Long Term Follow Up of Bladder Amyloidosis

Abstract

This is an evaluation of a patient presenting with bladder amyloidosis and a seven year asymptomatic history between gross hematuria episodes. Cystoscopic evaluation showed a diffuse progression of amyloid deposits throughout the bladder. Biopsy confirmed the diagnosis and was negative for malignancy. Further evaluation ruled out systemic disease. To date, he has declined treatment. There is little available literature on long term urologic follow up for these patients. Bladder amyloidosis is rare, but most urologists will encounter it in their clinical practice. There are no agreed upon guidelines or recommendations for long term management of these patients, likely owing to its rarity. This patient had local progression confirmed on biopsy without evidence of malignancy. Evaluation for systemic amyloidosis was also negative. While a single, isolated case, it is unique for the length of follow up, the local progression and lack of symptoms. It is consistent with the low likelihood of systemic progression but does raise the question of how to treat these patients long-term. The authors recommend initial biopsy both to confirm diagnosis and rule out malignancy, evaluation for systemic disease and regular cystoscopic examinations to help direct therapy.