Follicular Cystitis Research Articles

Comprehensive evaluation of leuprorelin-associated adverse events: insights from FDA adverse event reporting system

ABSTRACT Background Leuprorelin, a gonadotropin-releasing hormone agonist, is widely used to treat hormone-related disorders. This study aims to explore and analyze the safety profile of leuprorelin by examining adverse event reports from the FDA Adverse Event Reporting System (FAERS) database. Methods This study conducted a retrospective pharmacovigilance analysis using FAERS data from Q1 2004 to Q1 2024. Adverse drug events (ADEs) related to leuprorelin were identified and categorized by system organ class and specific adverse events. Statistical methods such as Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM) were used to detect safety signals. Results A total of 63,928 ADE reports implicated leuprorelin, with 500 preferred terms and 25 system organ classes showing significant disproportionality. Notable rare ADEs identified were bulbospinal muscular atrophy congenital (n = 26; ROR 1282.72, PRR 1282.52, IC 7.91, EBGM 241.28), follicular cystitis (n = 3; ROR 126.84, PRR 126.84, IC 6.48, EBGM 89.09), and anaplastic meningioma (n = 3; ROR 46.73, PRR 46.73, IC 5.34, EBGM 40.5). Conclusion Most findings were expected, but new signals like follicular cystitis, previously unreported, emerged. Further studies are essential to validate these findings, crucial for clinical monitoring and risk identification of leuprorelin.

Novel insights into post-marketing AEs associated with leuprorelin: A comprehensive analysis utilizing the FAERS database

PurposeThis research focused on meticulously tracking and identifying adverse reactions associated with leuprorelin, a drug prescribed for conditions such as prostate cancer, endometriosis, uterine fibroids, and early-onset puberty. The main objective was to enhance patient safety and offer informed guidance on the appropriate use of this treatment. MethodsFrom the first quarter of 2004 to the fourth quarter of 2023, a comprehensive analysis was conducted on a significant number of adverse event reports (AERs) from the FDA Adverse Event Reporting System (FAERS) database. Data mining with dismutation analysis was conducted to quantify signals associated with adverse events (AEs) related to leuprorelin, utilizing powerful algorithms such as ROR, PRR, BCPNN, and EBGM. ResultsA total of 102 positive reaction terms (PT) spanning 24 System Organ Classes (SOCs) were identified from an analysis of 60,709 reports associated with leuprorelin use. Notably, several previously unrecognized adverse reactions were uncovered, including Artificial Menopause, Ovarian Adhesion, Follicular Cystitis, Intercepted product preparation error, among others. These findings underscore the importance of exercising additional vigilance regarding the potential adverse effects of leuprorelin, such as Abscess Sterile, Injection site granuloma, Intercepted medication error, and Bulbospinal muscular atrophy congenital. ConclusionsThis research has successfully uncovered new and unforeseen signals associated with adverse drug reactions (ADRs) following leuprorelin administration. The study provides valuable insights into the intricate connection between ADRs and leuprorelin usage. The results underscore the crucial significance of continuous surveillance and meticulous monitoring to promptly identify and manage AEs, ultimately enhancing patient safety and well-being while undergoing leuprorelin therapy.

Follicular cystitis: An uncommon case - diagnosis and therapeutic approach

Follicular cystitis is a rare bladder disease that is difficult to diagnose due to its non-specific symptoms. The diagnostic is made by biopsies of the affected area, and the anatomopathological study confirms it. The treatment of follicular cystitis is not well established, and more research is needed to determine the optimal treatment protocol. We present a case of a 44-year-old man with a medical history of type 1 diabetes and pulmonary tuberculosis who was diagnosed with follicular cystitis. The patient was treated with corticoids, and the evolution was good. However, it is important to note that the recurrence of cystitis is frequent, and prevention techniques should be followed to avoid urinary infections.

Escherichia coli-associated follicular cystitis in dogs: Clinical and pathologic characterization.

