What is the treatment for cystitis glandularis?

Treatment for Cystitis Glandularis

The treatment for cystitis glandularis primarily involves transurethral resection of the lesion, followed by appropriate medical therapy including anti-inflammatory agents such as COX-2 inhibitors and oral steroids to reduce inflammation and prevent recurrence. 1

Diagnostic Approach

• Cystitis glandularis is a rare proliferative disease of the bladder associated with chronic inflammation or obstruction 1
• Diagnosis requires cystoscopy with biopsy to confirm the presence of glandular metaplasia of the urothelium 1
• Ultrasound examination may reveal bladder wall thickening and signs of obstruction in severe cases 1

Primary Treatment Options

Surgical Management

• Transurethral resection (TUR) of the lesion is the first-line treatment to remove the proliferative tissue and relieve obstruction 1
• Complete resection is essential to prevent recurrence and allow for histopathological examination 1

Medical Management

• Anti-inflammatory therapy is recommended post-resection:
  • COX-2 inhibitors to reduce inflammation 1
  • Oral corticosteroids in cases with significant inflammation 1
• Antibiotics should be administered if there is evidence of concurrent bacterial infection 2

Follow-up and Monitoring

• Regular cystoscopic surveillance is recommended at 3-6 month intervals for the first 2 years 2
• Urinary cytology should be performed periodically to monitor for potential malignant transformation 2
• Upper tract imaging should be considered every 1-2 years for high-risk cases 2

Treatment of Associated Symptoms

For Cystitis Symptoms

• If symptoms of cystitis are present, treat according to standard guidelines:
  • First-line options include nitrofurantoin (100 mg twice daily for 5 days) if renal function is adequate (eGFR >30 ml/min) 3
  • Fosfomycin trometamol (3 g single dose) is an appropriate alternative 3
  • For persistent symptoms, fluoroquinolones may be considered as second-line agents 2

For Bladder Irritation

• Anticholinergic medications can help manage irritative bladder symptoms 2
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 2
• Bladder instillations with anesthetic and anti-inflammatory solutions may provide relief in severe cases 4

Special Considerations

• In cases with significant obstruction, temporary urinary diversion may be necessary 1
• For extensive disease or recurrent cases, more aggressive surgical approaches may be required 1
• Long-term follow-up is essential due to the uncertain potential for malignant transformation 1

Treatment Algorithm

1. Confirm diagnosis with cystoscopy and biopsy
2. Perform complete transurethral resection of all visible lesions
3. Initiate anti-inflammatory therapy with COX-2 inhibitors and/or oral steroids
4. Treat any concurrent bacterial infection with appropriate antibiotics
5. Schedule regular follow-up cystoscopy every 3-6 months for the first 2 years
6. Manage persistent symptoms with targeted therapy (anticholinergics, analgesics)
7. Consider more aggressive intervention for recurrent or extensive disease

Common Pitfalls to Avoid

• Incomplete resection of lesions, leading to early recurrence 1
• Inadequate follow-up, risking missed progression or recurrence 2
• Failure to distinguish between cystitis glandularis and adenocarcinoma of the bladder 1
• Overuse of antibiotics when no bacterial infection is present 2