The detection rate of cystitis glandularis has increased in recent years, which is related to the increasing attention paid by clinicians to the disease. It is possible to take a biopsy from a suspicious lesion to make a definite diagnosis. However, the etiology of cystitis glandularis is still unclear, and its occurrence may be related to primary diseases such as chronic bladder inflammation, calculus, obstruction, neurogenic bladder and bladder eversion. However, there is no satisfactory evidence to prove the causality between them. According to the current research, cystitis glandularis can be considered as a disease accompanied by hyperplasia and metaplasia. The process is that epithelial hyperplasia sinks into Brunn's fossa, cracks appear inside, or branches or annular lumens are formed, glandular metaplasia forms gland structure in the center, and lymphocytes and plasma cells infiltrate. So it is called cystitis glandularis. In this process, if only mucus is found in the lumen and no glandular metaplasia is found, it is called cystic cystitis. Therefore, cystic cystitis and cystitis glandularis can be regarded as two stages or degrees of the same pathological process, and they often appear together in clinical pathological examination, which is called cystic cystitis glandularis.
Cystitis glandularis mainly occurs in the triangle and bladder neck, and its cause is unknown. Anatomically speaking, there may be the following reasons: 1. Triangle area and bladder neck are the focus of urodynamic force, because there is no submucosa, the position is fixed, and there is no randomness of contraction and contraction in other parts; 2. This part is often the high incidence area of bladder inflammation and retrograde infection of urethra. Therefore, physical factors and the stimulation of chemical components in urine may be one of the causes of cystitis glandularis. There is no definite evidence about the relationship between cystitis glandularis and canceration. Previous reports show that the canceration rate is significantly higher than that of nonspecific inflammation of bladder. Although scholars disagree that cystitis glandularis is a precancerous lesion, active treatment and careful follow-up have been recognized and advocated.
The diagnosis of cystitis glandularis depends on pathology, but cystoscopy has important reference value for diagnosis. Cystitis glandularis has the following characteristics under cystoscope: 1. The lesions were mainly located in the triangle and bladder neck; 2. The lesions are multicentric, often scattered, patchy or clustered; 3. It is polymorphic, nipple-like, lobulated and mixed in follicular phase, and there is no blood vessel growth on it; 4. Most of the ureteral orifice can't be seen clearly. The above characteristics are easy to distinguish from transitional cell carcinoma of bladder, but some cases are difficult to distinguish from follicular chronic cystitis and adenocarcinoma. For patients with localized tumor-like appearance or extensive lesions with erosion and bleeding, the possibility of adenocarcinoma or local malignant transformation should be considered. Pathological examination should be advocated to make a diagnosis before treatment.
At present, there is no satisfactory treatment for cystitis glandularis. TUR or laser therapy is the main surgical method, which has a certain effect. However, the application of TUR in treatment is limited, and its indications should be localized lesions or bladder neck lesions affecting urination, and the operation should burn mucosa and submucosa evenly and thoroughly. For patients with a wide range of lesions, the effect of electrotomy is not ideal, and it may not be completely removed and remain, and extensive electrotomy will aggravate the symptoms of bladder irritation, so the operation is relatively difficult. For extensive intravesical lesions involving triangle and bladder neck, or local adenocarcinoma, radical cystectomy should be performed, but the range of lesions should be selected. We should seriously consider the severity of the disease and the quality of life of patients in the future. For patients without surgery, regular cystoscopy is a very necessary monitoring method, which is helpful to find the progress of the disease and monitor the pathology of suspicious tissues. Generally speaking, cystitis glandularis still needs to be studied and discussed in pathogenesis and treatment.