Glandular Cystitis, UTI, and Surgical Treatment

[jaceyliu]

My mother in-law went to a hospital in China complaining of frequent urination. They did urine tests (simple tests not cultures) to test for infection, which they said were negative, but the doctors suspected cancer and sent her to a urologist, who did a cystoscopy and diagnosed glandular cystitis, not cancer. We have the picture from that procedure and you can see a mass of cysts which looks like fish scales. There is no sign of a stone or anything. The urologist said she has a urinary tract infection but it's a special kind of infection that won't show up in the simple urine tests, that it was so complex that it had turned into cysts, and that it could no longer be treated with antibiotics (although they sent her home with injectable ampicillin, oral ampicillin, and cefalexin--all of which they said she should take but would not cure the infection.) They also prescribed tolterodine. They said that what she really needs to treat the problem is a surgery to remove the glandular cystitis material, which will cure the infection. She believed what they said and didn't take the antibiotics because she thought they were of no use, and now she has lower back pain and probably has a kidney infection. After researching these conditions, it seems that if the frequent urination and now lower back pain are signs of infection, that the antibiotic treatment should suffice and that surgery is unneccessary. We suspect that the doctors may be recommending an unneccesary procedure just to make money, which sometimes happens here. So my question is: Is surgery neccessary to remove the cystitis? Or will treating the infection, say with cephalexin alone, be a better course of action? Or should she take both kinds of antibiotics? Is surgery a good idea to get rid of the cystitis so it can't turn into cancer in the future? Or is it a good idea to undergo surgery just so the doctors can make absolutely certain that the cysts aren't malignant? As much information as you can provide would be greatly appreciated, since my mother in-law doesn't have the resources to acquire a visa to seek medical care outside of mainland China, and as for a second opinion within China, there are no more hospitals in the province who have other urologists. The medical system here is such that people don't even have primary care physicians, they just go to the hospital for treatment. We have nowhere else to turn for medical advice. If you need any other information, we can probably provide it. Thank you so much in advance.

[Kevin Pho, MD]

It is difficult to say without examination.  Also difficult to make specific recommendations, since I am not familiar with the Chinese medical system.

Most cases of cystitis will improve with antibiotics, especially if it shows up during the urine tests.

An exception will be interstitial cystitis.  This is normally diagnosed via a potassium sensitivity tests, and can cause some of the symptoms that you are describing.  Treatment can be considered with a medication known as Elmiron.  

I am not aware of surgery being an option to treat interstitial or glandular cystitis - however, I am not a urologist, so my knowledge in this area is limited.

The cystoscopy is a pretty comprehensive test to ensure that there is no evidence of cancer in the lower GU tract, including the bladder.

Another urological opinion is recommended if surgery is being considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[jaceyliu]

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