Female Stress Urinary Incontinence (SUI)
To demonstrate several examples of commonly encountered forms of chronic cystitis in post-menopausal women.
Following IRB approval, all images were obtained during cystoscopy under anesthesia with a 17,5 Fr female scope and a 30 degree lens.
Serving as a contrasting entity, an example of squamous metaplasia is illustrated. It occurs only over the trigone and has a smooth white appearance.
A common form of chronic cystitis in this age group is cystitis cystica characterized histologically by hyperplasia of the bladder mucosa and presence of cysts or Von Brunn nests within the lamina propria. A survey of the rest of the bladder indicates no other lesions superiorly, laterally, or posteriorly towards the bladder base. Therefore these lesions are only confined to the trigone, hence called trigonitis.
Chronic lesions of trigonitis can take on various appearances mixing pus pockets, tiny stones or encrustations, and large cystic areas. These lesions can also extend beyond the confines of the trigone to the bladder base and to the lateral walls as well as dome. This is often termed pan-cystitis.
After electrofulguration of these lesions for antibiotic refractory recurrent urinary tract infections (UTIs), recurrent lesions of pink, clustered, cystitis cystica stand out on a whitish background corresponding to the healed sites of prior fulguration.
Some bladders have total involvement of all bladder walls like in one example of pan-cystitis glandularis where there is no spared area of bladder mucosa.
This brief movie concludes with 2 examples of less frequent chronic cystitis conditions. First clear vesicles or vesicular cystitis, a fairly rare entity reported in 1988. A myriad of small tiny clear vesicles are noted throughout the bladder wall, often difficult to see when they are only anteriorly, rarely containing pus. The other is a keratinizing chronic cystitis producing sheets of white sloughed mucosa. These two types are exceedingly difficult to treat endoscopically or with antibiotic therapies, and can result at times in a decision for simple cystectomy.
Several types of chronic cystitis can be encountered in the post-menopausal women, possibly explaining the recurrent pattern of some UTIs.