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Creasy W, Stewart DJ, Garriboli M, Simmonds N, Balasubramanian R. Eosinophilic cystitis-an obscure case of obstructive uropathy in infancy. Pediatr Nephrol 2024:10.1007/s00467-024-06463-w. [PMID: 39150522 DOI: 10.1007/s00467-024-06463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024]
Abstract
We report on an infant with features of intermittent obstructive uropathy, acute kidney injury, hypertension and type 4 renal tubular acidosis (RTA) despite urethral catheterisation and fluid resuscitation. Radiological findings showed upper tract dilatation, likely bilateral vesicoureteric junction obstruction and bladder base thickening which was concerning for possible malignancy. Renal biopsy demonstrated eosinophilic infiltrate, suggestive of kidney involvement. Bladder biopsy was diagnostic for eosinophilic cystitis (EC) showing mature degranulating eosinophils. EC is a rare, easily treatable and important differential of bladder mass in children which may present with an atypical obstructive uropathy. This report adds to the limited literature of this condition within the paediatric population. EC should be considered early in children presenting with eosinophilia, urinary tract obstruction and kidney dysfunction, with uncertain aetiology. This case also highlights the need for detailed imaging, including visualisation of the bladder base, in cases of likely obstructive uropathy.
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Affiliation(s)
- Will Creasy
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Douglas J Stewart
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
| | - Naomi Simmonds
- Department of Histopathology, St Thomas' Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Ramnath Balasubramanian
- Department of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Hussein Al-janabi M, Ali FM, Nammour A, Salloum R. Eosinophilic cystitis mimics bladder tumor: A rare case report. Heliyon 2024; 10:e32993. [PMID: 38988575 PMCID: PMC11233994 DOI: 10.1016/j.heliyon.2024.e32993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Eosinophilic cystitis is a rare inflammatory condition of the bladder characterized by eosinophils infiltrating the bladder wall. It affects people of all ages and with no gender difference. Eosinophilic cystitis can mimic bladder tumors and other chronic cystitis, which makes it a challenging condition to diagnose. In this article, we will discuss the causes, symptoms, diagnosis, and treatment of eosinophilic cystitis, as well as how it might be mistaken for bladder tumors.
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Affiliation(s)
| | | | - Ali Nammour
- Department of Urology, Tishreen University Hospital, Lattakia, Syria
| | - Rabab Salloum
- Department of Pathology, Tishreen University Hospital, Lattakia, Syria
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3
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van Ginkel C, Hurst RE, Janssen D. The urothelial barrier in interstitial cystitis/bladder pain syndrome: its form and function, an overview of preclinical models. Curr Opin Urol 2024; 34:77-83. [PMID: 37933666 PMCID: PMC10842656 DOI: 10.1097/mou.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Investigating bladder pain syndrome/interstitial cystitis (IC/BPS) preclinically is challenging. Various research models have been used to mimic the urothelial barrier closely and replicate the disease. The aim of this review is to discuss preclinical research related to the urothelial barrier in context of IC/BPS. RECENT FINDINGS In vivo models mimic IC/BPS mainly with toxic substances in the urine, with protaminesulfate and proteoglycan deglycolysation resembling a temporary impaired barrier as seen in IC/BPS. This temporary increased permeability has also been found in vitro models. Glycosaminoglycan replenishment therapy has been described, in vivo and in vitro, to protect and enhance recover properties of the urothelium. The roles of immune and neurogenic factors in the pathogenesis of IC/BPS remains relatively understudied. SUMMARY Preclinical studies provide opportunities to identify the involvement of specific pathologic pathways in IC/BPS. For further research is warranted to elucidate the primary or secondary role of permeability, together with inflammatory and neurogenic causes of the disease.
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Affiliation(s)
- Charlotte van Ginkel
- Department of Urology, Radboud university medical Center, Nijmegen, The Netherlands
| | | | - Dick Janssen
- Department of Urology, Radboud university medical Center, Nijmegen, The Netherlands
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4
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Htoo A, George RS, Mian BM, Akgul M. Correlation of urinary catheterization with histologic grading of eosinophilic cystitis: a single institutional review of 27 cases. Acad Pathol 2023; 10:100078. [PMID: 37101897 PMCID: PMC10123339 DOI: 10.1016/j.acpath.2023.100078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 04/28/2023] Open
Abstract
Eosinophilic cystitis (EC) is an uncommon diagnosis, mimicking urothelial carcinoma. Multiple etiologies including iatrogenic, infectious, and neoplastic have been suggested, effecting both adults and pediatric population. A retrospective clinicopathologic review of patients with EC in our institution between 2003 and 2021 was conducted. Age, gender, presenting symptoms, cystoscopic findings, and history of urinary bladder instrumentation were recorded. Histologically, urothelial and stromal changes were noted, and mucosal eosinophilic infiltration was graded as mild (scattered eosinophils in the lamina propria), moderate (visible small clusters of eosinophils without brisk reactive changes), or severe (dense eosinophilic infiltrate with ulcer formation and/or muscularis propria infiltration). Twenty-seven patients (male to female ratio = 18/9, median age 58 [12-85 years]), of whom two were in the pediatric age group were identified. Leading presenting symptoms were hematuria (9/27, 33%), neurogenic bladder (8/27, 30%), and lower urinary tract symptoms (5/27, 18%). Four of 27 (15%) patients had history of urothelial carcinoma of urinary bladder. Cystoscopy commonly revealed erythematous mucosa (21/27, 78%) and/or urinary bladder mass (6/27, 22%). Seventeen of 27 (63%) of patients had history of long-term/frequent catheterization. Mild, moderate, and severe eosinophilic infiltrates were seen in 4/27 (15%), 9/27 (33%), and 14/27 (52%) of cases. Proliferative cystitis (19/27, 70%) and granulation tissue (15/27, 56%) were additional common findings. All cases of long-term/frequent instrumentation cases had moderate or severe eosinophilic infiltrate. EC should be in the differential diagnosis; particularly in patients with long term/frequent catheterization.
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Affiliation(s)
- Arkar Htoo
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Rose S. George
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Badar M. Mian
- Department of Surgery in the Division of Urology at Albany Medical College, Albany, NY, USA
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
- Corresponding author. Department of Pathology and Laboratory Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY, 12208, USA.
