Cystitis cystica et glandularis (CCEG) is a mucosal proliferative change common to the normal bladder mucosa. Proliferative lesions of the normal bladder mucosa initially appear as von Brunn’s nests, in which normal bladder uroepithelial cells are nested deep into the submucosa and the cells grow in clusters with no internal spaces, which in earlier years were termed proliferative cystitis.
This reactive proliferative change is seen in approximately 85-95% of normal subjects. These nests of cells may or may not be in contact with the epithelium (i.e., isolated in the submucosa). With the persistence or enhancement of reactive stimuli, interstitial spaces may appear within the cell nests and the lumen may become covered with multiple layers of columnar or long columnar epithelial cells and become glandular hyperplasia, also known as glandular cystitis, whereas the formation of cystic spaces with pink-stained fluid is known as cystic hyperplasia, also known as cystitis. The use of cystitis as a title may be related to the fact that this type of proliferative lesion is mostly associated with inflammatory irritation. von Brunn’s nest, adenoid cystitis and cystic cystitis often coexist, as well as with other pathological changes of the bladder mucosa (bladder inflammation and tumors, etc.).
Since the early 1950s, scholars have reported that CCEG may be associated with bladder adenocarcinoma, but later analysis by scholars showed that the reports at that time were based only on a coexistence phenomenon, and there was no analysis and study of the causal relationship between them. It was only in the years that followed that we gradually recognized the correlation between the presence of long-term inflammation and cancer. Since then, there have been sporadic reports of CCEG carcinogenesis for decades, and it was from the 1950s that several international medical centers recommended CCEG as a precancerous lesion and recommended regular biopsy follow-up. It was not until the discovery of intestinal epithelial metaplasia (i.e., intestinal adenoid cystitis) that definitive evidence of malignancy was found for this type of proliferative lesion. Bowel adenoid cystitis is a relatively rare type of adenoid cystitis that is multifocal in the bladder, with a large follicular pattern and widespread distribution throughout the walls of the bladder centered on the triangle. In fact, intestinal adenoid cystitis is also associated with chronic inflammatory irritation (especially in neurogenic bladders with long-term indwelling urinary catheters), but is in a critical stage of malignancy due to chronic inflammatory irritation of the mucosa, and this type of adenoid cystitis does require transurethral resection of the bladder mass to stop the malignancy from occurring. However, the main carcinogenic factor is still related to long-term chronic inflammatory stimulation. There is an emerging international consensus on the inflammation-mucosal proliferative lesion-intestinal epithelial metaplasia-adenocarcinoma relationship. It is particularly important to fully recognize inflammation as the initial causative factor for these mucosal proliferative lesions of the bladder and even for the development of adenocarcinoma. Therefore, it is not difficult to understand that most patients diagnosed with adenocystitis have clinical manifestations of urinary frequency and urgency or even pain in the bladder or urethra, but in fact these patients are often associated with some kind of inflammatory bladder disease. For biopsy findings with adenoid or cystic cystitis, or even intestinal adenoid cystitis after electrodesiccation requires careful search for the cause of inflammation.
The widespread international recommendation of intermittent home catheterization as an alternative to long-term indwelling urinary catheters for the resolution of voiding problems in patients with neurogenic bladder also has this in mind, with intermittent home catheterization being far less irritating to the bladder than long-term indwelling urinary catheters. There is also an international consensus for aggressive anti-inflammatory therapy in patients with pathologically obtained CCEG diagnosis, while the method of bladder irrigation chemotherapy in such patients after obtaining the diagnosis has long been abandoned internationally; this local chemotherapy not only aggravates the bladder inflammatory response and significantly worsens the patient’s urinary tract irritation, but also does not help to prevent the possibility of malignancy due to long-term inflammatory stimulation. From the analysis of the domestic literature that could be collected from Wanfang data, there are certain misconceptions about the diagnosis and treatment of adenoid cystitis in China, and most scholars still ignore the important aspect of anti-inflammatory treatment and still use transurethral resection and postoperative bladder irrigation chemotherapy for all adenoid cystitis. Although scholars from Cleveland Medical Center in the United States questioned the Chinese report, it may be related to the fact that foreign scholars only read the abstract of this literature.
From the Chinese literature questioned by the foreign authors, the Chinese scholars nevertheless presented clinically significant evidence, such as the data in the article showing an efficiency of 94% for treatment of adenocystitis after bladder stone removal and 84% for treatment of adenocystitis after lower urinary tract obstruction release, and 53% for treatment of adenocystitis after urinary tract infection control, with these good results being associated with significant reduction in bladder inflammation. The 21% cancer rate reported in the article is also the main reason for the questioning by American scholars, and the article does not list the specifics of the patients with cancer, nor does it prove causality.
In recent years, scholars in China have also systematically discussed the diagnosis and treatment of adenoid cystitis, while recognizing that there are some problems with the current status of treatment of adenoid cystitis in China, and have proposed a diagnosis and treatment plan based on the basic principles of active search for the cause of bladder inflammation and anti-inflammatory treatment. In this issue, the article “Observation of the efficacy of bladder instillation of sterile sodium hyaluronate solution after electrodesiccation for adenoid cystitis”, although there are still some misconceptions in the understanding of adenoid cystitis and related definitions, the authors also realize that there may be problems with bladder instillation of chemotherapeutic drugs after adenoid cystitis surgery and designed a randomized controlled study, which showed that treatment against inflammation (bladder instillation of cystotec) was effective in preventing adenoid The results showed that treatment against inflammation (cystoplasty) was effective in preventing recurrence of adenocystitis, providing evidence from clinical trials for the above point of view, which is the original intention of this journal to publish this article, hoping that more doctors in our urology community will pay attention to adenocystitis and its related research and get out of the misconceptions as early as possible.