Background
Eosinophilic cystitis is an unusual variant of cystitis that may be characterized by dysuria and hematuria. Biopsy is essential to establish the diagnosis.
OUTLINE
DISEASE ASSOCIATIONS CHARACTERIZATION Eosinophilic cystitis induced by mitomycin-C.
Ulker V, Apaydin E, Gursan A, Ozyurt C, Kandiloglu G.
Department of Urology, Ege University Medical School, Izmir, Turkey.
Int Urol Nephrol 1996;28(6):755-9 Abstract quote
Eosinophilic cystitis is an unusual form of cystitis which is characterized by irritative voiding symptoms and haematuria.
In the report herein two adult cases of eosinophilic cystitis treated with intravesical Mitomycin-C instillations for prophylaxis of bladder carcinoma are presented and the literature is reviewed.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION Eosinophilic cystitis--not that uncommon!
Devasia A, Kekre NS, Date A, Pandey AP, Gopalakrishnan G.
Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Scand J Urol Nephrol 1999 Dec;33(6):396-9 Abstract quote
The clinical presentation, radiological manifestations and response to therapy of seven cases of biopsy-proven eosinophilic cystitis seen over an 8-year period were evaluated retrospectively.
All of the five men and two women had symptoms of dysuria and frequency, with haematuria in two cases. One developed acute painful retention. The urine was sterile in all. Radiological findings included bladder mass lesions and upper tract dilatation. Cystoscopy showed papillary, erythematous and ulcerative mucosal lesions, and in one instance a large mass lesion. The various procedures carried out were cold cup biopsies, transurethral resections, or fulgration of lesions and partial cystectomy. Medical therapy included non-steroidal anti-inflammatory drugs and prophylactic antibiotics to cover the procedures carried out.
There was excellent symptomatic improvement in all patients. This is the largest single-centre experience reported, and is unusual as the majority of the patients in this series were men.
Diagnosis and management of eosinophilic cystitis: a pooled analysis of 135 cases.
van den Ouden D.
St. Clara Hospital Rotterdam, The Netherlands.
Eur Urol 2000 Apr;37(4):386-94 Abstract quote
OBJECTIVE: Eosinophilic cystitis is a rare disease. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management.
METHODS: A pooled analysis was performed of 135 patients with eosinophilic cystitis presented in the literature. The evaluation included patient age, sex and race, presenting symptoms, diagnostic examinations, treatment and results, and complications.
RESULTS: The mean age at diagnosis was 41.6 years (range 5 days to 87 years). An equal distribution existed between males (44%) and females (35%), but in children (21%) boys were more often affected (14%) than girls (7%). The most common presenting symptoms were frequency (67%), dysuria (62%), gross/microscopic hematuria (68%), suprapubic pain (49%) and urinary retention (10%). All patients had a cystoscopy and biopsy; a biopsy is mandatory to establish the diagnosis. Positive urine cultures were found in 26% of the patients. Periferal eosinophilia was present in 43%. An intravenous urography was performed in 66%, ultrasonography in 15%, cystography in 23% and a CT scan in 10%. The majority of patients was treated with combinations of corticosteroids, antihistaminics and antibiotics (45%), avoiding of the suspected antigen (17%), transurethral resection of the lesions (9%), partial cystectomy (4%) or total cystectomy (4%). The success rates for the different treatments were variable: transurethral resection combined with corticosteroids, antihistaminics or antibiotics seemed most successful, while total cystectomy is reserved for patients with unresponsive disease and hematuria. The most common complications were dilation of the upper urinary tract (27%) and eosinophilic gastroenteritis (4.5%); all other complications occurred in less than 3% of the patients.
CONCLUSION: Eosinophilic cystitis is equally distributed among the sexes, but in children boys are affected more often than girls. The presenting symptoms are frequency, dysuria, hematuria, suprapubic pain and urinary retention. The treatment of choice is (radical) transurethral resection of the lesions in the bladder and a combination of corticosteroids and antihistaminics. Antibiotics are given when a urinary tract infection is present, or when dilation of the upper urinary tract exists. Most patients are cured but recurrence is a frequent finding.
VARIANTS Tumor-forming eosinophilic cystitis in children. Case report and review of literature.
Gerharz EW, Grueber M, Melekos MD, Weingaertner K, Barth P, Riedmiller H.
Department of Urology, Philipps University Medical School, Marburg, FRG.
Eur Urol 1994;25(2):138-41 Abstract quote
Eosinophilic cystitis is an unusual bladder lesion of unclear etiology first described in 1960. It usually causes irritative voiding symptoms and hematuria and in its rare tumor-like appearance the disease may mimic an invasive bladder neoplasm.
In the report herein, a case of an 11-year-old boy with a tumor-forming eosinophilic cystitis is presented which was mistaken for an infiltrative vesical malignancy until the histopathological study was completed.
The principal clinical findings, differential diagnosis, etiology, pathogenesis and treatment modalities of this inflammatory disease are discussed.
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