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5
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Toxicity patterns associated with chronic ketamine exposure. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [DOI: 10.1016/j.toxac.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Konstantinou GN, Voukelatou V. Eosinophilic cystitis refractory to steroids successfully treated with benralizumab: A case report. FRONTIERS IN ALLERGY 2023; 3:1055129. [PMID: 36704755 PMCID: PMC9871778 DOI: 10.3389/falgy.2022.1055129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
We report a case of a 66-year-old male diagnosed with refractory to oral corticosteroids eosinophilic cystitis (EoC). Hematuria was the first and only sign of the disease that was otherwise asymptomatic, and the only abnormal lab finding he had was peripheral eosinophilia (700 cells/μl). Due to cardiovascular issues, an invasive surgical procedure was declined. As an alternative, benralizumab, an anti-IL-5Rα monoclonal antibody with anti-eosinophilic properties, was administered. The patient responded rapidly with clinical and histological complete remission of the EoC four months after benralizumab started. He continued benralizumab 30 mg Q4-weeks for 12 months without experiencing any side effects. Six months after the last dose, he is completely healthy with no peripheral eosinophilia. EoC is a rare condition with no standardized treatment. Those with corticosteroid-refractory EoC are eligible for surgery. Benralizumab has an excellent safety profile; therefore, it should be considered before deciding on invasive surgical procedures in selected, refractory to non-specific treatment cases, especially with EoC of unclear etiology. It is unclear if benralizumab may immunomodulate the unknown underlying mechanisms of EoC, considering that EoC did not relapse after benralizumab was deemed eliminated. Further studies are needed to investigate this possibility.
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Eosinophilic Inflammation and Equine Herpesvirus-1 Associated With Haemorrhagic Cystitis in a Horse. Case Report. J Equine Vet Sci 2022; 119:104161. [PMID: 36343833 DOI: 10.1016/j.jevs.2022.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Equine idiopathic haemorrhagic cystitis (EIHC) is a recently described form of aseptic cystitis in horses in which there is no discernible underlying cause. This case report describes a 9-year-old Thoroughbred gelding that presented with stranguria, pollakiuria, and haematuria. Cystoscopy revealed ulceration and haemorrhage of the bladder mucosa, diffuse mural hyperaemia and marked urine sedimentation. Histopathological evaluation of the bladder revealed chronic active ulcerative neutrophilic, lymphoplasmacytic, and eosinophilic cystitis. There was no bacterial or fungal growth upon culture but polymerase chain reaction (PCR) testing and sequencing for equine herpesvirus-1 (EHV-1) on bladder mucosa was positive. Conservative therapy with broad spectrum antimicrobials and non-steroidal anti-inflammatory therapy yielded complete resolution of clinical signs with significant improvement of macroscopic lesions in 14 days. Although a positive EHV-1 PCR suggests a viral cause, the horse's clinical signs, histology and recovery rate are more consistent with equine idiopathic haemorrhagic cystitis (EIHC). Neutrophilic and lymphoplasmacytic inflammation is a known feature of EIHC but eosinophilic infiltrates have not been previously described. The significance of the eosinophilic involvement is not certain; however, their presence has been associated with fungal, viral, parasitic, and immune-mediated aetiologies in other body systems. This is the first report of a horse with possible EIHC in Australia, as well as the first case with eosinophilic infiltrates and testing positive for EHV-1.
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Shin HB, Park HS, Kim JH, Park J. A rare case of eosinophilic cystitis involving the inside and outside of the urinary bladder associated with an infected urachal cyst. BMC Urol 2021; 21:116. [PMID: 34461879 PMCID: PMC8404243 DOI: 10.1186/s12894-021-00885-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eosinophilic cystitis is a rare inflammatory disease of the bladder characterized by eosinophilic infiltration of the bladder wall. Most Eosinophilic cystitis cases present with mucosal lesions of the urinary bladder. We present a very rare case of large mass-forming eosinophilic cystitis, involving the inside and outside of the bladder associated with an infected urachal cyst. CASE PRESENTATION A 59-year-old man presented with gross hematuria, fever, dysuria, and suprapubic pain. Computed tomography showed a heterogeneously enhancing mass that measured 7.6 cm × 4 cm located on the anterosuperior portion of the bladder with an internal fluid collection. Cystoscopy revealed a raspberry-like mass lesion on the bladder dome. Transurethral resection of the bladder was initially performed. The mass lesion protruding from inside the bladder was removed, and pus-like fluid was drained. The pathologic diagnosis was eosinophilic cystitis. Follow-up computed tomography showed a remnant mass outside the bladder and urachal cyst. To eliminate the remnant lesion, robot-assisted partial cystectomy was performed. The patient showed no evidence of recurrent disease on follow-up cystoscopy and computed tomography for up to 2 years. CONCLUSIONS Clinicians should consider the possibility of eosinophilic cystitis in patients who present with hematuria, fever, and suprapubic pain and have both intravesical and extravesical masses.
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Affiliation(s)
- Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Sik Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine,, Daejeon, Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea. .,Department of Urology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu-si, Gyeonggi-do, 11759, Republic of Korea.
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9
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Ng J, Lui LMW, Rosenblat JD, Teopiz KM, Lipsitz O, Cha DS, Xiong J, Nasri F, Lee Y, Kratiuk K, Rodrigues NB, Gill H, Subramaniapillai M, Mansur RB, Ho R, Cao B, McIntyre RS. Ketamine-induced urological toxicity: potential mechanisms and translation for adults with mood disorders receiving ketamine treatment. Psychopharmacology (Berl) 2021; 238:917-926. [PMID: 33484298 DOI: 10.1007/s00213-021-05767-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Intravenous (IV) ketamine has been shown to have rapid and robust antidepressant effects in adults with treatment-resistant depression (TRD). Urological toxicity has been observed in chronic ketamine abusers as evidenced by dysuria, urgency, and hematuria. The foregoing observation provides the basis for evaluating whether ketamine-induced urological toxicity (KIUT) is associated with sub-anesthetic doses of ketamine (0.5-1.0 mg/kg) in adults with mood disorders. The overarching objective of this article is to identify potential mechanisms of KIUT which appears to be dose and frequency dependent. Available research indicates that high-frequency ketamine is associated with disruption of the urothelial barrier as well as direct ketamine toxicity (i.e., decreased expression of junction proteins) in KIUT of the bladder. Chronic and high-frequency ketamine use is also associated with bladder inflammation mediated via neurogenic and IgE inflammation. Other non-mutually exclusive causes are nerve hyperplasia, hypersensitivity, cell apoptosis, microvascular damage, and overexpression of carcinogenic genes. Notwithstanding the evidence of KIUT in ketamine abusers, there is no evidence that ketamine and/or esketamine treatment in adults with mood disorders is associated with KIUT. However, all patients receiving ketamine/esketamine for mood disorder treatment should be queried about genitourinary symptoms during acute and, where applicable, maintenance dosing.