Follicular cystitis is an uncommon inflammatory change in the urinary bladder wall characterized by the formation of tertiary lymphoid structures (TLSs) in the submucosa. To characterize clinical and pathologic features of follicular cystitis in dogs and to explore in situ distribution and possible role of Escherichia coli as an associated cause. Eight dogs diagnosed with follicular cystitis and 2 control dogs. Retrospective descriptive study. Dogs diagnosed with follicular cystitis (macroscopic follicular lesions in the urinary bladder mucosa and histopathologic detection of TLSs in bladder wall biopsies) were identified from medical records. Paraffin embedded bladder wall biopsies were subject to in situ hybridization for E. coli 16SrRNA identification. Follicular cystitis was diagnosed in large breed (median weight 24.9 kg, interquartile range [IQR] 18.8-35.4 kg) female dogs with a history of chronic recurrent urinary tract infections (UTIs; median duration of clinical signs 7 months, IQR 3-17 months; median number of previous UTIs 5, IQR 4-6). Positive E. coli 16SrRNA signal was detected within developing, immature and mature TLSs in 7/8 dogs, through submucosal stroma in 8/8 dogs and within the urothelium in 3/8 dogs. Chronic inflammation associated with an intramural E. coli infection in the urinary bladder wall represents a possible triggering factor for the development of follicular cystitis.

Follicular cystitis in a dog: First case report described in Brazil

Follicular cystitis in a dog: First case report described in Brazil

Bladder Mucosal Cystitis Cystica Lesions Are Tertiary Lymphoid Tissues That Correlate With Recurrent Urinary Tract Infection Frequency in Postmenopausal Women.

We identify correlates and clinical outcomes of cystitis cystica, a poorly understood chronic inflammatory bladder change, in women with recurrent urinary tract infections. A retrospective, observational cohort of women with recurrent urinary tract infections who underwent cystoscopy (n=138) from 2015 to 2018 were identified using electronic medical records. Cystitis cystica status was abstracted from cystoscopy reports and correlations were identified by logistic regression. Urinary tract infection-free survival time associated with cystitis cystica was evaluated by Cox proportional hazards regression. Exact logistic regression was used to identify factors associated with changes to cystitis cystica lesions on repeat cystoscopy. Biopsies of cystitis cystica lesions were examined by routine histology and immunofluorescence. Fifty-three patients (38%) had cystitis cystica on cystoscopy. Cystitis cystica was associated with postmenopausal status (OR: 5.53, 95% CI: 1.39-37.21), pelvic floor myofascial pain (6.82, 1.78-45.04), having ≥4 urinary tract infections in the past year (2.28, 1.04-5.09), and a shorter time to next urinary tract infection (HR: 1.54, 95% CI: 1.01-2.35). Forty-two patients (82%) demonstrated improvement or resolution of lesions. Ten/11 (91%) biopsied cystitis cystica lesions were tertiary lymphoid tissue with germinal centers and resembled follicular cystitis. Cystitis cystica lesions were associated with postmenopausal status, pelvic floor myofascial pain, and number of urinary tract infections in the prior year and predicted worse recurrent urinary tract infection outcomes. Cystitis cystica lesions are tertiary lymphoid tissue/follicular cystitis that may improve or resolve over time with treatment. Identifying cystitis cystica in recurrent urinary tract infection patients may be useful in informing future urinary tract infection risk and tailoring appropriate treatment strategies.

Lessons from a pilot study of screening for upper tract urothelial cell carcinoma in Lynch syndrome.

Background Lynch syndrome is a hereditary disorder, with a very high risk of developing colorectal carcinoma (CRC) and a predilection to develop other cancers, including upper tract urothelial carcinoma (UTUC). We aimed to assess the prevalence of UTUC in a Lynch syndrome cohort undergoing screening for CRC, to determine the need for a UTUC screening programme. Methods Lynch syndrome patients were screened with urine dipstick for microscopic haematuria. Patients with confirmed microhaematuria were offered urine cytology, microscopy and culture, ultrasound (US) of their upper tracts and flexible cystoscopy. Results Of the 89 patients screened, 86 had an MLH1 mutation and two had an MSH2 mutation. Eleven of the 12 patients who had microscopic haematuria were female. Ten patients had urinary tract infections. One patient had follicular cystitis and another had a simple renal cyst. No patients had hydronephrosis on ultrasound. All urine cytology specimens were negative for malignancy. Conclusion No cases of UTUC were detected in our cohort during this study. A more rational screening protocol in this group may be to screen patients for UTUC with known MSH2 mutations at an earlier age (over 35).

Histomorphological evaluation of non-neoplastic lesions of the urinary bladder

Aim: The aim of this study is to evaluate the urinary bladder biopsies for non-neoplastic lesions. Materials and Methods: This study includes 41 non-neoplastic bladder lesion cases out of 125 urinary bladder samples received by histopathology laboratories of two medical colleges between October 2017 and January 2020. The samples included transurethral tumor resections and bladder biopsies. Results: In the present study, seventy-two (59%) cases had neoplastic lesions, 29 (24%) cases had non-neoplastic lesions and 12 (10%) cases showed neoplastic in association with non-neoplastic lesions. The most common non-neoplastic lesions encountered were follicular cystitis, chronic cystitis, and hemorrhagic cystitis. Conclusion:In symptomatic lower urinary tract disease, cystoscopy and histopathological evaluation is rewarding in the diagnosis of various non-neoplastic causative lesions. Awareness of these entities facilitates easy diagnosis and differentiation from malignant processes.

