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Background Interstitial cystitis (IC) is a chronic condition with complex symptoms, including pelvic pain and urinary frequency. Current treatments often involve a combination of therapies, but their effectiveness remains a topic of ongoing investigation. This study aimed to evaluate the clinical efficacy of a treatment regimen combining intravesical instillation of heparin and alkalized lidocaine, hydrodistention, and transurethral fulguration, using pelvic ultrasound monitoring and symptom scales to assess patient outcomes. Methods From June 2016 to June 2023, patients who were diagnosed as interstitial cystitis in urology department of the xuzhou central hospital were selected. All patients received intravesical instillation regimen of 2% lidocaine 10 ml + 5% sodium bicarbonate 5 ml + heparin 25000 IU for 6 months, and they were randomly divided into two groups according to the simple randomization (coin toss): hydrodistention and transurethral fulguration (HD/TF) group and non-HD/TF group. The 24-h urination frequency, nocturia frequency, pelvic ultrasound measurement results (bladder volume at maximum filling state, bladder wall thickness after urination, residual urine volume), O'Leary-Sant interstitial cystitis symptom index (ICSI), O'Leary-Sant interstitial cystitis problem index (ICPI), pelvic pain and urgency/frequency (PUF), pain visual analogue score (VAS), self-rating anxiety scale (SAS) were recorded before treatment and 3 and 6 months after treatment. Results A total of 68 patients were included in this study, including 13 males (19.12%) and 55 females (80.88%), with an average age of 59.07 ± 8.15 years. According to the simple randomization, 68 patients were randomly divided into HD/TF group ( n = 30) and non-HD/TF group ( n = 38). After the 3rd and 6 th months of treatment, the 24-h urination frequency and nocturia frequency in both groups decreased significantly ( P < 0.05), and the 24-h urination frequency and nocturia frequency after the 3rd and 6 th months of treatment in HD/TF group decreased significantly compared with that in non-HD/TF group ( P < 0.05). After the 3rd and 6 th months of treatment, the bladder volume at maximum filling state in the two groups increased and the residual urine volume decreased ( P < 0.05). In addition, the bladder volume at maximum filling state of the HD/TF group increased significantly compared to the non-HD/TF group after 3rd and 6 th months of treatment ( P < 0.05), while the bladder wall thickness after urination decreased compared to the non-HD/TF group after 3rd months of treatment ( P < 0.05). There was no significant difference in residual urine volume between HD/TF group and non-HD/TF group before and after treatment ( P > 0.05). The postoperative scores at 3rd and 6 th months of ICPI, ICSI, PUF, SAS and VAS in both groups were significantly lower than those before treatment ( P < 0.05), and The postoperative scores at 3rd and 6 th months of ICPI, ICSI, PUF, SAS and VAS in HD/TF group were significantly lower than those in non-HD/TF group ( P < 0.05). Conclusions Intravesical instillation of heparin/alkalized lidocaine combined with hydrodistention and transurethral fulguration is an effective treatment for interstitial cystitis, which can significantly reduce patient pain and improve patient prognosis. Moreover, the use of pelvic ultrasound to monitor indicators such as bladder volume at maximum filling state and residual urine volume, combined with ICSI, ICPI, PUF, VAS, and SAS scores, has high application value for evaluating the efficacy of intravesical instillation regimen combined with hydrodistention and transurethral fulguration in the treatment of interstitial cystitis.

We report on an infant with features of intermittent obstructive uropathy, acute kidney injury, hypertension and type 4 renal tubular acidosis (RTA) despite urethral catheterisation and fluid resuscitation. Radiological findings showed upper tract dilatation, likely bilateral vesicoureteric junction obstruction and bladder base thickening which was concerning for possible malignancy. Renal biopsy demonstrated eosinophilic infiltrate, suggestive of kidney involvement. Bladder biopsy was diagnostic for eosinophilic cystitis (EC) showing mature degranulating eosinophils. EC is a rare, easily treatable and important differential of bladder mass in children which may present with an atypical obstructive uropathy. This report adds to the limited literature of this condition within the paediatric population. EC should be considered early in children presenting with eosinophilia, urinary tract obstruction and kidney dysfunction, with uncertain aetiology. This case also highlights the need for detailed imaging, including visualisation of the bladder base, in cases of likely obstructive uropathy.

