Abstract
Ureteritis cystica is a rare urological disease with an undefined etiology. Despite the benign behavior, the differential diagnosis should be investigated, as other conditions the cause filling defects in the ureters may occur. We present a rare case of a patient with ureteritis cystica whose differential diagnosis was satisfactory.
Keywords: Diagnosis, Endourology, Ureteritis cystica
Introduction
Ureteritis cystica is a rare urological disease with an undefined etiology. It is generally benign and often associated with chronic inflammatory injury of the urothelium.1 The diagnosis can be performed by computed tomography or magnetic resonance, which reveal filling defects in the ureters. However, it can also be an incidental finding during ureteroscopy. Despite the benign behavior, the differential diagnosis should be investigated, as other conditions the cause filling defects in the ureters may occur.2
We present a rare case of a patient with ureteritis cystica whose differential diagnosis was satisfactory.
Case presentation
A 69-year-old female patient visited the clinic with a history of recurring urinary infection and left renal lithiasis with a surgical indication for flexible trans-ureteroscopic ureterolithotripsy. Computed tomography revealed filling defects in the ureter (Fig. 1).
Fig. 1.
Several lesions with a cystic appearance and pearly color of varied sizes in the ureter. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
After the preoperative cardiological evaluation and the determination of the absence of urinary infection, the patient was submitted to rigid ureteroscopy, which revealed several lesions with a cystic appearance and pearly color of varied sizes throughout the entire length of the ureter (Fig. 2).
Fig. 2.
Computed tomography of the abdomen showing multiple filling defects.
The lesions were biopsied and sent for histopathologic examination. Biopsy specimens were negative for malignancy and the condition was diagnosed as ureteritis cystica (Fig. 3). The patient was then submitted to endoscopic treatment of the kidney stone and was discharged from hospital the following day with no symptoms.
Fig. 3.
Histopathologic examination showing cystic structures consistent with ureteritis cystica.
Discussion
Ureteritis cystica is more prevalent in older women,3 which is in agreement with the demographic characteristics of the present case.
Although its etiology is unknown, certain factors are associated with ureteritis cystica, such as urinary infection and kidney stones, which are chronic aggressors of the urothelium.4 In the present case, the patient had a history of lower urinary tract infection and had a kidney stone, which may have contributed to the emergence of this condition.
Despite the benign nature of ureteritis cystica, other conditions can also cause filling defects in the ureters, such as transitional cell carcinoma, blood clots, air bubbles, calculi, polyps and urinary tuberculosis.5 Therefore, the differential diagnosis is needed to determine the best treatment option.
Conclusions
The differential diagnosis is needed to determine the best treatment option. As this disease is silent and the patient is asymptomatic, treatment should be conservative.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
No disclosures.
References
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