Rare condition of bladder inflammation requires no treatment, may be incurable

DEAR DR. ROACH >>

I am looking for some clarification on cystitis glandularis. My 53-yearold son was recently diagnosed with this condition. He has been experiencing urinary frequency/ urgency for more than two years. He is in excellent health and works out religiously, but he does smoke.

Online research provides conflicting opinions. Some sites indicate that it is an extremely rare condition, while others say that it is fairly common. Also, some sites indicate that the condition can become malignant over time.

My son’s doctor told him the condition is incurable, and he will just have to live with it. Can you please provide more information about this condition? — J.R.

DEAR READER >>

“Cystis” is the Latin word for bladder, so “cystitis” means bladder inflammation. Persistent inflammation in the bladder, such as with chronic infection or interstitial cystitis, can lead to a change in the cells lining the bladder. They can go from normal bladder-lining (urothelial) cells to cells that look more like those in secretory glands (hence “cystitis glandularis”).

This condition in general is called “metaplasia,” but does not by itself mean that the lining of the bladder will become cancerous.

There is debate over how common this is, with autopsy studies showing areas of change in the bladder in 60% of people (who died from other causes), while other authors say it is a rare condition.

There is also argument over the degree of risk of this condition progressing to bladder cancer, but I found one well-done study of cases that estimated the risk over time to be about 9% (followup time averaged about four years). This is clearly higher than the risk of bladder cancer overall, since about 1% of women and 3% of men will get bladder cancer in their lifetime.

If there were evidence of chronic infection, that should be treated; otherwise, there is no treatment for cystitis glandularis beyond periodic evaluation to look for any evidence of changes to cancer. There is no clear evidence to support the frequency of examination, but annual exams have been proposed.