What are the other Names for this Condition? (Also known as/Synonyms)

• Pyeloureteritis Cystica

What is Ureteritis Cystica? (Definition/Background Information)

• Ureteritis Cystica is a rare benign condition that appears as a tumor/mass within the ureters; the ureters are tubes that help transport urine from the kidneys to the urinary bladder. Ureteritis Cystica is generally detected while performing imaging studies of the abdomen or pelvic region for unrelated conditions
• In Ureteritis Cystica, an inflammation of the ureter occurs from a variety of factors that cause repeated irritation of the ureteral walls. Such factors include chronic infections, presence of kidney stones, and uncontrolled long-term diabetes
• Generally, no significant signs and symptoms of Ureteritis Cystica are noted. The condition may appear anywhere along the ureters, including at the renal pelvis; also, it may simultaneously involve both the left and right ureter. Occasionally, it may cause an obstruction to the flow of urine from the kidney to the bladder resulting in additional complications
• Ureteritis Cystica generally resolves on treating the underlying cause of the condition. In some cases, the lesions may be surgically removed. The prognosis of the condition is typically excellent, since it is only a benign reactive process

Who gets Ureteritis Cystica? (Age and Sex Distribution)

• Ureteritis Cystica may affect individuals of any age group, although most cases are diagnosed in adults in the 50 to 60 years’ age group
• Both male and females are affected, but a greater number of cases are reported in women
• The condition is observed worldwide; all racial and ethnic groups are affected

What are the Risk Factors for Ureteritis Cystica? (Predisposing Factors)

Any disease, infection, or medical procedure causing chronic irritation of the ureters may lead to the development of Ureteritis Cystica. Following are some of the risk factors associated with Ureteritis Cystica:

• Chronic diabetes: It is an important risk factor for this condition
• Presence of kidney stones (nephrolithiasis) is another key risk factor
• Recurrent urinary tract infections (UTIs)
• Common bacterial infections caused by pathogens such as:
  • Enterococcus
  • Escherichia coli (most common)
  • Mycobacterium tuberculosis
  • Proteus sp.
• Schistosomiasis
• Chronic pyelitis; bacterial infection of the renal pelvis
• Urinary bladder outlet obstructions
• Urinary bladder catheterisation procedures

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ureteritis Cystica? (Etiology)

Ureteritis Cystica is caused by the chronic irritation or inflammation of the surface of the ureters due to several factors.

• The ureters are a pair of smooth muscle tubes that act as conduits for urine transport, from the kidneys to the urinary bladder
• Ureteritis Cystica is considered to be the outcome of certain reactive changes in the ureter wall tissue due to persistent irritation

Note: When the tissues of the renal pelvis are involved, the condition is termed Pyeloureteritis Cystica.

What are the Signs and Symptoms of Ureteritis Cystica?

In many cases, Ureteritis Cystica does not present any significant signs and symptoms. In some cases, the following may be noted:

• The condition may appear as a mass on imaging studies; some are observed to be about 2-3 cm in size
• It can cause a chronic obstruction of the ureter (to the free flow of urine)
• Single or multiple lesions may be observed in the ureters
• It can be unilateral or bilateral (involving one or both ureters); it is reported that nearly 50% of the cases are bilateral
• Signs and symptoms of the underlying condition/infection, if any, may be noted

Ureteritis Cystica usually develop in the proximal ureter (portion of ureter nearer to the kidney); although it may be observed anywhere along the length of the ureters. When this condition involves the urinary bladder, it is termed cystitis cystica. It may also form in the renal pelvis due to chronic pyelitis.

How is Ureteritis Cystica Diagnosed?

Ureteritis Cystica is often an incidental finding, when the individual is being examined for other medical conditions. The following tests and exams may be performed:

• Complete evaluation of medical history along with thorough physical exam
• Urinalysis or urine tests
• Urine culture, to check for an infection
• CT urogram: A radiology procedure using X-rays to generate high-quality images of the urinary tract, involving the kidneys, ureters, and urinary bladder
• Ureteroscopy: It is an imaging (endoscopic) procedure using a special fiber optic device to examine the upper urinary tract, which is inserted through the urethra
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

The healthcare provider may undertake a differential diagnosis to eliminate other conditions or tumor types, before arriving at a definitive diagnosis. This may include the following:

Radiological differential diagnosis:

• Blood clots
• Leukoplakia
• Stevens-Johnson syndrome
• Tuberculous urethritis
• Ureteral stones
• Vascular indentations

Pathological differential diagnosis:

• Adenocarcinoma in situ of the urinary bladder
• Invasive urothelial carcinoma
• Inverted urothelial papilloma
• Transitional cell carcinoma (TCC)
• Urothelial carcinoma in situ involving von Brunn nests
• Urothelial carcinoma, nested variant
• Von Brunn nest hyperplasia

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ureteritis Cystica?

No major complications from Ureteritis Cystica are generally observed. In some cases, it may result in the following:

• Emotional stress due to concerns of ureter tumor
• Recurrent infections
• It may be associated with an increased incidence for transitional cell carcinoma. However, this is most likely due to chronic irritation being a causative factor rather than to Ureteritis Cystica (in itself)

How is Ureteritis Cystica Treated?

The treatment of Ureteritis Cystica may involve the following measures:

• Treating or removing the underlying cause of irritation of the ureters is the most important consideration
• Antibiotic therapy may be necessary, if bacterial infections develop
• Complete surgical removal of the lesions based on the healthcare provider’s evaluation

How can Ureteritis Cystica be Prevented?

The preventive measures for Ureteritis Cystica are mostly aimed at controlling or avoiding the factors that cause ureter irritation and inflammation. These may include:

• Undertaking suitable treatment of diabetes
• Taking early appropriate treatment for conditions such as urinary tract infections and kidney stones
• Ensuring adequate care while performing any medical procedures involving the kidney, ureters, and urinary bladder

What is the Prognosis of Ureteritis Cystica? (Outcomes/Resolutions)

• The prognosis of Ureteritis Cystica is typically excellent, since it is a reactive process with no malignancy potential
• Usually, the condition gets better on its own, when the underlying cause of chronic irritation or inflammation is removed

Additional and Relevant Useful Information for Ureteritis Cystica:

Please visit our Kidney & Bladder Health Center for more physician-approved health information:

https://www.dovemed.com/healthy-living/kidney-health/