Adenocystitis

　　Adenocystitis of the bladder is a transformatory lesion of bladder mucosal tissue. There are three theories about the origin of the mucosal glandular epithelium of the bladder:

　　1. Embryonic origin theory:Abnormal closure of the umbilical urachus can lead to urachal cysts or nests, or intestinal epithelium residue during the differentiation of the cloaca.

　　2. Pund regression theory:When the epithelium loses its normal function, it may regress to the previous stage of its normal differentiation process.

　　3. Theory of epithelial tissue transformation:Under the action of chronic stimulating factors, the transitional epithelial tissue is converted into adenoid epithelium, achieving the purpose of self-protection by secreting mucus. Some people speculate that there may also be factors such as vitamin deficiency, allergic reactions, toxic metabolic products, hormonal imbalance, and special carcinogens. Common chronic stimulating factors include infection, obstruction, physical stimulation (stones, foreign bodies, etc.), and chemical carcinogens.

　　Among them, the third theory is currently widely accepted. The occurrence and development of adenocystitis is a gradual process: simple hyperplasia of transitional epithelium - Brunn nodule - Brunn nest - cystic bladder炎 - adenocystitis. The Brunn nest is a nodular structure formed when the transitional epithelium is stimulated chronically, grows into the submucosa in a flower bud-like manner, and is surrounded and divided by the surrounding connective tissue, separating from the transitional epithelium. The Brunn nest is composed of well-differentiated transitional epithelium, with epithelial cells arranged vertically to the surrounding basement membrane. The central cystic change of the Brunn nest is covered by mucosal transitional epithelium, known as cystic bladder炎. The epithelium within the lumen can further transform into a mucus columnar epithelium similar to intestinal mucosa, known as adenocystitis. In most cases, Brunn nodule, cystic change, and adenomatous tissue transformation are present simultaneously. Adenocystitis and cystadenocystitis are actually different stages of the same lesion and can be collectively referred to as adenocystitis.

　　Adenocystitis can be associated with leukoplakia of the mucosa, follicular cystitis, and bullous edema, and is often accompanied by non-specific infections. Follicular cystitis is a type of chronic cystitis, commonly seen in chronic urinary tract infections. Cystoscopy can observe small grayish-yellow papillary nodules, which are often surrounded by inflammatory mucosa. However, normal mucosa may also be seen between the nodules.

　　Adenocystitis of the bladder mainly manifests as recurrent attacks and refractory symptoms such as frequent urination, urgency, dysuria, hematuria, discomfort in the supra-pubic area and perineum, a sense of lower abdominal坠胀, urinary incontinence, and dyspareunia. The predisposed locations of the lesions are in sequence the bladder trigone, bladder neck, and surrounding ureteral orifices, with the neck orifice most commonly seen at 3 to 9 o'clock. The clinical manifestations of adenocystitis are closely related to the location of the lesions: those located in the trigone mainly show bladder irritation symptoms; those in the bladder neck often have symptoms of incomplete urination and discomfort in the lower abdomen, with severe cases presenting with difficulty in urination; lesions involving the ureteral orifices can cause symptoms such as ureteral dilation and renal积水 in the lumbar region; those with a more extensive range of lesions often present with hematuria; and those with concurrent bladder calculi may show symptoms such as intermittent urinary flow.

　　Adenocystic cystitis can be caused by infection, and poor living habits in daily life are also a risk factor for cystitis, and it is very important. For example, long-term use of aluminum cooking pots, addictive consumption of coffee, carbonated drinks, chocolate, and alcohol, which are harmful to the bladder, can all cause bladder inflammation.

　　It is strictly forbidden to drink alcohol, chili, chicken, fish, beef, shrimp, seafood, salted vegetables, and only salt, vinegar, monosodium glutamate (do not use other seasonings) can be used as seasonings during the medication treatment for cystitis.

　　If the patient does not control their diet well, it will extend the treatment time, so attention should be paid to the following points in daily life.

　　1. Eat more diuretic foods:Such as watermelons, grapes, pineapples, celery, pears, and so on.

　　2. Increase the intake of diuretic foods to alleviate urinary tract syndrome:Foods like螺蛳(spinach), corn, mung beans, scallion whites, and so on can help alleviate symptoms such as frequent urination, urgency, and dysuria.

