydronephrosis and renal failure.

Mixed hyperplastic type: a mixed type that is based on diffuse hyperplasia and hypertrophy combined with papillary hyperplasia and/or nodular hyperplasia, and has the manifestations of the first three types.

Treatment

The treatment of glandular cystitis mainly includes drug therapy, surgical treatment and the combination of the two. Surgical treatment can be done by intracavitary or open surgery, and drug therapy is intravesical instillation.