Histomorphologic study of cystoscopic urinary bladder biopsies: A gold standard

Histomorphologic study of cystoscopic urinary bladder biopsies: A gold standard - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.034, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Histopathological Spectrum of Bladder Lesions : Our Observation in 128 Cystoscopic Specimen

Background : Diseases of the bladder, particularly, inflammation (Cystitis), constitutes an important source of clinical signs & symptoms. Tumours of the bladder are an important source of both morbidity and mortality. The aim of the study was to make a histopathological evaluation of various bladder lesions and to observe the frequency of different bladder lesions. Material and methods : The study was conducted in the Department of Pathology, Chittagong Maa-O-Shishu Hospital Medical College (CMOSHMC) from Jan 2012 to Dec 2016. Patients particulars and histopathological diagnosis were kept in records. Tissue was processed in paraffin section technique and stained with routine Hematoxilin and eosin stains. Results : One hundred and twenty eight (128) cystoscopic sample were studied. Out of 128 cases males were 103 and 25 were females with a male to female ratio of 4.21:1. In malignant lesions the male to female ratio was 3.82:1. Age distribution ranges from 13 to 85 years with an average age of 57 years. The maximum age group belonged to 51 to 60 years and 61 to 70 years. The spectrum of lesions included non neoplastic and neoplastic lesions. Non neoplastic lesions were eosinophilic cystitis, granulomatous cystitis, radiation induced cystitis, chronic follicular cystitis and cystitis gladularis etc. The neoplastic lesions were, transitional cell papilloma, Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) low and high grade Transitional Cell Carcinoma (TCC) and leiomyosarcoma. Low grade TCC was the predominant type. Conclusion : Cystoscopic biopsy followed by histopatholigical examination is essential to diagnose any organic bladder lesion for proper management. Smooth muscle should be included in biopsy whenever malignancy is suspected.
 JCMCTA 2017 ; 28 (1) : 42 - 44

Pyogenic Granuloma of the Urinary Bladder: A Rare Entity

Introduction: Pyogenic granuloma is a reactive hyperplastic change commonly encountered in the skin and oral cavity. Very rarely they can occur in the urinary bladder. Case Report: 73 year old male presented with obstructive urinary symptoms and pain during micturition. He had an open prostatic surgery 25 years ago. His investigations were not contributory and there was no improvement with alpha blockers. Cystoscopy revealed a solitary, pedunculated 1 cm lesion in the posterior wall of the bladder along with inflammatory changes. Biopsy from the lesion revealed a diagnosis of pyogenic granuloma along with follicular cystitis. His symptoms resolved after the procedure and he was treated with a prolonged course of antibiotics. His imaging and follow up cystoscopy after six months were normal. He remains asymptomatic at 1 year of follow up. Conclusion: Pyogenic granuloma of the bladder is very rare and till now only eight cases have been reported worldwide. The important factor in management is to differentiate this condition from malignancy and treatment with transurethral resection and antibiotics may suffice.

Ureteral implantation using a three-stitch ureteroneocystostomy: description of technique and outcome in nine dogs.

To report the procedure, postoperative outcome and complications of a new technique for ureteral implantation by means of a three-stitch ureteroneocystostomy in dogs. Clinical records of dogs requiring ureteral implantation between April 2007 and June 2013 were retrospectively reviewed. Data retrieved included signalment, preoperative biochemistry results, details of the surgical procedure, perioperative and postoperative complications, postoperative biochemistry results and outcome. Nine dogs fulfilled the inclusion criteria. Follow-up times ranged from 10 to 79 months (median 30 months), with 8 of 9 dogs having an excellent long-term outcome and no major postoperative complications. One dog with follicular cystitis as a comorbidity developed obstruction from inflammatory granuloma and required revision surgery. The three-stitch technique for ureteral implantation compares favourably to previously documented techniques in terms of outcome and complication rates. Reduced tissue handling and a decreased volume of suture material may be beneficial for healing. The technique is also faster than previously described options, which may be of benefit in unstable patients requiring ureteral implantation due to traumatic injury or rupture.

