Bladder contracture associated with diffuse nephrogenic adenoma: a case report

A 52-year-old man presented with severe irritative lower urinary tract symptoms. Cystoscopy revealed extensive scattered papillary tumor-like lesions, mainly involving the lateral and posterior bladder walls. Computed tomography urography (CTU) showed bladder-wall thickening and reduced bladder capacity. Endoscopic biopsy and transurethral resection of bladder tumor (TURBT) were performed on two occasions; both histopathological examinations demonstrated suppurative inflammation, marked acute and chronic inflammatory cell infiltration, granulation-tissue proliferation, and focal lymphoid hyperplasia. Empirical antituberculous therapy was administered for suspected tuberculosis, but the irritative symptoms persisted. Repeat cystoscopy 6 months later again demonstrated extensive scattered papillary tumor-like lesions. Another TURBT was performed, and subsequent pathological consultation established the diagnosis of bladder nephrogenic adenoma. During follow-up, bladder capacity continued to decline, and retrograde cystography demonstrated left vesicoureteral reflux after instillation of only 30 mL of contrast medium. Because bladder contracture severely impaired quality of life, radical cystectomy with orthotopic ileal neobladder substitution was ultimately performed. At 3 months postoperatively, the voiding interval had increased to 1-2 h, nocturia had decreased to approximately three episodes per night, and the perineal radiating pain had resolved, without significant urgency or urinary incontinence.