An unusual case of obstructive uropathy: Cystitis cystica with ureteritis cystica

A 45-year-old man presented with loin pain and burning micturation. He had a positive Bilharzial titre and impaired renal function. Ultrasonography (USG) revealed right hydroureteronephrosis and a thickened bladder wall with areas of calcification. A diuretic 99mTc - DTPA scan (technetium-99m diethylene triamine penta acetic acid) showed features of obstruction in both the kidneys. Cystoscopy showed polypoid transparent cystic lesions obscuring both the ureters. The obstruction was relived by percutaneous nephrostomy (PCN). Nephrostogram showed multiple scalloped filling defects in the right ureter with obstruction at the uretero vesical junction (UVJ), suspicious of ureteritis cystica (UC). Biopsy of the lesions showed features of Bilharzial proliferative cystitis with extensive cystitis glandularis and cystitis cystica (CC). Complete cure was achieved by semi-interventional methods and prompt treatment of the underlying infection. Diagnosis, management, and progression of this case with review of literature are discussed