Hematologic lesions in urine cytology

Bladder infiltration by leukemia or lymphoma is rare and can mimic benign processes such as follicular cystitis (FC). Eight benign and malignant hematologic diseases encountered in urine cytology were retrospectively reviewed for clinical, radiographic, and cytologic findings. There were 2 cases of acute myeloid leukemia, 2 cases of diffuse large B-cell lymphoma, and 4 cases of FC. The most common presenting symptom was hematuria. Imaging findings included echogenic debris within the bladder or an adjacent soft tissue mass in acute myeloid leukemia cases and bladder wall thickening in diffuse large B-cell lymphoma cases. No FC cases had any imaging abnormalities. Cytologic material of the leukemia cases showed numerous myeloid blasts with markedly increased nuclear-to-cytoplasmic ratios, centrally located nuclei, inconspicuous nucleoli, nuclear indentations, and some irregular nuclear membranes. The background showed sparse urothelial cells and histiocytes. Both lymphoma cases showed a discohesive population of atypical large lymphoid cells with irregular nuclear borders and prominent nucleoli. The FC cases had a background lymphoid cell population with a maturation spectrum from small lymphocytes to large lymphoid cells (immunoblasts) and histiocytes including tingible body macrophages. Additionally, there were many mature squamous cells and reactive urothelial cells. Bladder leukemia, lymphoma, and FC are infrequently encountered on urine cytology. FC can be distinguished from a hematologic malignancy by the presence of a lymphocytic maturation spectrum and tingible body macrophages. Radiologic abnormalities are associated with malignant processes; however, discrete bladder masses are usually not identified.

Follicular cystitis in a dog

A four-year-old female Cavalier King Charles Spaniel with a history of recurrent lower urinary tract disease refractory to treatment was referred to our hospital. Clinical examination was unremarkable apart from...

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

Subclassifying Atypia in Urine Cytology: Is it Reproducible?

Results: The study group consisted of 8 male and 6 female patients; aged 49-83 years (mean: 71 years). 13/14 casees were diagnosed as positive; a single lymphoma case was orinaly classified as negative, the overall accuracy of cytologic diagnoses was 93%. Of the ten cytomorphologic/ background features that were recorded; small clustering, nuclear molding, inconspicuous nucleoli characterized small cell carcinoma. Prominent nucleoli and inflamed background/diathesis were prevalent in lymphoma and melanoma cases. Intracellular pigment and multi-nucleation were recorded only in melanoma cases. Hyperchromasia was prominent feature in small cell carcinoma and melanoma cases. Conclusion: 1. The presence of small atypical cells in urine cytology should raise the possibility of underlying malignancy in urinary tract, even if the cystoscopic or other imaging findings are normal. 2. Small cell carcinoma can be accurately diagnosed in urine ThinPrep cytology by detecting cell clustering, nuclear molding, and hyperchromasia without prominent nucleoli. 3. The presence of small atypical cells with prominent nucleoli raise the suspicion for lymphoma or melanoma, while the accompaniment of tingible body macrophages may suggest follicular cystitis.

The importance of cystoscopy and bladder biopsy in women with refractory overactive bladder: the urogynaecologist's point of view?

ObjectivesTo assess the sensitivity, specificity, positive and negative predictive value of cystoscopy and the clinical value of bladder biopsy in women with refractory overactive bladder (OAB) symptoms. Study designProspective observational study carried out in a tertiary referral urogynaecology unit in London. Consecutive women with OAB resistant to pharmacotherapy who underwent cystoscopy, hydrodistention and bladder biopsy were studied. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cystoscopy as well as histological findings for chronic cystitis were evaluated. Results106 women aged 22–91 years were studied. Histopathology showed chronic cystitis in 94 women, follicular cystitis 3, acute and chronic cystitis in 2, transitional cell carcinoma in 6 and no abnormality in 1 woman. Trabeculations and increased vascularity were the most common cystoscopic findings, seen in 71% and 72% of women respectively. Haemorrhages on first filling and haemorrhages on refilling had specificities of 86.6% and 80% respectively for chronic cystitis. Their sensitivities were 9.8% and 13.1% respectively. Trabeculations and increased vascularity had sensitivities of 68.1% and 68.1% and their specificities were 11.6% and 4.5% respectively. Trabeculations, increased vascularity, haemorrhages on first filling and haemorrhages on refilling all had a PPV over 80% for chronic cystitis. ConclusionsMore than 90% of women with refractory OAB symptoms have chronic cystitis on histopathology. Cystoscopy alone is useful, but not always adequate to diagnose chronic cystitis. Antibiotic therapy in those women might be beneficial before starting anticholinergics. Larger randomised controlled trials are mandatory to confirm our hypothesis.

