Severe bladder trabeculation mimics malignancy on intravenous pyelography
© Springer-Verlag Berlin/Heidelberg 2006
Received: 24 August 2005
Accepted: 23 December 2005
Published: 15 March 2006
Intravenous pyelography was performed in a woman with severe (grade IV) pelvic organ prolapse. The imaging of the bladder suggested a neoplasm, but at cystoscopy the diagnosis proved to be severe bladder trabeculation.
Bladder trabeculation has often been seen in patients with chronic lower urinary tract disease by cystoscopy, but has seldom been shown on intravenous pyelography. The author reported an interesting case of severe bladder trabeculation demonstrated on intravenous pyelography and cystoscopy.
This patient had severe pelvic organ prolapse and the associated hydronephrosis had to be ruled out by urography . In addition, she had flank pain and thus urinary stones should also be considered. Intravenous pyelography can provide information on the urinary tract and once a urinary tract filling defect has been revealed, it should be regarded as a potential malignancy . In this case, the radiologic study revealed a suspected bladder neoplasm, but was unable to provide adequate bladder imaging and cystoscopy was required . The accurate diagnosis was made by direct vision via cystoscopy.
In this patient, as there was no history of recurrent urinary tract infection or lower urinary tract symptoms such as urgency and frequency, the severe trabeculation might be the consequence of chronic detrusor strain resulting from an obstructed bladder outlet caused by severe pelvic organ prolapse. Therefore, in severe pelvic organ prolapse, bladder trabeculation must be included in the differential diagnosis of a bladder filling defect on intravenous pyelography.
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