　　3. Drinking more water:Patients should not reduce their water intake or not drink water because they want to reduce the number of times they go to the bathroom. Since urination has a detoxifying effect, adenocystitis patients should drink more water to increase the frequency of urination.

　　4. Avoid sour and spicy刺激性 foods:Such as strong alcohol, chili, balsamic vinegar, sour fruits, and so on.

　　5. Avoid eating citrus:Because citrus can cause alkaline urine, which is conducive to bacterial growth.

　　6. Avoid caffeine:Caffeine can cause the bladder neck to contract, leading to spasmodic pain in the bladder, so coffee should be consumed less.

　　These dietary precautions should be particularly noted in daily life to reduce the chance of developing cystitis.

　　Adenocystic cystitis is prone to recurrence, and patients should persist in treatment, never give up halfway, and definitely not stop taking medication when they feel their symptoms have disappeared. Most patients often believe that cystitis is caused by infection and ignore daily diet. In fact, daily living habits are also an important factor in triggering cystitis, so patients should pay attention to their diet during treatment.

　　1. Increase the intake of diuretic foods:Since patients may have symptoms of difficulty urinating, they should consume more diuretic foods, such as watermelons, grapes, pineapples, celery, pears, and so on.

　　2. Increase the intake of diuretic foods to alleviate urinary tract syndrome:Patients often show symptoms such as frequent urination, urgency, and dysuria, which are associated with urinary tract syndrome. It is recommended to eat more foods like螺蛳(spinach), corn, and mung beans, which can help alleviate urinary tract syndrome.

　　3. Drinking more water:Patients should not reduce their water intake or not drink water because they want to reduce the number of times they go to the bathroom. Since urination has a detoxifying effect, adenocystitis patients should drink more water to increase the frequency of urination.

　　4. Avoiding caffeine and citrus:Caffeine can cause spasmodic pain in the bladder, and citrus can lead to alkaline urine, so caffeine and citrus should be avoided.

　　The treatment of adenocystitis includes eliminating the triggering factors, controlling infection with antibiotics, washing the bladder with 10% weak protein silver or 1% to 2% nitric acid silver solution, surgical treatment, and intravesical chemotherapy. The specific treatment methods are described as follows.

　　I. Eliminating the triggering factors:Adenocystitis is caused by long-term chronic irritation of the bladder, so it is first necessary to find these irritants, such as bladder stones, benign prostatic hyperplasia, bladder neck sclerosis, and chemical substances acting on the bladder, and remove them. In some patients, the symptoms and bladder lesions can completely disappear after the irritants are eliminated.

　　II. Antibiotic control of infection:Infection is both a triggering factor for adenocystitis and a concomitant disease. It is very important to select sensitive drugs based on bacterial culture. Since the infecting bacteria are mostly Escherichia coli, drugs such as acriflavine, streptomycin, kanamycin, gentamicin, ampicillin (ampicillin), or cephalosporins can be selected.

　　III. Washing the bladder with 10% weak protein silver or 1% to 2% nitric acid silver solution:It can temporarily relieve symptoms but is prone to recurrence. There have been reports of using argon ion laser irradiation and BCG perfusion therapy for adenocystitis, which has certain efficacy and requires further observation.

　　IV. Surgical Treatment:

　　1. Lesions involving the ureteral orifice cause upper urinary tract obstruction or a larger papillary tumor-like lesion, and partial cystectomy and ureterovesical reimplantation should be performed.

　　2. Follicular lesions are treated with bladder mucosal stripping surgery.

　　3. Lesions are relatively limited, without complications such as stones or benign prostatic hyperplasia, and transurethral resection can be used.

　　4. Lesions are widespread and severe, the bladder wall is significantly thickened, and the bladder capacity is significantly reduced. There is a high suspicion or concurrent adenocarcinoma, and a total cystectomy should be performed.

　　V. Intravesical Chemotherapy:Since adenocystitis is a precancerous lesion of bladder cancer, intravesical infusion of chemotherapeutic drugs such as mitomycin, hydroxycamptothecin, and others should be adopted.