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Unveiling Cystitis: Understanding the Differences Between Cystitis Glandularis and Common Cystitis

With increased awareness of cystoscopy and biopsy, cystitis glandularis, which used to be considered rare, is now being reported more frequently and has become a common and frequent clinical condition. Although it is still classified as an "inflammatory disease," inflammation is only one of the causes of the lesion, which is essentially hyperplasia and metaplasia of the migratory epithelium.

Differences Between Cystitis Glandularis and Common Cystitis

The clinical presentation of cystitis glandularis is essentially the same as that of common cystitis in that it may present with urinary frequency, urgency, dysuria, hematuria, dysuria, and difficulty in urination as well as frequently associated pain in the lower abdomen or perineal area. 

The urodynamic examination of some patients will show a decrease in the maximum urinary flow rate. If regular anti-inflammatory treatment is ineffective and tuberculosis can be ruled out, we should be highly suspicious of the existence of this "special" inflammatory disease.

1. Different Definitions

Common cystitis mainly refers to bacterial cystitis. As the name suggests, it is caused by bacterial infection. External bacteria enter the urethra and bladder through retrograde infection, leading to bacterial cystitis, while routine urine examination will find white blood cells (+). This requires symptomatic treatment with oral antibiotics. 

Cystitis glandularis, although nominally inflammatory, is a non-bacterial inflammation, a non-neoplastic bladder lesion, atypical hyperplasia, not a malignant tumor, but only a pre-cancerous lesion. Such patients also do not need antibiotics, and if cystoscopy reveals significant space-occupying lesions in the bladder, cystectomy is required.

2. Different Pathologic Tissues

There are four types of pathologic tissues in cystitis glandularis:

(1) Migratory epithelial type: Characterized by Brunn's nests.

(2) Intestinal epithelial type appears as a cleft: A branching or circular lumen is formed within the Brunn nest when the nucleus is located on the basolateral side, and the cytoplasm contains abundant mucus vacuoles apically.

(3) Prostatic epithelial type: The glandular epithelium is single-layered columnar, cuboidal or pseudo-complex columnar. The glandular lumen is larger and the zouaves are more numerous and unequal in height. The glandular epithelium has irregular microvilli, and the cells are rich in rough surface-appearing glandular organization, transformed into the adenoidal structure. There is also infiltration of lymphocytes and plasma cells, endoplasmic reticulum and secretory granules, and collagen-like basement membrane between the glandular epithelium and stroma.

(4) Mixed migratory-prostate epithelial type: Microscopic presence of both Brunn's nest and prostatic tissue transformation structures.

3. Different Cystoscopic Performance 

The bladder cystoscopy findings for general or common cystitis (non-specific infection) are "increased and thickened mucosal blood vessel patterns." In contrast, cystitis glandularis has a more specific cystoscopic manifestation, such as cystic changes, chorioallantoic hyperplasia, papillomatous, follicular lesions, chronic inflammation, and mucosal non-significant changes in the type.

Although cystitis glandularis is relatively rare, it can be hazardous. Reports show that it has a high incidence of precancerous lesions. It is likely to become bladder cancer due to certain unspecified risk factors, so patients must be extra vigilant about cystitis glandularis.

It is well known that women are more prone to urinary tract infections. However, if there are recurrent urinary tract infections or this history persists for many years, it can easily evolve from common cystitis to cystitis glandularis. Both common cystitis and cystitis glandularis require aggressive treatment.

Currently, there is no specific treatment for cystitis glandularis. Traditional Chinese medicine Diuretic and Anti-inflammatory Pill can effectively improve the patient's abnormal urination and relieve pain and discomfort. Long-term persistent use can also help patients treat the disease and improve the quality of life.

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