Pelvic lipomatosis with cystitis glandularis managed with cyclooxygenase-2 inhibitor: A case report

BACKGROUND

Pelvic lipomatosis (PL) is a rare benign condition with characteristic overgrowth of histologically benign fat and invasion and compression of pelvic organs, often leading to non-specific lower urinary tract symptoms (LUTS). Approximately 40% of patients with PL have cystitis glandularis (CG). The cause of PL combined with CG is poorly understood, and there is currently no effective treatment. Refractory CG with upper urinary tract obstruction even requires partial or radical bladder resection.

CASE SUMMARY

In this case, a patient suffering from PL with CG was treated by transurethral resection of bladder tumour (TUR-BT) and oral administration of celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor. The LUTS were alleviated, and the cystoscopy results improved significantly. Immunohistochemistry showed up-regulated COX-2 expression in the epithelium of TUR-BT samples, suggesting that COX-2 may participate in the pathophysiological process of PL combined with CG.

CONCLUSION

We report for the first time that celecoxib may be an effective treatment strategy for PL combined with refractory CG.

Diagnostic accuracy of CT imaging parameters in pelvic lipomatosis

PURPOSE

To predict the diagnosis of pelvic lipomatosis (PL) by assessing CT imaging parameters.

METHODS

Fifty clinically proven PL patients and 50 controls were included. Two radiologists recorded the types of bladder shapes and measured the following CT imaging parameters: (1) pelvic fat volume (PFV); (2) a set of morphological indices of bladder and rectosigmoid, including the ratio of craniocaudal to anterior-posterior length of bladder (CC/AP), angle between anterior and posterior wall (AAP), relative length of posterior urethra (rLPU), right and left angles between bladder and seminal vesicle (RABS and LABS), distance from verumontanum to anterior wall of rectum (DVR) and rectosigmoid morphological index (RMI). Secondary complications were also noted.

RESULTS

The results were evaluated by an unpaired t test, ROC analysis and logistic regression. All CT imaging parameters except RMI (p = 1.000) indicated a statistical difference between PL and controls (p < 0.01). The AUCs of these parameters were between 0.724 (for rLPU) and 0.993 (for AAP). The sensitivity and specificity were 94% and 98% for AAP and 92% and 94% for the combined model, respectively. 23 patients were pathologically diagnosed with cystitis glandular. The incidence of hydronephrosis in the PL group was higher than that in the control group (p < 0.01).

CONCLUSION

CT imaging parameters can predict the diagnosis of PL. The combined model of objective parameters including PFV, rLPU and DVR showed the best diagnostic performance for PL.

Difficult cystoscopy due to "Elongated" urethra- think of pelvic lipomatosis

Pelvic lipomatosis is a rare, proliferative disease with unknown etiology involving an overgrowth of normal fat in the pelvic retroperitoneal space. ^1-5 Cystitis glandularis or cystitis cystica can be observed in 75% of patients with pelvic lipomatosis. ⁵ We describe a 44-yr-old chronic smoker with suspicion of bladder mass who was referred to us following an inconclusive cystoscopy due to an "elongated” urethra and was later diagnosed to be a case of pelvic lipomatosis with cystitis cystica. Because the association of this condition with bladder adenocarcinoma and the possibility of obstructive uropathy later, we have kept the patient on close follow-up.

Robotic Management of Pelvic Lipomatosis-Experience with Difficulties Encountered and the Techniques to Successful Outcomes

Background

Pelvic lipomatosis (PL) is a rare condition characterized by diffuse pelvic overgrowth of nonmalignant but infiltrative adipose tissue in perivesical and perirectal space.

Objective

To share our robotic experience and difficulties encountered and suggested techniques to overcome them successfully. It is the first series from India.

Design, setting, and participants

A prospective observational study was conducted. All consecutive patients diagnosed with PL between 2016 and 2019 underwent robotic-assisted wide bladder fat extirpation and bilateral ureteral reimplantation (extravesical refluxing type) with double J stenting and were evaluated prospectively.

Outcome measurements and statistical analysis

Demographics, serum creatinine level, radiographic features, postoperative complications, and patient-reported outcomes were evaluated. Continuous variables are presented as median and range, as the sample size is very small.

Results and limitations

We encountered a total of five patients with PL. The median console time was 126 (range 120–130) min, with a median estimated blood loss of 120 (range 100–150) ml. Postoperative complications were Clavien-Dindo grade I in three cases, and the median hospital stay was 2 d. Distal ureteric margins showed subepithelial edema with submucosal fibrosis, and bladder fat biopsies were reported as adipose tissue with hemorrhage. At initial 3-mo and annual follow-ups, all patients had normal serum creatinine and there was no evidence of disease recurrence. Limitations of our study are the very small sample size (a low incidence of PL) and short follow-up time period (the question of how long the surgical effect will be sustained due to abnormal proliferation of fat cells remains unanswered).

Conclusions

Robotic management of wide bladder fat extirpation and bilateral ureteral reimplantation with double J stenting has a good success rate and good outcome in PL.

Patient summary

Pelvic lipomatosis is a very rare condition. Robotic management in treating the condition has good outcome for the patient. Here, we have discussed the difficulties encountered in treating the condition and the techniques used to overcome them.

Pelvic lipomatosis and renal transplantation: A case report

BACKGROUND

Pelvic lipomatosis is a rare disease of unknown etiology, characterized by the overgrowth of pelvic adipose tissue that causes compression of the urinary tract including the bladder and ureters, rectum and blood vessels. The patient may progressively develop obstructive uropathy which could subsequently lead to renal failure. At present, there are no reports of renal transplantation due to uremia caused by pelvic lipomatosis. The ideal management of patients with pelvic lipomatosis after renal transplantation is not yet well-established due to the lack of literature and follow-up data.

CASE SUMMARY

We report a 37-year-old male patient with pelvic lipomatosis who received a successful living donor renal transplantation on July 22, 2015. The operation was complicated as the iliac vessels and bladder were wrapped entirely in excessive abnormal fat. The external iliac artery and vein were located using ultrasonographic guidance. The adipose tissue around the right bladder was removed as far as possible, and the graft ureter was reimplanted into the bladder, using the Lich-Gregoir technique. At 22 mo after transplantation, graft percutaneous nephrostomy was performed under ultrasonographic guidance for urinary diversion due to hydronephrosis of the graft kidney. Follow-up at four years showed that the renal allograft function was stable.

CONCLUSION

When patients with pelvic lipomatosis develop renal failure, renal transplantation could be a feasible treatment strategy.

Pelvic lipomatosis associated with portal vein thrombosis and hydronephrosis: a case report

Pelvic lipomatosis is an uncommon disease with no clear etiology and it occurs secondary to deposition of a large amount of fatty tissue in the pelvis. This deposition causes compression to the rectum, bladder, and venous structures. Because of this compression, various symptoms, such as recurrent urinary infections, dysuria, tenesmus, and constipation, have mostly been reported. However, iliac or superior vena cava thrombosis secondary to vascular compression of pelvic lipomatosis is rare. This report describes a case of pelvic lipomatosis, which was associated with right-sided mild hydronephrosis and portal vein thrombosis.

Image characteristics of computer tomography urography in pelvic lipomatosis

Pelvic lipomatosis is a rare disease where fat tissue deposition is observed in spaces of the pelvic area. The disease has a wide range of presenting obstruction symptoms varying from lower urinary tract symptoms to bowel symptoms. In this report, we described the clinical findings, classical radiological features and treatment in an elderly male patient with pelvic lipomatosis.