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Affiliation(s)
- Jason Ng
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Leanna M W Lui
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kayla M Teopiz
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Orly Lipsitz
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.,School of Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Jiaqi Xiong
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Flora Nasri
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Hartej Gill
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Mehala Subramaniapillai
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, 400715, China.,National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing, 400715, China
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, 399 Bathurst Street, MP 9-325, Toronto, ON, M5T 2S8, Canada. .,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada. .,Brain and Cognition Discovery Foundation, Toronto, Canada.
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10
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El-Ghar MA, Farg H, Sharaf DE, El-Diasty T. CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010032. [PMID: 33401464 PMCID: PMC7824127 DOI: 10.3390/medicina57010032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis.
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11
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Al Sbihi AF, Manasrah N, Al Qasem S, Abdelhady M, Shi D. Gross Hematuria in an Elderly Smoker Male Due to Eosinophilic Cystitis. Cureus 2020; 12:e12400. [PMID: 33532159 PMCID: PMC7847224 DOI: 10.7759/cureus.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This is a case of a 71-year-old smoker man who presented with four days of gross hematuria, which turned to be caused by eosinophilic cystitis (EC) proven by bladder biopsy. EC is a rare clinical and pathological inflammatory condition of the bladder with an unknown exact cause. It can present with hematuria, urinary frequency, dysuria, and suprapubic pain. Sometimes, the presentation can mimic urinary tract infection (UTI) or malignancy, especially in older patients.
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Affiliation(s)
- Ali F Al Sbihi
- Internal Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
| | | | - Mazen Abdelhady
- Urology, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
| | - Dongping Shi
- Pathology, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
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12
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Schifano N, Chiappini S, Castiglione F, Salonia A, Schifano F. Is medicinal ketamine associated with urinary dysfunction issues? Assessment of both the European Medicines Agency (EMA) and the UK Yellow Card Scheme pharmacovigilance database-related reports. Low Urin Tract Symptoms 2020; 13:230-237. [PMID: 33037767 DOI: 10.1111/luts.12355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A range of ketamine-induced uropathy (KIU) issues have been typically described in ketamine misusers. Conversely, more knowledge is needed in terms of medicinal ketamine-related urological disturbances, since ketamine prescribing is being increasingly considered for a range of medical and psychopathological conditions. METHODS To assess medicinal KIU issues, we aimed at analyzing both the 2005-2017 European Medicines Agency (EMA) and the 2006-2018 UK Yellow Card Scheme (YCS) pharmacovigilance databases. RESULTS A total number (eg, all categories) of 11 632 EMA ketamine-related adverse drug reaction (ADR) reports were here identified. Out of these, some 9971 ADRs (eg, 85.7% of the total) were judged as "suspect" and were here analyzed. Some 1758 ADRs (17.7% of 9971, corresponding to 194 individual patients) referred to urological issues, relating to either kidney/ureter (922 ADRs) or bladder/urethra (837 ADRs). Ketamine was the sole drug administered in 156/194 (80.4%) cases/patients. Although most cases occurred in the 1 month-1 year time frame following the start of ketamine prescribing, in 30 cases the ADR occurred within 48 hours. Most ADR-related cases resolved, although both sequelae (18 cases) and fatalities (79/1758; 4.5%) were recorded. Overall, YCS data were consistent with EMA findings, with some 50/217 (23%) ADRs referring to renal/urinary disorders. CONCLUSIONS Current data may only represent a gross underestimate of the KIU real prevalence issues. It is here suggested that chronic treatment involving higher doses/repeated exposure to ketamine be restricted to the context of controlled trials or clinical audits.
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Affiliation(s)
- Nicolo' Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Fabio Castiglione
- Institute of Andrology, Department of Urology, University College London Hospitals NHS Trust, London, UK.,NIHR Biomedical Research Centre University College London Hospital, London, UK.,Division of Surgery and Interventional Science, UCL, London, UK
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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13
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Castellani D, Pirola GM, Gubbiotti M, Rubilotta E, Gudaru K, Gregori A, Dellabella M. What urologists need to know about ketamine-induced uropathy: A systematic review. Neurourol Urodyn 2020; 39:1049-1062. [PMID: 32212278 DOI: 10.1002/nau.24341] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022]
Abstract
AIMS Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamine-induced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments. METHODS We performed the literature search in PubMed, Web of Science, Scopus, and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted. RESULTS A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity to the urothelium, disrupting its barrier function and enhancing cell apoptosis. The presence of ketamine/ions in the bladder wall result in neurogenic/IgE-mediated inflammation, stimulation of the inducible nitric oxide synthase-cytokines-cyclooxygenase pathway with persistent inflammation and fibrosis. Abstinence is the first therapeutic step. Anti-inflammatory drugs, analgesics and anticholinergics, intravesical instillation of hyaluronic acid, hydrodistension and intravesical injection of botulin toxin-A were helpful in patients with early-stage KIU. In patients with end-stage disease, the control of intractable symptoms and the increase of bladder capacity were the main recommendations to perform augmentation enterocystoplasty. CONCLUSIONS KIU is becoming a worldwide health concern, which should be taken into account in the differential diagnosis of ulcerative cystitis.
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Affiliation(s)
| | - Giacomo M Pirola
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Marilena Gubbiotti
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Kalyan Gudaru
- Department of Urology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Andrea Gregori
- Department of Urology, ASST Fatebenefratelli Sacco, Milan, Italy
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15
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Chaker K, Bouzouita A, Gharbi M, Blel A, Chakroun M, Ayed H, Cherif M, Ben Slama MR, Rammeh S, Derouiche A, Chebil M. [Diagnosis and treatment of eosinophilic cystitis]. Pan Afr Med J 2019; 31:45. [PMID: 30918571 PMCID: PMC6430843 DOI: 10.11604/pamj.2018.31.45.16149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
La cystite à éosinophiles est une pathologie inflammatoire de la paroi vésicale. Elle est rare, il n'existe pas des recommandations établies concernant sa prise en charge. Il s'agit d'une étude rétrospective ayant concerné dix observations de cystites à éosinophiles diagnostiquées et prises en charge dans notre service entre 2006 et 2017. L'âge moyen des patients était de 46 ans. On a noté une prédominance masculine. Un terrain atopique était noté dans 3 cas. Le mode de présentation le plus fréquent était des signes urinaires irritatifs dans 9 cas, une hématurie macroscopique dans 8 cas et des algies pelviennes dans 6 cas. Une hyper-éosinophilie sanguine était présente dans 4 cas. La cystoscopie avait montré des pétéchies dans 5 cas, un aspect pseudo-tumoral dans 4 cas et était normal dans un cas. Pour les formes pseudo-tumorales une résection endoscopique a été pratiquée. Quatre patients ont été traités par les anti-inflammatoires non stéroïdien, avec amélioration des symptômes. Six malades ont été surveillés. Après un recul moyen de 50 mois, aucune récidive n'a été rapportée. La cystite à éosinophiles est une pathologie rare. La présentation clinique est non spécifique. La prise en charge repose sur des moyens médicaux non invasifs dans les formes peu symptomatiques.
