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bladder and predisposing factors (e.g. urolithiasis or neurological bladder dysfunction) for cystitis were not identified in this case. Further, no signs of abnormal urination or systemic illness were reported to suggest a pre-existing cystitis that could have led to formation of the polypoid lesions. The clinical improvement following antibiotic treatment provides circumstantial evidence of bacterial involvement; urinary culture might have helped to delineate that relationship but, unfortunately, was not performed in this case. Interestingly, numerous bacterial species have been cultured from dogs with polypoid cystitis perhaps suggesting that opportunistic bacteria are harboured within the polypoid tissue rather than causing the lesions (Martinez et al. 2003). In addition to urine culture, culture of biopsy samples is recommended as urine culture is often negative even when bacteria are present (Kilic
et al. 2002; Martinez et al. 2003). Where relevant, the removal of potential irritants is
advocated for the resolution of polypoid cystitis. Removal of permanent indwelling urinary catheters resulted in disappearance of the polypoid lesions in one human case series (Ekelund et al. 1983). If this fails, surgical excision or partial cystectomy is recommended and is considered the more effective treatment strategy for polypoid cystitis in man and dogs (Kilic
such as amoxicillin, enrofloxacin and potentiated sulfonamides have been used with initial resolution of clinical signs in dogs, but cessation of treatment was generally followed by recurrence of haematuria (Martinez et al. 2003). The decision to use a potentiated sulfonamide in this case was based on the availability of an oral formulation to facilitate long-term administration by the horse’s owners, its broad spectrum of activity and the ability to reach high concentrations in the urinary tract (Van Duijkeren et al. 1994). As with many clinical cases, financial constraints limited
et al. 2002; Martinez et al. 2003). Antibiotics
some aspects of the investigation of this case. As mentioned, culture of urine and biopsy samples might have helped determine the role of bacteria in this condition and allowed more targeted antimicrobial therapy. The high erythrocyte count and leucocytes present in the ureteral samples was considered most likely to be due to trauma during sample collection or secondary to vesicoureteral reflux rather than of renal origin, but this could not be confirmed with concurrent or follow-up analysis from ureteral and bladder urinary samples. Additionally, inconsistency in the way that erythrocyte counts were reported prevented useful comparison between urine samples collected from different sites (ureter vs. bladder) and at different time-points. This last point highlights the importance of consistent testing methodology, particularly in chronic cases. A final cystoscopy to confirm complete resolution of the polypoid formation would have been ideal, but was not performed. The aetiology of polypoid cystitis in man and domestic
animals appears complex and remains poorly understood. Whilst the condition is commonly associated with irritation or trauma to the bladder mucosa, this is not always the case. Further, the role of bacteria in polypoid cystitis remains to be elucidated. Surgical removal is currently advocated for treatment of polypoid cystitis in dogs and man because, although initially responsive, the condition tends to recur with even very prolonged courses of antibiotics. However, in the equine case described here, remission or resolution of the condition appeared to be associated with the prolonged administration of broad-spectrum antibiotics, suggesting that
Authorship All authors contributed to clinical case management. The manuscript was drafted by C. Rosales and revised by the other authors. All authors approved the final version of the manuscript.
Manufacturers' addresses
1Zoetis, Sydney, New South Wales, Australia. 2International Animal Health Products, Huntingwood, New South Wales, Australia.
References
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Lane, Z. and Epstein, J. (2008) Polypoid/papillary cystitis: a series of 41 cases misdiagnosed as papillary urothelial neoplasia. Am. J. Surg. Pathol. 32, 758-764.
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© 2017 EVJ Ltd
some cases of polypoid cystitis might not require surgical intervention.
Authors’ declaration of interests No conflicts of interest have been declared.
Ethical animal research
Institutional animal ethics approval was not required for this case report.
Source of funding None.
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