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Polypoid & Papillary Cystitis: Definition & Treatment

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Polypoid and papillary cystitis affects the bladder and is often misdiagnosed as other ailments. This lesson will discuss the definition and treatment of polypoid and papillary cystitis.

Urinary symptoms

Thomas was recently in the hospital for knee surgery and has an enlarged prostate. During the surgery he had a urinary catheter placed to control his urine. Once it was removed he had trouble peeing due to his enlarged prostate. The catheter was put back in for two days and he was able to pee after the removal. Once home Thomas has been having some painful urination for one week and has had hematuria for the last two days. He is now worried that he has a urinary tract or bladder infection so he goes to the doctor. He describes his symptoms and the doctor immediately completes several tests to see if there is an infection.

Symptoms and Diagnosis of Polypoid and Papillary Cystitis

Thomas describes his main symptoms which include painful urination and hematuria. He describes the pain with burning urination and pressure in the bladder. At times he feels like he has to strain, has had an increase in frequency, and an increase in urgency to pee.

The doctor is suspicious of some type of bladder or urinary tract infection so he begins testing. Testing includes:

  • Urinalysis
  • Urine culture
  • Urine cytology (more in-depth test of urine and cells)
  • Blood tests consisting of blood urea nitrogen (BUN), creatinine, complete blood count (CBC), and chemistry
  • Abdominal ultrasound
  • Cystoscopy (a tube with a camera is inserted into the urethra to assess the urethra and bladder; samples of tissue may be taken at this time)
  • Abdominal CT scan

Bladder cells after a cystoscopy
Bladder cells examined after a cystoscopy

Thomas's doctor initially orders a urinalysis, urine culture, urine cytology, and blood tests. The findings show red and white blood cells in the urine which indicate trauma, irritation, or infection. Kidney stones or a bladder infection are possible. The urine culture and blood tests are normal, but the urine cytology show cells that may be associated with bladder cancer. The doctor then orders an abdominal CT scan which shows a polypoid lesion and bladder wall thickening with inflammation.

The doctor suspects polypoid and papillary cystitis but wants to make sure there are no cancerous cells so he also performs a cystoscopy and obtains a small sample of the lesion. The cystoscopy confirms that the lesion is not malignant so it is not cancerous. Thomas is diagnosed with polypoid and papillary cystitis due to the inflammation, thickening of the bladder wall, and lesion. Thomas asks his doctor to explain what polypoid and papillary cystitis is.

What is Polypoid and Papillary Cystitis?

Polypoid and papillary cystitis are described as a benign lesion in the mucosal lining of the bladder. The most common cause of polypoid and papillary cystitis is urinary catheterization; however, it can occur randomly as well. This type of cystitis is often similar to findings of bladder cancer. The inflammation and lesion causes the urinary symptoms that Thomas has.

The only difference between polypoid and papillary cystitis is that polypoid cystitis is acute and papillary cystitis is chronic. This is differentiated by looking at the structure of the mucosal thickening and lesion. Polypoid lesions are broad based with a tapered end lined by normal lining of the bladder. Papillary lesions have stromal fibrosis which is an increased thickening in the tissue of the lesion along with the supportive tissue. It is possible for someone to have polypoid and papillary cystitis at the same time. Now that Thomas knows what is wrong, he asks the doctor how it is treated.

Urinary catheter that can irritate the bladder
Urinary catheter that can irritate the bladder

Treatment of Polypoid and Papillary Cystitis

Treatment of polypoid and papillary cystitis varies depending on the symptoms and size of the lesion. The first line of treatment is to remove the source of irritation which in some cases involves removing the urinary catheter. However, there may be no source of irritation for some patients. There is usually no other treatment that is needed. However, if symptoms are bothersome, medications such as antibiotics are used to ensure the infection goes away. Very rarely will the lesion have to be removed. Polypoid and papillary cystitis tends to resolve on its own.

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