From the Guidelines
Diffuse bladder wall thickening is primarily caused by chronic inflammation, infection, or obstruction of the bladder, with the most common causes including urinary tract infections (UTIs), bladder outlet obstruction, and interstitial cystitis. The most recent and highest quality study, 1, published in 2024, highlights the importance of comprehensive staging and imaging in detecting bladder cancer and its potential causes of diffuse bladder wall thickening.
Causes of Diffuse Bladder Wall Thickening
- Urinary tract infections (UTIs), particularly recurrent or chronic infections with bacteria like E. coli, which trigger inflammatory responses in the bladder wall 1
- Bladder outlet obstruction from conditions such as benign prostatic hyperplasia, urethral strictures, or neurogenic bladder, causing the bladder to work harder to expel urine, resulting in muscular hypertrophy and wall thickening 1
- Interstitial cystitis, a chronic condition characterized by bladder pain and pressure, can lead to significant wall thickening over time
- Radiation cystitis following pelvic radiation therapy, chemotherapy-induced cystitis, bladder cancer (particularly invasive types), and systemic conditions like diabetes that affect bladder function 1
- Chronic overdistension from conditions like neurogenic bladder can also contribute to wall thickening
Importance of Prompt Evaluation
Prompt evaluation of bladder wall thickening is crucial as it may represent serious underlying pathology requiring specific treatment. Imaging modalities such as CT and MRI play a significant role in detecting and staging bladder cancer, as well as identifying other potential causes of diffuse bladder wall thickening 1.
Treatment
Treatment depends on addressing the underlying cause, which may include:
- Antibiotics for infection
- Alpha-blockers for obstruction
- Anti-inflammatory medications for inflammatory conditions
- Other specific treatments for underlying conditions such as bladder cancer or interstitial cystitis.
From the Research
Causes of Diffuse Bladder Wall Thickening
- Diffuse bladder wall thickening can be caused by various factors, including bladder malignancy 2, interstitial cystitis/bladder pain syndrome (IC/BPS) 3, 4
- In some cases, diffuse bladder wall thickening may not be associated with malignancy, as seen in a study where no patients with diffuse bladder wall thickening had malignancy 5
- Other possible causes of diffuse bladder wall thickening include chronic bladder wall inflammation and fibrosis 3, 4
- Clinical symptoms such as gross hematuria, bladder/urethral stones, history of prostate cancer treated with radiation, follow-up after bladder/ureter carcinoma treatment, long-term urinary stents, and colovesicular fistulas may be associated with diffuse bladder wall thickening 6
Association with Interstitial Cystitis/Bladder Pain Syndrome
- Diffuse bladder wall thickening has been correlated with clinical phenotypes of IC/BPS, including histopathological findings 3
- Patients with diffuse bladder wall thickening displayed smaller first sensation of filling, cystometric bladder capacity, and voided volume compared to those with smooth bladder wall or focal bladder thickening 3
- Focal or diffuse bladder wall thickening on CT might indicate the presence of chronic bladder wall inflammation and fibrosis and could be used to differentiate bladder-centered IC/BPS 3, 4
Clinical Significance
- Incidentally detected bladder wall thickening on CT can be suggestive of bladder malignancy, and further work-up including cystoscopy and urine cytology should be performed to assess bladder malignancy 2
- Bladder wall thickness on CT can reflect chronic inflammation of the bladder wall in patients with IC/BPS, which is clinically relevant for the diagnosis and treatment of IC subtypes 4