Cystitis Glandularis: A 10-Year Institutional Experience and Review of the Literature

Aims Cystitis glandularis (CG) and cystitis cystica et glandularis (CCEG) are benign proliferative lesions of the bladder that may closely mimic carcinoma on imaging, cystoscopy, and histology. Their natural history and malignant potential remain uncertain, which can make management challenging for urologists. This study aimed to analyze the clinical behavior and malignant potential of CG and CCEG by reviewing a decade of institutional experience alongside current literature. Methods This retrospective observational review of all patients diagnosed with CG, cystitis cystica, or CCEG at Guy's and St Thomas' Hospital was conducted over a 10-year period. Demographic data (including age, sex, ethnicity, and relevant clinical history), presenting symptoms, imaging and cystoscopic findings, histopathology, treatment, and follow-up information were collected. The published literature was reviewed with a focus on histological features, immunohistochemistry, molecular findings, and the possible association with malignancy. Results Sixty-seven patients were identified. Median age at diagnosis was 61 years (range: 39-84 years), and 57 (85.1%) were male. The most common presentations were lower urinary tract symptoms (LUTS; 28.4%), visible hematuria (20.9%), and non-visible hematuria (16.4%). Cystitis glandularis was present in 30 (44.8%) patients, and intestinal-type metaplasia in 16 (23.9%) patients. Cystitis cystica was found in 53 cases (79.1%), and was associated with urothelial carcinoma in six (9.0%) patients. Lesions most frequently involved the bladder neck or trigone (62.7%). Median follow-up was 9.2 years (range: 2.2-17.8 years). No patient in this series developed de novo carcinoma arising from CG or CCEG during surveillance. Two patients with extensive trigonal involvement and upper tract obstruction underwent robot-assisted bilateral ureteric reimplantation. Conclusion CG and CCEG are usually benign conditions but can be difficult to distinguish from primary adenocarcinoma of the bladder, especially when intestinal-type metaplasia or mucus extravasation is present. The intestinal variant, particularly when extensive or associated with dysplasia, has been proposed as a potential premalignant lesion. Molecular studies show some overlap in gene expression profiles between CG and urothelial carcinoma, but clinical series have not consistently demonstrated an increased risk of progression. Management is centered on relief of underlying irritation, endoscopic resection of mass-like lesions, and surveillance in selected cases. In patients with extensive disease causing obstruction, reconstructive procedures, such as ureteric reimplantation or, rarely, cystectomy, may be required.