The Use of Radiotherapy in the Management of Follicular Cystitis Refractory to Conservative and Surgical Management

Follicular cysitis is a proliferative benign lesion which can act locally malignant. Conservative management is best; however, when this fails, surgical resection is necessary up to and including cystectomy in extreme refractory cases. We present a clinical review and our results using radiation in this disease in a woman facing cystectomy.

Pathological study of non-neoplastic urinary bladder lesions in cattle and buffaloes: a preliminary report

A total of 236 urinary bladders (94 cattle and 142 buffaloes) collected from Bareilly, Uttar Pradesh, India, were studied for spontaneous lesions. These adult animals belonged to Institute's organized dairy farm and rural areas in the Rohilkhand region of Uttar Pradesh. Grossly, congestion, hemorrhages, and cystoliths in urinary bladders were diagnosed. Histopathologically, the major conditions diagnosed were acute cystitis, 44 (18.64%), including, congestion, hemorrhages, sub-acute cystitis; chronic cystitis, 74 (31.35%), including chronic cystitis un-complicated type, lymphocytic cystitis, plasmolymphocytic cystitis, follicular cystitis, hyperplasia, nodular/acinar hyperplasia, and cystolithiasis; and nothing unusual diagnosed, 118 (50.00%). Similar types of pathological conditions were diagnosed in both species of animals with exception of follicular cystitis and nodular/acinar hyperplasia which was diagnosed respectively only in buffaloes and cystoliths in cows. In addition, a good number of 17/25 (68%) urinary bladder samples tested were found positive for presence of bovine papillomavirus type-2 (BPV-2) by polymerase chain reaction. These included eight cases of acute cystitis, an equal number of cases of chronic cystitis, and one normal bladder. BPV-2 is known as potential source of enzootic bovine hematuria along with other co-factors in enzootic areas. Lesions of zoonotic significance, like tuberculosis, etc., were not diagnosed. None of the observed lesions represented conditions, which, by themselves, would warrant carcass condemnation in buffaloes.

Marked hydronephrosis and hydroureter after distigmine therapy in an adult male patient with paraplegia due to spinal cord injury: a case report

IntroductionDistigmine, a long-acting anti-cholinesterase, is associated with side effects such as Parkinsonism, cholinergic crisis, and rhabdomyolysis. We report a spinal cord injury patient, who developed marked hydronephrosis and hydroureter after distigmine therapy, which led to a series of complications over subsequent years.Case presentationA 38-year-old male developed T-9 paraplegia in 1989. Intravenous urography, performed in 1989, showed normal kidneys, ureters and bladder. He was prescribed distigmine bromide orally and was allowed to pass urine spontaneously. In 1992, intravenous urography showed bilateral marked hydronephrosis and hydroureter. Distigmine was discontinued. He continued to pass urine spontaneously.In 2006, intravenous urography showed moderate dilatation of both pelvicalyceal systems and ureters down to the level of urinary bladder. This patient was performing self-catheterisation only once a day. He was advised to do catheterisations at least three times a day. In December 2008, this patient developed haematuriawhich lasted for nearly four months.. He received trimethoprim, then cephalexin, followed by Macrodantin, amoxicillin and ciprofloxacin. In February 2009, intravenous urography showed calculus at the lower pole of left kidney. Both kidneys were moderately hydronephrotic. Ureters were dilated down to the bladder. Dilute contrast was seen in the bladder due to residual urine. This patient was advised to perform six catheterisations a day, and take propiverine hydrochloride 15 mg, three times a day. Microbiology of urine showed Klebsiella oxytoca, Pseudomonas aeruginosa, and Enterococcus faecalis. Cystoscopy revealed papillary lesions in bladder neck and trigone. Transurethral resection was performed. Histology showed marked chronic cystitis including follicular cystitis and papillary/polypoid cystitis. There was no evidence of malignancy.ConclusionDistigmine therapy resulted in marked bilateral hydronephrosis and hydroureter. Persistence of hydronephrosis after omitting distigmine, and presence of residual urine in bladder over many years probably predisposed to formation of polypoid cystitis and follicular cystitis, and contributed to prolonged haematuria, which occurred after an episode of urine infection. This case illustrates the dangers of prescribing distigmine to promote spontaneous voiding in spinal cord injury patients. Instead of using distigmine, spinal cord injury patients should be advised to consider intermittent catheterisation together with oxybutynin or propiverine to achieve complete, low-pressure emptying of urinary bladder.