Augmentation ileocystoplasty in a case of eosinophilic cystitis

Eosinophilic cystitis (EC) is a rare form of bladder inflammation characterized by massive eosinophilic infiltration of the bladder wall. The most frequent signs and symptoms are pollakiuria, urgency, macroscopic haematuria and hypogastric pain: the involvement of the ureters may cause hydronephrosis and renal failure. Eosinophilia and eosinophiluria are present in 35% and in 50% of the cases respectively. EC may evolve towards sclerosis up to the anatomoclinical picture of small retracted bladder, which requires to be differentiated from tubercular cystitis, interstitial cystitis and cancer. Imaging techniques are not definitely diagnostic. Diagnosis can be reached only by biopsy with the microscopic demonstration of eosinofilic infiltration of the whole bladder wall in the early and acute stages, while fibrosis with poor cellularity predominates in the chronic stages. Etiology is unknown and the hypothesis of an allergic origin is unproved even though remissions or recoveries induced by steroidal therapy have been reported. Surgical therapy of EC, as in our observation, is absolutely required to correct urgency and incontinence and to prevent renal failure when the urinary upper tract has been primarily or secondarily involved.