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EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2019) 31 (5) 250-254 doi: 10.1111/eve.12807
Case Report Polypoid cystitis as a cause of haematuria in a pony mare
C. M. Rosales* , N. J. Bamford , S. L. Sullivan, J. R. Bauquier and B. S. Tennent-Brown U-Vet Equine Centre, The University of Melbourne, Werribee, Victoria, Australia. *Corresponding author email:
cristina.rosales8@
gmail.com
Keywords: horse; bladder; urinalysis; cystoscopy
Summary A 15-year-old pony mare was presented for investigation of haematuria of 2 weeks’ duration. On cystoscopy, multiple small pedunculated soft tissue structures were observed on the bladder mucosa. Histopathological analysis of the masses was consistent with chronic polypoid cystitis. The polypoid lesions and associated haematuria resolved following prolonged antibiotic treatment. Polypoid cystitis has not previously been described in horses. This condition should be considered a differential for haematuria, requiring cystoscopy and biopsy to confirm a diagnosis.
Introduction
Haematuria can arise from haemorrhage anywhere along the urinary tract. Commonly recognised causes of haematuria in horses include urethral defects (Schumacher et al. 1995), uroliths (Lund et al. 2013), various forms of neoplasia (Fischer et al. 1985; Voeroes et al. 1993; Hurcombe et al. 2008) and urinary tract infections (pyelonephritis and cystitis) (Kisthardt et al. 1999; Saulez et al. 2005). Less commonly, haematuria has been associated with exercise (Schott et al. 1995), idiopathic renal haemorrhage (Schott 2009; Gracia-Calvo et al. 2014), certain toxicoses including Blister beetle (cantharidin) ingestion (Schoeb and Panciera 1978; Schmitz 1989), gentamicin toxic nephropathy (Riviere et al. 1982) and long-term or excessive nonsteroidal anti- inflammatory drug administration (Aleman et al. 2011). The term ‘polypoid cystitis’ is used to describe a condition
of the urinary bladder featuring reversible, outward-growing (polyp-like) inflammatory lesions (Kilic
et al. 2002). The
condition is a rare cause of gross haematuria in human patients that is often mistaken as an indicator of neoplastic bladder disease (Lane and Epstein 2008). Histologically, polypoid cystitis is characterised by urothelial hyperplasia with microabscess formation within the urothelium (Ekelund et al. 1983). Oedema of the submucosa, infiltration with lymphocytes and granulocytes, increased vascularity and evidence of haemorrhage are also described. In man, polypoid cystitis commonly occurs as a result of bladder mucosal injury secondary to urolithiasis (Martinez et al. 2003) or urethral catheterisation (Ekelund et al. 1983), but in some cases an underlying aetiology is not identified (Kilic
et al.
2002). For human patients, the reasons for presentation are usually related to bladder obstruction or haematuria (Kilic
et al. 2002; Lane and Epstein 2008). Polypoid cystitis has been documented in dogs, for which the most common reason for presentation is gross haematuria, with abnormal urination behaviour also common (Moses et al. 2002; Martinez et al. 2003; Eo Jin et al. 2009). The condition has also been reported in domestic cattle associated with bracken fern
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toxicosis (Carvalho et al. 2006). Polypoid cystitis has not been documented in horses and this report describes haematuria related to the condition in an otherwise healthy pony.
Case details
Case history A 15-year-old Australian Riding Pony mare presented to the University of Melbourne’s Veterinary Teaching Hospital (VTH) with a history of discoloured (red-tinged) urine present throughout urination. The discoloured urine was first noticed by the owners 2 weeks previously and was not associated with exercise. The owners reported neither signs of abdominal discomfort nor signs of dysuria, stranguria or pollakiuria. The mare did not have access to known noxious plants, including bracken fern. On initial evaluation by the referring veterinarian, the pony appeared to be in good health with a normal heart rate, respiratory rate and rectal temperature. Following sedation with detomidine (Dormosedan1;0.01 mg/kg bwt i.v.), a speculum examination of the vagina and cervix was performed and was considered normal. A urine sample collected at the same visit had a specific gravity of 1.015, with dipstick evaluation revealing a pH of 8.0 and moderate proteinuria. On sediment examination, >200 erythrocytes/high powered field were observed although the white cell count of the sample was normal (<5/high powered field) and there was no evidence of casts or crystals. Culture of the urine sample was not performed based on the absence of pyuria. Haematology and plasma biochemistry profiles collected at
the time of this initial evaluation were normal. Based on these findings, the pony was referred to the VTH for further evaluation.
Clinical findings On presentation to the VTH, the mare was bright and alert and in good condition (BCS 6 out of 9) (Henneke et al. 1983). Resting heart (44 beats/min) and respiratory (14 breaths/min) rates were normal with no abnormalities appreciated on thoracic auscultation. Rectal temperature was 37.7°C. Oral mucous membranes were pink with a capillary refill time of <2 s. No evidence of mucosal haemorrhage suggestive of primary haemostatic dysfunction was present. Hydration, based on skin turgor, jugular refill and mucous membrane character, was considered adequate. The pony showed no signs of abdominal discomfort or evidence of urinary incontinence or stranguria during evaluation at the VTH. The mare was sedated with detomidine (Dormosedan1;
0.01 mg/kg bwt i.v.) and butorphanol (Torbugesic1; 0.01 mg/ kg bwt i.v.). Vaginoscopy was unremarkable and the external os of the cervix was closed with no discharge evident. Cystoscopy revealed grossly red-tinged urine that was
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