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Affiliation(s)
- Kays Chaker
- Service d'Urologie, Hôpital Charles Nicole, Tunis, Tunisie
| | | | - Marwa Gharbi
- Service d'Urologie, Hôpital Charles Nicole, Tunis, Tunisie
| | - Ahlem Blel
- Service d'Anatomie Pathologique, Hôpital Charles Nicole, Tunis, Tunisie
| | | | - Haroun Ayed
- Service d'Urologie, Hôpital Charles Nicole, Tunis, Tunisie
| | - Mohamed Cherif
- Service d'Urologie, Hôpital Charles Nicole, Tunis, Tunisie
| | | | - Soumaya Rammeh
- Service d'Anatomie Pathologique, Hôpital Charles Nicole, Tunis, Tunisie
| | | | - Mohamed Chebil
- Service d'Urologie, Hôpital Charles Nicole, Tunis, Tunisie
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16
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Rossanese M, Palumbo V, Sioletic S, Crestani A, Giannarini G, Ficarra V. Surgical Treatment of Eosinophilic Cystitis in Adults: A Report of Two Cases and a Literature Review. Urol Int 2018; 102:122-124. [PMID: 29554647 DOI: 10.1159/000485257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Marta Rossanese
- Department of Human and Paediatric Pathology "Gaetano Barresi," Urologic Section, University of Messina, Messina, Italy
| | - Vito Palumbo
- Department of Human and Paediatric Pathology "Gaetano Barresi," Urologic Section, University of Messina, Messina, Italy
| | - Stefano Sioletic
- Pathology Unit, Academic Medical Centre "Santa Maria Della Misericordia", Udine, Italy
| | - Alessandro Crestani
- Urology Unit, Academic Medical Centre "Santa Maria Della Misericordia", Udine, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria Della Misericordia", Udine, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology "Gaetano Barresi," Urologic Section, University of Messina, Messina,
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17
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Jhang JF, Hsu YH, Jiang YH, Lee CL, Kuo HC. Histopathological characteristics of ketamine-associated uropathy and their clinical association. Neurourol Urodyn 2018; 37:1764-1772. [DOI: 10.1002/nau.23514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/30/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jia-Fong Jhang
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
| | - Yuan-Hong Jiang
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
| | - Cheng-Ling Lee
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
| | - Hann-Chorng Kuo
- Department of Urology; Buddhist Tzu Chi General Hospital; Tzu Chi University; Hualien Taiwan
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18
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Choi MY, Tsigelny IF, Boichard A, Skjevik ÅA, Shabaik A, Kurzrock R. BRAF mutation as a novel driver of eosinophilic cystitis. Cancer Biol Ther 2017; 18:655-659. [PMID: 28829677 DOI: 10.1080/15384047.2017.1360449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Eosinophilic cystitis is a rare manifestation of hypereosinophilia and a cause of morbidity, including dysuria and hematuria. Although some cases can be attributed to infection or allergy, most cases are assessed to be idiopathic and treated with corticosteroids. However, hypereosinophilia can also be due to actionable clonal molecular alterations in the haematopoietic cells, similar to other myeloproliferative neoplasms. Common mutations associated with eosonophilic syndromes are of platelet-derived growth factor receptor α or β or c-kit, though other pathogenic mutations have been found by next generation sequencing. Determination of a specific mutation may therefore identify clonality and refine treatment of some cases. Here we review the molecular features of eosinophilic disorders. We also describe the use of a liquid biopsy of circulating cell-free DNA in the workup of a case of eosinophilic cystitis in which next generation sequencing of cell-free DNA showed a BRAF I463T mutation. In silico modeling supports the functional impact and potential clinical relevance of BRAF I463T.
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Affiliation(s)
- Michael Y Choi
- a Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center , University of California, San Diego , 3855 Health Sciences Drive #0820, La Jolla , CA
| | - Igor F Tsigelny
- b Center for Personalized Cancer Therapy, Division of Hematology and Oncology, San Diego Supercomputer Center, and Department of Neurosciences , University of California, San Diego , 9500 Gilman Drive #0505, CureMatch Inc., Lusk Blvd., Suite F208, San Diego, La Jolla , CA.,c CureMatch Inc. , 6390 Lusk Blvd., Suite F208, San Diego 92121
| | - Amelie Boichard
- d Center for Personalized Cancer Therapy, Division of Hematology and Oncology, San Diego Supercomputer Center , University of California, San Diego , 3855 Health Sciences Drive #0658, La Jolla , CA
| | - Åge A Skjevik
- e San Diego Supercomputer Center and Department of Biomedicine , University of Bergen , Bergen , Norway
| | - Ahmed Shabaik
- f Department of Pathology, UCSD Medical Center , University of California, San Diego , 200 W. Arbor Drive #8720 San Diego , CA
| | - Razelle Kurzrock
- a Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center , University of California, San Diego , 3855 Health Sciences Drive #0820, La Jolla , CA
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19
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Kilic O, Akand M, Gul M, Karabagli P, Goktas S. Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e24562. [PMID: 27621918 PMCID: PMC5002967 DOI: 10.5812/ircmj.24562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/25/2015] [Accepted: 05/17/2015] [Indexed: 12/05/2022]
Abstract
Introduction Eosinophilic cystitis (EC) is a rare and poorly understood inflammatory condition, characterized by eosinophilic infiltration of all layers of the bladder wall, which mimics bladder tumors. EC may present with symptoms such as increased urination frequency, dysuria, gross/microscopic hematuria, suprapubic pain and urinary retention. Case Presentation We present a 17-year-old male patient, who was continent night and day in his childhood, and was admitted to our clinic for complaints of hematuria and nocturnal enuresis for the past six months. His history and physical examination were unremarkable, and routine hematological and biochemical tests were normal. Cystoscopy revealed a 4 × 3 cm erythematous, polypoidal, solid lesion on the bladder dome. Histopathological examination of the lesion revealed transitional epithelium with stromal edema, where diffuse, dense infiltration of lamina propria by eosinophils and lymphocytes was also seen. According to these findings, a histopathological diagnosis of EC was made, and the patient was treated with corticosteroids, antimicrobial agents and antihistamines. His symptoms dramatically improved and nocturnal enuresis also recovered after treatment. Conclusions Although it is a rare entity, EC should be kept in mind in the differential diagnosis of patients presenting with dysuria, hematuria and any kind of acquired voiding dysfunction, including frequency, pollakiuria and incontinence.
