Bullous cystitis

Author: Mirna N. Toukatly, M.D. (see Authors page)

Revised: 23 March 2016, last major update July 2015

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Bullous cystitis [title]
Cite this page: Bullous cystitis. website. Accessed October 21st, 2016.
Definition / General
  • Reversible inflammatory condition of bladder mucosa with extensive submucosal edema
  • An endoscopic term referring to bullous appearing edematous bladder mucosa, that mimics neoplastic bladder lesions
  • A variant of polypoid cystitis, but with broader based and larger lesions
  • Wide age variation from young children to adults
  • Associated with chronic cystitis in girls
  • Chronic irritation (chronic catheter use, neuromuscular ureteral dysplasia, vesicoureteral reflux or urolithiasis)
  • Association with bullous pemphigoid (BP) has been suggested in at least on case report; expression of BP180 has been demonstrated in the transitional epithelium of the bladder by indirect immunofluorescence
    • In addition, BP230 has been demonstrated by immunofluorescence in a rat bladder tumor cell line
  • May be associated with an acute infection (hip arthritis, gonorrheal pelvic inflammatory disease)
Clinical Features
  • May be asymptomatic or present with dysuria, extreme frequency and urgent micturition responsible for pseudo-urinary incontinence
  • If located in the trigone and periureteral zone, may produce transient acute ureteral obstruction
Radiology Description
  • Pelvic CT and MRI may demonstrate thickening of bladder wall
  • Intravenous urography and sonography may show hypoechoic mucosa and nodular filling defects caused by the edema, and if prominent, ureteral obstruction
  • This may be radiographically indistinguishable from bladder carcinoma
Prognostic Factors
  • Intermediate severity; usually reversible
Case Reports
  • Usually treated by removing the offending agent (catheter) or the infectious or inflammatory condition (such as in BP)
  • Surgery may be needed to correct a vesicoureteral reflux
Gross Description
  • On cystoscopy, bladder shows numerous bullae with a pseudoneoplastic appearance
  • Changes seen are a thickened mucosa that is smooth in early stages and becomes redundant and polypoid in later stages
Micro Description
  • Broad bulbous projections of mucosa with prominent submucosal edema, acute and chronic inflammation, lymphangiectasis
  • Urothelium may show reactive atypia, focal or diffuse thickening
  • Congenital mucosal variants include overdevelopment of lymphoid tissue as massive lymphoid follicles and a lymphangiectatic form (Urologiia 2000;1:3)
Micro Images

Images hosted on other servers:
Missing Image

Many eosinophils

Missing Image Missing Image

Neutrophils seen within urothelium

Differential Diagnosis