Endoscopic treatment of eosinophilic cystitis

Abstract

Since 1990 we have treated 11 cases of eosinophilic cystitis. All patients were adult or elderly men with an average age of 66.4 years (range 46–83). Seven patients had previous superficial bladder cancer and 5 of these were treated with instillations of mitomycin C. Three patients were hospitalized following repeated episodes of macrohematuria. One case had peritonitis due to spontaneous rupture of the bladder. Cystoscopy showed hyperemic areas in all patients, mamillated areas in 7 cases and ulcerated and necrotic areas in 2 cases. The bladder mucosa appeared bloody in one patient. In nine cases multiple biopsies and wide fulguration of involved areas were performed. Two patients were submitted to complete resection of the lesions. The pathological examination documented an infiltration of eosinophils into the mucosa and lamina propria in all cases; in one of these the infiltration involved the muscularis. The patients have been followed for 24.5 months (range 13–37), with periodic cystoscopy and bladder biopsies. We have not documented recurrences of eosinophilic cystitis. Although the treatment of eosinophilic cystitis is controversial, our experience with diathermic fulguration or transurethral resection has proved effective with minimal invasiveness.