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Affiliation(s)
- Ozcan Kilic
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Murat Akand
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
- Corresponding Author: Murat Akand, Department of Urology, School of Medicine, Selcuk University, Konya, Turkey. Tel: +90-5327438333, Fax: +90-3322412184, E-mail:
| | - Murat Gul
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Pinar Karabagli
- Department of Pathology, School of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Goktas
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
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20
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Aleem S, Kumar B, Fasano MB, Takacs E, Azar AE. Successful use of cyclosporine as treatment for eosinophilic cystitis: a case report. World Allergy Organ J 2016; 9:22. [PMID: 27458500 PMCID: PMC4939020 DOI: 10.1186/s40413-016-0113-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022] Open
Abstract
Background Eosinophilic cystitis is a rare inflammatory disorder characterized by eosinophilic infiltration of all layers of the urinary bladder wall. Due to lack of consensus and potential for side effect from various therapeutic options, treatment of the disease is often challenging. Case presentation A 64-year old woman with hypertensive nephropathy resulting in stage III chronic kidney disease, obstructive sleep apnea, and obstructive lung disease presented with a 4 month history of dysuria, urgency, frequency, and persistent hematuria. Based on eosinophilic infiltration on bladder wall biopsy in the absence of any evidence of infection, malignancy, or immune disorder, she was diagnosed with eosinophilic cystitis. Despite multiple medication regimens, her symptoms persisted, requiring high-dose prednisone with steroid-related side effects. After four months, she was started on cyclosporine, which led to symptomatic improvement and reduction in prednisone dosage. At that time, repeat urine cytology and cystoscopy did not reveal friable tissues or eosinophiluria. Conclusion This case illustrates the utility of using cyclosporine to treat eosinophilic cystitis in adult patient with multiple comorbid conditions.
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Affiliation(s)
- Sohaib Aleem
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ; Division of Immunology, Department of Internal Medicine - C42 GH, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Bharat Kumar
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Mary Beth Fasano
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Elizabeth Takacs
- Department of Urology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Antoine Emile Azar
- Division of Immunology, University at Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ; Present address: Division of Allergy and Clinical Immunology, John Hopkins Asthma & Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224 USA
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21
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Chia D. Eosinophilic cystitis and haematuria: Case report of a rare disease and common presentation. Int J Surg Case Rep 2016; 24:43-5. [PMID: 27179336 PMCID: PMC4873027 DOI: 10.1016/j.ijscr.2016.04.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 11/25/2022] Open
Abstract
Eosinophilic cystitis is a disease of unknown aetiology, however there is an association with a history of allergies and atopy. Common presentations are urinary frequency, dysuria, haematuria, and suprapubic pain, leading to diagnosis of less sinister urinary causes such as urinary tract infections. Natural history is difficult to predict, varying from acute self-resolving cases to chronic debilitating conditions requiring hospital admissions and radical interventions. It is difficult to distinguish from other forms of cystitis and biopsy is necessary for diagnosis. Treatment can vary from medical to operative intervention, or a combination of both.
Introduction Eosinophilic cystitis is a rare inflammatory condition of the bladder that can cause haematuria. The aetiology is unknown and clinical presentation is difficult to distinguish from other causes of haematuria. Diagnosis is confirmed by biopsy. In this case, a patient with haematuria is diagnosed with eosinohpilic cystitis after presenting to hospital. He was commenced on antibiotics for a presumed urinary tract infection with no resolution of haematuria and symptoms. After diagnosis he was commenced on treatment with resolution of symptoms. Case presentation A 73-year-old male presents with first episode of haematuria. He was initially diagnosed with a urinary tract infection and commenced on antibiotics with no resolution. After further investigations including a cystoscopy and bladder biopsy, he was diagnosed with eosinophilic cystitis. He was treated with steroids improving his symptoms. Conclusion Eosinophilic cystitis is a rare disease of the bladder which is difficult to distinguish from other causes of haematuria, and is often misdiagnosed. Bladder biopsy is necessary for diagnosis. Early diagnosis is important, and it is through a combination of non-operative and operative interventions such as biopsy. Natural history is difficult to predict as it is difficult to determine is a patient will have a benign course with resolution with or without treatment, or result in a chronic course which may result in bladder damage and renal failure. This case highlights the importance of investigating haematuria that is unresponsive to initial empiric treatment such as antibiotics. It is important to refer to a Urologist for further investigation to rule out a sinister cause, but to also obtain a diagnosis, leading to definitive treatment.
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Affiliation(s)
- Daniel Chia
- Department of Urology, Westmead Hospital, Corner of Hawkesbury Road and Darcy Road, Westmead, Sydney, NSW, 2145, Australia.
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22
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Jhang JF, Hsu YH, Kuo HC. Possible pathophysiology of ketamine-related cystitis and associated treatment strategies. Int J Urol 2015; 22:816-25. [PMID: 26087832 DOI: 10.1111/iju.12841] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/24/2015] [Indexed: 12/21/2022]
Abstract
Ketamine-related cystitis is characterized by ketamine-induced urinary frequency and bladder pain. It has become a serious problem in recent years. The most typical grossly pathological bladder change with ketamine related cystitis is a contracted bladder and bladder wall thickening. Ulcerative cystitis with an easily bleeding mucosa is a common cystoscopic finding. Microscopically, the urothelium is denuded and is infiltrated by inflammatory cells, such as mast cells and eosinophils. The pathogenesis of ketamine-related cystitis is complicated and involves many different pathways. Past evidence suggests a direct toxic effect, bladder barrier dysfunction, neurogenic inflammation, immunoglobulin-E-mediated inflammation, overexpression of carcinogenic genes, abnormal apoptosis and nitric oxide synthase-mediated inflammation contribute to the pathogenesis of ketamine-related cystitis. The first step to managing ketamine-related cystitis is always asking patients to cease ketamine. Medical treatment might be helpful in patients with early ketamine-related cystitis and abstinence from ketamine. Several case studies showed that the intravesical installation of hyaluronic acid and intravesical injection of botulinum toxin type A were effective for symptom relief in selected patients. For patients with irreversible pathological change, such as contracted bladder, augmentation enterocystoplasty might be the only solution to increase bladder capacity and relieve intractable bladder pain.
