What is the recommended treatment for cystitis glandularis?

Treatment of Cystitis Glandularis

For cystitis glandularis, the recommended treatment is primarily observation and elimination of predisposing factors, with surgical intervention reserved for cases with obstructive symptoms or suspected malignancy. 1

Understanding Cystitis Glandularis

Cystitis glandularis is an unusual proliferative condition of the bladder associated with chronic inflammation. It is characterized by metaplasia of the transitional epithelium of the urinary bladder, resulting in the formation of glandular structures within the bladder mucosa. While typically found as an incidental microscopic finding, it can occasionally present as macroscopic lesions.

Treatment Approach

First-Line Management:

• Observation and monitoring for asymptomatic cases
• Elimination of predisposing factors such as:
  • Chronic inflammation
  • Urinary tract infections
  • Urinary obstruction
  • Indwelling catheters (if present) 2

For Symptomatic Cases:

1. Transurethral resection for cases with:

   • Obstructive symptoms
   • Hematuria
   • Bladder mass formation 1

2. Anti-inflammatory therapy:

   • COX-2 inhibitors
   • Oral steroids (short course) for severe inflammation 1

Follow-up Care:

• Regular cystoscopic surveillance (every 6-12 months)
• Monitoring for recurrence or progression
• Repeat biopsy if suspicious changes occur

Special Considerations

Relationship to Malignancy

While the malignant potential of cystitis glandularis remains controversial, some cases have been documented to progress to adenocarcinoma. Therefore, vigilant follow-up is essential, particularly for the intestinal metaplasia subtype.

Differential Treatment Based on Presentation

• Asymptomatic incidental finding: Observation only
• Recurrent hematuria: Transurethral resection of visible lesions
• Obstructive symptoms: Surgical intervention and anti-inflammatory therapy 1

Treatment Pitfalls to Avoid

1. Misdiagnosis as malignancy: Cystitis glandularis can mimic bladder cancer on imaging and cystoscopy. Proper histopathological examination is crucial.

2. Overtreatment: Asymptomatic cases generally do not require aggressive intervention.

3. Inadequate follow-up: Due to the potential (albeit rare) for malignant transformation, regular surveillance is important.

4. Failure to address underlying causes: Chronic inflammation or infection should be treated to prevent recurrence.

While some treatments used for interstitial cystitis (such as pentosan polysulfate) have been studied for various bladder conditions 3, 4, 5, 6, there is insufficient evidence to recommend these specifically for cystitis glandularis.

The case report from 2022 demonstrates that even in severe cases with obstructive symptoms, appropriate endoscopic intervention combined with anti-inflammatory therapy can yield promising outcomes 1.