A Rare Condition: The Ureteritis Cystica

In November 1997, a 65-year-old woman was admitted with a complaint of stress urinary incontinence for 2 years. Dysuria, hematuria, and any systemic illness were not noted in her medical history. Physical examination revealed only grade-2 cystocele. Bonney and cotton swab tests were positive. 8-10 erythrocytes and 2-3 leucocytes per high-power field were detected by urine analysis. No bacterial growth was established at midstream urine culture. Blood levels of urea, creatinine, uric acid, and electrolytes were within normal limits. The ultrasonography (USG) of the kidneys and bladder was normal. IVP showed 3 and 4 filling defects in the left and right ureters respectively (Figures 1 and 2). A computerized tomography of the abdomen and pelvis demonstrated an intraluminal lesion in the proximal part of the right ureter that covered the lumen incompletely. A multichannel cystometry confirmed the pure stress incontinence. Cytology findings of selective urine specimens collected from both ureters under local anesthesia were negative for atypical cells. Bilateral rigid ureteroscopies were performed under general anesthesia. Six polypoid lesion in the right and 4 lesions in the left ureter were diagnosed during this procedure. Multiple biopsies were done bilaterally and laparoscopic retropubic bladder neck suspension was performed subsequently to correct the stress incontinence. Histopathologic examinations of the biopsy specimens were negative for malignancy and the condition was diagnosed as bilateral UC. The patient was followed every 6 or 12 months for a period of 45 months. Routine contrast and cytology studies showed no evidence of malignancy and no significant interval changes in the lesions, ureters, and intrarenal collecting systems.