Purpose To explore the diagnostic characteristics of cystitis glandularis (CG) using magnetic resonance imaging (MRI). Materials and methods A retrospective study was conducted on pathologically confirmed patients who underwent bladder MRI examination between January 2019 and November 2023. Image analysis was jointly conducted, with emphasis on lesion location, morphology, size, signal intensity, and pattern of enhancement, by two genitourinary radiologists with 22 and 15 years of experience, respectively. Results A total of 27 patients with 27 lesions were included (median age 47 years, 24 males). The lesions were mostly located in the bladder trigone area (18/27). The lesions could be categorized as focal thickening (17/27), nodular (8/27), and diffuse thickening of the entire bladder (2/27) in morphological terms. On T2-weighted imaging (T2WI), 15 of 17 focal thickening lesions appeared as a slightly hyperintense thickened inner layer, with a higher signal in the center of the thickened inner layer, resembling a sandwich sign, and 6 of 8 nodular lesions were slightly hyperintense. On T1-weighted imaging (T1WI), 19 patients showed slight hypointensity. The lesions on DWI showed mainly high (5/27) and slightly high signal (21/27), with an average mean apparent diffusion coefficient (mADC) value of 2.171 ± 0.052 × 10 −3 mm 2 /s. Among the 23 patients who underwent dynamic contrast-enhanced (DCE) scanning, 18 lesions showed mild enhancement in the arterial phase (average 1.7 times comparing to unenhanced phase), and the degree of enhancement gradually increased in the venous and delayed phases (average 2.2 and 2.3 times compared to the unenhanced phase, respectively), showing a progressive enhancement pattern. Conclusion On MRI, the majority of CG manifest as focal thickening or nodules in the bladder trigone area, showing slight hyperintensity on T2WI, slight hypointensity on T1WI, and a progressive enhancement pattern, without significant restriction on DWI. Focal thickening lesions may exhibit a special sandwich sign.

Hepatic portal venous gas (HPVG) is the presence of air bubbles in the portal vein and its branches. Traditionally it was considered a lethal condition because the main etiology was bowel ischemia. However, with the extensive use of diagnostic tools, it became clear that the causes of this condition are diverse and may include, but are not limited to, bowel necrosis. Here, we present a rare case of HPVG in an elderly dialysis patient with diabetes mellitus, initially diagnosed by ultrasound and CT scan. Our patient experienced abdominal pain, dysuria, oliguria, and other urinary symptoms starting three weeks prior. After considering all diagnostic tools and correlating them with the patient's history, clinical findings, and follow-up, the underlying cause of the HPVG was determined to be emphysematous cystitis. We concluded that the presence of HPVG in the initial screening test should prompt a comprehensive investigation to determine the cause, as a rare condition like emphysematous cystitis can result in HPVG.

Emphysematous cystitis (EC) is a rare severe urinary tract infection characterised by pockets of air in and around the urinary bladder wall caused by gas-forming organisms. Common predisposing factors are chronic infection, immunosuppression, diabetes and neurogenic bladder. The presentation may vary from mild illness to severe life-threatening cystitis. We report two cases of incidental detection of EC diagnosed on imaging for the evaluation of unrelated symptoms. Although asymptomatic, this lethal disease still warrants prompt recognition and treatment with broad-spectrum antibiotics and urinary bladder drainage to prevent severe morbidity and mortality.

Background Eosinophilic cystitis (EC) is rare in children and remains poorly understood. Our aim was to analyse the clinical and imaging features of eosinophilic cystitis in children. Methods A retrospective review of histologically confirmed eosinophilic cystitis between January 2008 and December 2022 was performed, including patient age, sex, symptoms, laboratory examination, radiology, treatment and outcome. Results Twelve children (two girls, 10 boys; age range: 3–12 years, mean age: 7.2 years) were included in the study. Urinary irritation symptoms (10/12), haematuria (5/12) and hypogastralgia (3/12) were the most common symptoms. Five patients had a history of allergies, six patients had elevated serum IgE, nine patients had elevated peripheral eosinophils and six patients had positive microscopic haematuria. Radiology revealed diffuse homogeneous or inhomogeneous thickening in seven patients, localised thickening in three patients, and solitary tumour-like lesions in the other two patients. Preservation of the mucosal line and bladder wall layering were observed in eleven patients, and perivesical exudation and small vessel dilatation were observed in ten patients. All four patients with delayed scans showed obvious delayed enhancement. One patient showed low signal intensity on T2-W imaging. All patients received antihistamine, antibiotic and/or corticosteroid therapy and two tumour-like patients underwent transurethral resection. Nine patients achieved complete response and three patients achieved partial response. Conclusion The clinical and imaging manifestations of EC in children have relative characteristics; when urologist and radiologist confronted with similar cases, EC should be considered. The final diagnosis depends on pathological biopsy.

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