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

Rossanese, Marta; Palumbo, Vito; Sioletic, Stefano; Crestani, Alessandro; Giannarini, Gianluca; Ficarra, Vincenzo

doi:10.1159/000485257

Cited by 14 publications

(25 citation statements)

References 8 publications

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“…Herpes simplex, for example, which manifests as skin and mucosal vesicles, has been seen in association with hemorrhagic cystitis [11]. Inflammatory etiologies such as eosinophilic cystitis have also been extensively described [12]. We believe further microbiological and histological evaluation of urine and tissue from patients with VC will be required to better understand the underlying pathobiology.…”

Section: Discussionmentioning

confidence: 99%

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

Crivelli

2020

Urol Int

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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.

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Section: Discussionmentioning

confidence: 99%

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

Crivelli

2020

Urol Int

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“…EC may be caused by immune system regulation disorders, which induce antigen stimulation and lead to immunoglobulin E (IgE)-mediated eosinophil activation and degranulation of mast cells, triggering the release of inflammatory mediators and injuring the bladder wall ( 8 ). Adult patients with EC may present with a variety of urinary symptoms, including frequent urination, urgent urination, odynuria, hematuria, dysuria and suprapubic pain; children with EC often have similar symptoms ( 9 , 10 ). Pathologic biopsy findings are therefore paramount for differential diagnosis ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic cystitis in children: A case report

Ning

et al. 2018

Exp Ther Med

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The aim of the present case report was to investigate the clinical features, pathological examination and treatment of eosinophilic cystitis (EC) in children. Two cases of EC were reported and reviewed from January 2016 to March 2017. Case 1 (male; 6 years old) had intermittent hematuria, frequent urination, urgent urination, difficulty in urination and abdominal pain. Case 2 (male; 7 years old) had frequent urination, urgent urination, urinary pain, dysuria and suprapubic pain with no hematuria. One patient had a history of allergies and both patients underwent a cystoscope biopsy. Blood eosinophils were clearly increased and a bone marrow biopsy examination revealed that marrow eosinophils were also increased in both cases. The urine culture results were negative. Ultrasonography and computed tomography revealed uneven thickening of the bladder wall and diffusive mucosal lesions. Cystoscopy revealed that the bladder volume became smaller and the mucosa at the bladder floor and neck was red. Lesions were biopsied through the urethra and the following characteristics were observed: Congestion and edema of the bladder mucosa, infiltration of the blood vessels and eosinophils in the muscular layer, accompanied by focal muscle necrosis. Patient 1 was administered anti-inflammatory and cetirizine hydrochloride treatments, followed by 6 weeks of prednisone dose-reduction therapy. Patient 2 was administered antibiotics and cetirizine hydrochloride. Following 6-month follow-ups, abnormal voiding symptoms had disappeared in each case. Ultrasonography and computed tomography revealed no bladder wall thickening or space-occupying lesions. EC in children is rare and easily misdiagnosed as nonspecific bladder inflammation or bladder occupying lesions. Cystoscopy and biopsy are necessary to diagnose EC and conservative treatments with anti-inflammatory, anti-allergic and cortical hormone nonspecific treatments are suggested.

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“…Although there are no consensus guidelines for treatment of eosinophilic cystitis, human and veterinary literature reviews show some effectiveness in management with corticosteroids, antihistamines, and antibiotics (Evason & Carr, 2007;Shih et al, 2012), even in refractory cases (when eosinophilic cystitis progress to a diffuse and aggressive form), in which total cystectomy or partial resection of the lesion have been reported (Rossanese et al, 2019;Walker, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Additional modalities have also been used in the treatment of human eosinophilic cystitis cases, including surgery (suprapubic catheter, cystectomy, or urinary diversion), pharmacotherapy (nonsteroidal anti-inflammatories, cyclophosphamide, doxorubicin, cyclosporine, mitomycin, and bethanechol), hydrodistension, and radiotherapy (Abilov et al, 2013;Aleem et al, 2016;Park, 2017;Rossanese et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic cystitis, a rare cause of persistent haematuria in a diabetic dog

Braz

Cruz

Santos

et al. 2021

Braz. J. Vet. Res. Anim. Sci.

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A cistite eosinofílica é uma doença inflamatória rara caracterizada por infiltração eosinofílica de todas as camadas da parede da bexiga. Essa enfermidade já foi descrita em adultos, crianças e cães. No entanto, não há um consenso de diretrizes sobre o seu tratamento. Mesmo que as literaturas humana e veterinária mostrem alguma eficácia no manejo com corticosteroides, anti-histamínicos e antibióticos, uma variedade de efeitos colaterais graves e frequentes estão associados à terapia com esteróides. Dessa forma, seu uso é relativamente contra-indicado para pacientes com diabetes mellitus e síndrome de Cushing, por exemplo. Um chow-chow, macho, castrado, de cinco anos e diabético estável foi encaminhado para atendimento com histórico de urina fétida, hematúria macroscópica e disúria não responsiva a antibióticos há 18 meses. A avaliação dos parâmetros físicos estava dentro dos padrões, exceto por desconforto abdominal suprapúbico. O hemograma e o perfil bioquímico estavam dentro dos valores de referência, exceto por eosinofilia periférica leve. Embora a ultrassonografia, a radiografia contratada da bexiga e os achados da urinálise indicassem malignidade, a histopatologia confirmou o diagnóstico definitivo de cistite eosinofílica. O manejo com ciclosporina foi satisfatório, com remissão completa da hematúria. Este relato de caso apresenta o primeiro uso documentado de ciclosporina para o tratamento de cistite eosinofílica, com sucesso, em um cão com diabetes.

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

Cited by 14 publications

References 8 publications

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

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

Eosinophilic cystitis in children: A case report

Eosinophilic cystitis, a rare cause of persistent haematuria in a diabetic dog

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