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Affiliation(s)
- Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
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23
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Han SG, Chen Y, Qian ZH, Yang L, Yu RS, Zhu XL, Li QH, Chen Q. Eosinophilic gastroenteritis associated with eosinophilic cystitis: Computed tomography and magnetic resonance imaging findings. World J Gastroenterol 2015; 21:3139-3145. [PMID: 25780317 PMCID: PMC4356939 DOI: 10.3748/wjg.v21.i10.3139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/07/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic gastroenteritis (EG) is a rare, distinct clinical entity, and EG associated with eosinophilic cystitis (EC) is extremely rare and has not been well documented. Here, we report two cases of EG and coexistent EC along with findings from computed tomography (CT) and magnetic resonance imaging (MRI). An 18-year-old male with a history of hematuria, urgency and occasional urodynia for two weeks and a 34-year-old male with a history of abdominal distention for one week were admitted to our hospital. Abdominal contrast-enhanced CT in both patients revealed wall thickening in different parts of the gastrointestinal tract with inhomogeneous reinforcement, coexistent with local or diffuse bladder wall thickening with progressive enhancement, and also showed that the bladder mucosal lining was nondestructive. Pelvic MRI showed that the local or diffuse thickened bladder wall was iso-intense on T1-weighted images, hypo-intense on T2-weighted images, and slightly restricted on diffusion weighted imaging (DWI) in one case. After therapy, the thickened wall of the gastrointestinal tract and urinary bladder had improved markedly in the two cases. To the best of our knowledge, this is the first report on the radiological imaging of EG and coexistent EC by both CT and MRI and the first with DWI findings.
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24
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Ozdoğan EB, Arslansoyu Çamlar S, Bilen S, Imamoğlu M, Tıraş S, Cansu A, Ozoran Y. An unusual cause of terminal hematuria in a child: Eosinophilic cystitis. Can Urol Assoc J 2014; 8:E867-71. [PMID: 25485018 DOI: 10.5489/cuaj.2173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Eosinophilic cystitis is a rare inflammatory disease of the bladder; it rarely occurs in children. Patients typically show irritative urination symptoms frequently, with a possible need for urgency, alongside dysuria, gross haematuria, suprapubic pain and painful urination. Sometimes bladder mass accumulation with the possibility of malignancy is also observed. We present an 8-year-old male patient who gained admission for terminal hematuria and discuss the management of eosinophilic cystitis.
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Affiliation(s)
- Elif Bahat Ozdoğan
- Department of Pediatrics, Division of Pediatric Nephrology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatrics, Division of Pediatric Nephrology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Sevcan Bilen
- Department of Pediatrics, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Mustafa Imamoğlu
- Department of Pediatric Surgery, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Sükran Tıraş
- Department of Pediatrics, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Ayşegül Cansu
- Department of Radiology, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
| | - Yavuz Ozoran
- Department of Medical Pathology, Faculity of Medicine, Faculity of Medicine, Karadeniz Tecnical University, Trabzon, Turkey
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25
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Mosholt KSS, Dahl C, Azawi NH. Eosinophilic cystitis: three cases, and a review over 10 years. BMJ Case Rep 2014; 2014:bcr-2014-205708. [PMID: 25312971 DOI: 10.1136/bcr-2014-205708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Eosinophilic cystitis (EC) is a rare disease. We describe three cases, where presentations of the disease are similar. To highlight probable causes of the disease, symptoms, clinical findings and treatment modalities, we reviewed 56 cases over a 10-year period. The most common symptoms were frequency, dysuria, urgency, pain and haematuria. Common clinical findings were presence of bladder mass, peripheral eosinophilia and thickened bladder wall. A variety of medical treatments were used, most frequently steroids, antibiotics and antihistamines. Recurrence occurred in patients on tapering or discontinuing prednisone, among other reasons. There is no consensus about the treatment of EC, but In light of our findings in this review, the treatment of choice in our department will be tapered prednisone over 6-8 weeks in combination with antihistamine.
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Affiliation(s)
| | - Claus Dahl
- Urological Department, Roskilde Hospital, Roskilde, Denmark
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26
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Jhang JF, Hsu YH, Jiang YH, Kuo HC. Elevated serum IgE may be associated with development of ketamine cystitis. J Urol 2014; 192:1249-56. [PMID: 24859443 DOI: 10.1016/j.juro.2014.05.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Previous studies revealed bladder mast cell and eosinophil cell infiltration in patients with ketamine cystitis. Due to possible hypersensitivity in those with this condition we investigated the association of serum Ig, histology findings and symptoms in patients with ketamine cystitis. MATERIALS AND METHODS We evaluated patients with ketamine cystitis for maximal bladder capacity, serum IgE, IgG and IgM, and pain visual analog scale score. Bladder biopsies were assessed for mast cells and eosinophils. Patients with interstitial cystitis/bladder pain syndrome, acute bacterial cystitis and controls were also studied. We used the Mann-Whitney U test for nonparametric data to compare serum IgE among groups with p <0.017 considered significant. RESULTS Median serum IgE was significantly higher in the 20 patients with ketamine cystitis (205.5 IU/ml, IQR 36.9, 514.0) than in the 10 controls (33.4 IU/ml, IQR 13.5, 71.7, p = 0.015) and the 15 with acute bacterial cystitis (34.6 IU/ml, IQR 24.2, 101.9, p = 0.015). It was marginally higher than in the 13 patients with interstitial cystitis/bladder pain syndrome (65.8 IU/ml, IQR 11.9, 133.0, p = 0.029). Of patients with ketamine cystitis the median visual analog scale pain score was significantly higher in those with serum IgE greater than compared to less than 200 IU/ml. Maximal bladder capacity was significantly less in patients with ketamine cystitis who had higher IgE. Patients with severe or moderate bladder eosinophil infiltration had a greater visual analog scale score, higher serum IgE and smaller maximal bladder capacity than patients with no or mild eosinophil infiltration. Serum IgE and the visual analog scale score correlated significantly (r(2) = 0.318, p = 0.01). CONCLUSIONS Patients with ketamine cystitis had higher serum IgE than patients with interstitial cystitis/bladder pain syndrome or acute bacterial cystitis, or controls. Serum IgE and the severity of eosinophil infiltration were associated with bladder pain severity and small maximal bladder capacity.
