Cystitis cystica mimicking as bladder tumour

Objective: We present our experience of managing six cases of cystitis cystica, which mimicked a bladder tumour. Materials and Methods: Six cases of cystitis cystica were diagnosed over a period of five years (2005-2011). Age varied from 26 to 54 years of which four patients were male and two were females. All of them presented with lower urinary tract symptoms (LUTS), urinary tract infection (UTI) in 3 patients and mild intermittent hematuria in 2 patients. Clinical examination and routine laboratory tests were normal except for presence of leucocytes and blood in urine. Ultrasound (USG) revealed thickened bladder wall with polypoidal lesions suspicious of malignancy. Urinary cytology was negative for malignant cells. Cystoscopy revealed multiple papillary lesions arising from the bladder neck and trigone. There was conspicuous absence of a blood vessel core in the centre of the papillary fronds. Transurethral biopsy of the bladder lesion revealed cystitis cystica with no evidence of malignancy. Four out of six patients responded well to conservative treatment with long-term oral antibiotics as per the culture and sensitivity reports. Transurethral resection was required in only two patients due to lesions causing obstructive symptoms.  Patients were followed up with history and clinical examination, urinary cytology and ultrasonographic monitoring of the lesions. Results: Of the six cases TUR, resection was required in only 2 patients with obstructing lesions and remaining 4 were managed conservatively. Conclusion: Cystitis cystica is a rare benign condition that can mimic bladder tumour. Cystoscopic appearance is typical and biopsy confirms the diagnosis. Treatment is usually conservative. TUR resection is required in selected cases. Long-term follow up is essential, as cystitis cystica is a premalignant disease of the urinary bladder.