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Affiliation(s)
- Jia-Fong Jhang
- Departments of Urology and Pathology (YHH), Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Yung-Hsiang Hsu
- Departments of Urology and Pathology (YHH), Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, Republic of China.
| | - Yuan-Hong Jiang
- Departments of Urology and Pathology (YHH), Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, Republic of China
| | - Hann-Chorng Kuo
- Departments of Urology and Pathology (YHH), Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan, Republic of China.
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27
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Yu S, Zhang Z, Li G. Montelukast as a successful treatment for eosinophilic cystitis in an asthmatic woman patient. Pak J Med Sci 2013; 29:1280-2. [PMID: 24353737 PMCID: PMC3858941 DOI: 10.12669/pjms.295.3492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022] Open
Abstract
Eosinophilic cystitis (EC) is a rare inflammatory disorder. We herein report a case of EC in an asthmatic female patient who had a recent exacerbation with none known allergen. She was administered montelukast sodium orally for four weeks and received complete remission. This medication was successfully discontinued after a three-month follow up period. This case report about successful treatment of an adult EC patient using montelukast sodium may provide a new option for EC patients with allergic history.
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Affiliation(s)
- Shicheng Yu
- Shicheng Yu, Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Zhigen Zhang
- Zhigen Zhang, Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Gonghui Li
- Gonghui Li, Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
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28
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D M, T M K, M S, V R M, V G. Eosinophilic cystitis mimicking bladder tumour - a rare case report. J Clin Diagn Res 2013; 7:2282-3. [PMID: 24298501 DOI: 10.7860/jcdr/2013/6018.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/01/2013] [Indexed: 11/24/2022]
Abstract
A 16-year-old male presented with urinary urgency, a frequency of 4 months duration and intermittent gross haematuria which were there since one month. Eosinophilia was noted in complete blood count and CT KUB with contrast showed a filling defect in the right lateral wall, over the vesicoureteric junction. Cystoscopy revealed a sessile mass lesion over right vesico-ureteric junction, with bullous oedema . Rest of the mucosa was normal. Transurethral resection of lesion was performed and histological examination showed features of eosinophilic cystitis. Patient was treated with corticosteroids, antimicrobial agents and antihistaminics and he is recovering well. We are presenting this case for its rare presentation and its possibility of mimicking a bladder tumour. Biopsy of the lesion was diagnostic and an early treatment showed good results.
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Affiliation(s)
- Manimaran D
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research , Tamilnadu, India
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Kumar S, Sharma V, Ganesamoni R, Singh S. Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature. Urol Ann 2013; 5:50-2. [PMID: 23662013 PMCID: PMC3643326 DOI: 10.4103/0974-7796.106969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/17/2011] [Indexed: 11/04/2022] Open
Abstract
Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Valent P, Klion AD, Horny HP, Roufosse F, Gotlib J, Weller PF, Hellmann A, Metzgeroth G, Leiferman KM, Arock M, Butterfield JH, Sperr WR, Sotlar K, Vandenberghe P, Haferlach T, Simon HU, Reiter A, Gleich GJ. Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes. J Allergy Clin Immunol 2012; 130:607-612.e9. [PMID: 22460074 DOI: 10.1016/j.jaci.2012.02.019] [Citation(s) in RCA: 469] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/16/2012] [Accepted: 02/03/2012] [Indexed: 02/08/2023]
Abstract
Eosinophilia is an important indicator of various neoplastic and nonneoplastic conditions. Depending on the underlying disease and mechanisms, eosinophil infiltration can lead to organ dysfunction, clinical symptoms, or both. During the past 2 decades, several different classifications of eosinophilic disorders and related syndromes have been proposed in various fields of medicine. Although criteria and definitions are, in part, overlapping, no global consensus has been presented to date. The Year 2011 Working Conference on Eosinophil Disorders and Syndromes was organized to update and refine the criteria and definitions for eosinophilic disorders and to merge prior classifications in a contemporary multidisciplinary schema. A panel of experts from the fields of immunology, allergy, hematology, and pathology contributed to this project. The expert group agreed on unifying terminologies and criteria and a classification that delineates various forms of hypereosinophilia, including primary and secondary variants based on specific hematologic and immunologic conditions, and various forms of the hypereosinophilic syndrome. For patients in whom no underlying disease or hypereosinophilic syndrome is found, the term hypereosinophilia of undetermined significance is introduced. The proposed novel criteria, definitions, and terminologies should assist in daily practice, as well as in the preparation and conduct of clinical trials.
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Affiliation(s)
- Peter Valent
- Department of Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.
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31
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Galutira PJT, Canonigo BB, Cabansag MRF, Bolong DT, Ong RC, Lopez RA. Presenting manifestations of eosinophilic cystitis in two Filipino children. Int Urol Nephrol 2009; 42:557-63. [PMID: 19866369 DOI: 10.1007/s11255-009-9665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 10/02/2009] [Indexed: 11/27/2022]
Abstract
Eosinophilic cystitis is a very rare clinical disease entity in the pediatric population. We report two cases of Filipino children with eosinophilic cystitis who presented with irritative voiding symptoms, gross hematuria, peripheral eosinophilia, and hydroureteronephrosis and urinary bladder wall thickening visualized on ultrasonography and CT urography. Cystoscopy and transurethral biopsy confirmed the diagnosis. Both patients were started with corticosteroid with or without an antihistamine. Resolution from the signs and symptoms were observed in both patients as documented by disappearance of peripheral eosinophilia, normal urinalysis results, and resolution of the hydroureteronephrosis and urinary bladder wall thickening on ultrasonography on follow-up.
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Affiliation(s)
- Paul Joseph T Galutira
- Section of Pediatric Nephrology, University of Santo Tomas Hospital, Manila, Philippines.
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Ebel Sepulveda LF, Foneron A, Troncoso L, Cañoles R, Carrasco C, Hornig A, Gil G, Corti D. [Eosinophilic cystitis: review and two case reports]. Actas Urol Esp 2009; 33:443-6. [PMID: 19579899 DOI: 10.1016/s0210-4806(09)74174-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eosinophilic cystitis is a low frequency disease, with less than 200 reported cases in the world. It is characterized by a bladder wall inflammation, mainly by eosinophils, with fibrosis and muscle necrosis areas. Its origin seems to be immunological, although the triggers are not well known. Several predispose factor have been described such as allergic diseases, bladder injuries, drugs, infections, etc. It affects patient of all ages, mainly adults. It presents with frecuency, haematuria and suprapubic pain. Other less frequent symptoms are disuria, urinary retention, nicturia, and enuresis. The laboratory study (urinalysis, urinalysis and haemogram) and radiology (ultrasound, intravenous pyelography, computed tomography and nuclear magnetic resonance) are non specific. The lesions observed in the cystoscopy could emulate other diseases, that why the proper diagnostic is the histological analysis. The management could be observation o antihistaminic, anti-inflammatory and corticoid treatment. In refractory cases, surgery is an alternative. In this work, two male adult cases are reported with their symptoms, studies and management.
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Affiliation(s)
- Luis F Ebel Sepulveda
- Servicio de Urología, Hospital Regional de Valdivia y Departamento de Urologia, Universidad Austral de Chile.
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Popescu OE, Landas SK, Haas GP. The Spectrum of Eosinophilic Cystitis in Males: Case Series and Literature Review. Arch Pathol Lab Med 2009; 133:289-94. [PMID: 19195972 DOI: 10.5858/133.2.289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Eosinophilic cystitis (EC) is an inflammatory condition of the bladder that has been linked to food allergens, infectious agents, drugs, and other genitourinary conditions. Like interstitial cystitis, EC has a strong female predominance. It is characterized by an intense eosinophilic infiltrate in the acute phase and fibrosis in the chronic phase.
Objectives.—To document and focus on specific features of EC in males and highlight the relationship between clinical and histopathologic findings.
Design.—The bladder biopsies of male patients were reviewed. Eight cases of EC were selected.
Results.—Several known associations were noted as well as unreported features and associations such as Charcot-Leyden crystals, celiac disease, lupus anticoagulant, and additional viral and bacterial agents.
Conclusions.—Eosinophilic cystitis represents a response to a variety of agents and may often be overlooked. The temporally biphasic morphologic features are the hallmark of this condition. Because clinical and imaging studies are not specific, a high index of clinical suspicion is often crucial to the correct diagnosis and proper management of EC.
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Affiliation(s)
- Oana-Eugenia Popescu
- From the Division of Anatomic Pathology, Children's and Women's Health Centre of British Columbia, Vancouver (Dr Popescu); and the Departments of Pathology and Urology (Dr Landas) and Urology (Dr Haas), State University of New York Upstate Medical University, Syracuse
| | - Steve K. Landas
- From the Division of Anatomic Pathology, Children's and Women's Health Centre of British Columbia, Vancouver (Dr Popescu); and the Departments of Pathology and Urology (Dr Landas) and Urology (Dr Haas), State University of New York Upstate Medical University, Syracuse
| | - Gabriel P. Haas
- From the Division of Anatomic Pathology, Children's and Women's Health Centre of British Columbia, Vancouver (Dr Popescu); and the Departments of Pathology and Urology (Dr Landas) and Urology (Dr Haas), State University of New York Upstate Medical University, Syracuse
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de Jongh R, Haenen GRMM, van Koeveringe GA, Dambros M, De Mey JGR, van Kerrebroeck PEV. Oxidative stress reduces the muscarinic receptor function in the urinary bladder. Neurourol Urodyn 2007; 26:302-8. [PMID: 16998857 DOI: 10.1002/nau.20298] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Several pathophysiological conditions in the urinary bladder, for example, ischemia/reperfusion and inflammation are characterized by the formation of reactive oxygen species (ROS). The ROS are highly toxic because they can destroy proteins, DNA, and lipids. The aim of this study was to investigate the effect of oxidative stress on excitation-contraction coupling of detrusor smooth muscle. MATERIALS AND METHODS Smooth muscle strips were dissected from pig urinary bladder and mounted in organ baths. Oxidative stress was mimicked by the addition of Cumene hydroperoxide (CHP), a lipophilic hydroperoxide, to the organ baths. Contractile responses to electrical field stimulation (EFS: 4-32 Hz), carbachol (10(-8)-3 x 10(-5) M), potassium (65.3 mM), and ATP (1 mM) were monitored before and after the addition of CHP. RESULTS Responses of detrusor strips to EFS were for the greater part based on neurogenic stimulation and the release of acetylcholine. CHP diminished contractile responses to EFS and carbachol to the same extent. The pD(2) value of the carbachol concentration-response curve decreased significantly after exposure to 0.1 mM, 0.4 mM, 0.8 mM CHP. Furthermore the maximal effect obtained with carbachol was significantly reduced after 0.1 mM, 0.4 mM, and 0.8 mM CHP treatment. Contractions induced by potassium and ATP were significantly less affected by oxidative stress compared to EFS- and carbachol-induced responses of comparable amplitude. CONCLUSIONS The results of our study demonstrate that oxidative stress induced by CHP affects pig bladder contractility. The muscarinic receptor signaling system is severely damaged. L-type calcium channels and the contractile system are less affected and cholinergic nerves remain largely unaffected.
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Affiliation(s)
- Rik de Jongh
- Department of Urology, University Hospital Maastricht, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
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Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ. From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation. Radiographics 2006; 26:1847-68. [PMID: 17102055 DOI: 10.1148/rg.266065126] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although the vast majority of bladder tumors are epithelial neoplasms, a variety of nonneoplastic disorders can cause either focal bladder masses or diffuse mural thickening and mimic malignancy. Some of these entities are rare and poorly understood such as inflammatory pseudotumor, which produces ulcerated, bleeding polypoid bladder masses. These masses may be large and have an extravesical component. Bladder endometriosis manifests as submucosal masses with characteristic magnetic resonance imaging features consisting of hemorrhagic foci and reactive fibrosis. Nephrogenic adenoma has no typical features, and pathologic evaluation is required for diagnosis. Although imaging features of malacoplakia are also nonspecific, characteristic Michaelis-Gutmann bodies are found at pathologic evaluation. The various types of cystitis (cystitis cystica, cystitis glandularis, and eosinophilic cystitis) require pathologic diagnosis. Bladder infection with tuberculosis and schistosomiasis produces nonspecific bladder wall thickening and ulceration in the acute phase and should be suspected in patients who are immunocompromised or from countries where these infections are common. The diagnosis of chemotherapy cystitis and radiation cystitis should be clinically evident, but imaging may be used to determine severity and to assess complications. Extrinsic inflammatory diseases such as Crohn disease and diverticulitis may be associated with fistulas to the bladder and focal bladder wall abnormality. The extravesical findings allow the diagnosis to be made easily. Finally, extrinsic masses arising from the prostate or distal ureter may cause filling defects, which can be confused with intrinsic bladder masses.
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Affiliation(s)
- Jade J Wong-You-Cheong
- Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201-1595, USA.
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