Iranian Urology and Renal Transplantation Center

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Bladder pseudotumor; Which treatment is justified?

Nasser Simforoosh - Ali Tabibi - Mohammad Hossein Soltani
General Urology
Shahid Labbafinejad Medical CenterTeharanIran.
Bladder - Inflammatory pseudotumor - Recurrence


The patient is a young girl presented with recurrent bladder pseudotumor and nonfunctioning kidney in the ipsilateral side of tumor.

Main Description

Case presentation


The patient is a16 year old girl presented with transient abdominal pain with no other symptoms. She had no previous history of disease or surgical procedures. Family history was unremarkable. Her physical examinations were normal. 


Sonography (Mar 2008)

Thin cortex of left kidney with sever hydroureteronephrosis and hypoechoic mass in the left and posterior wall of bladder is seen.


CT SCAN (Apr 2008)


Sever left hydroureteronephrosis and suspicious mass in the left and bottom of the bladder is noted.


MRI (Apr 2008)


Sever left hydroureteronephrosis is present with paranchymal thining. Large polypoid filling defect is noted in left lateral aspect of bladder.


Urine cytology

Urine cytology was negative for malignancy.


DMSA SCAN (Apr 2008)


Nonvisualized left kidney (nonfunctioning) and proper cortical function of right kidney.


Cystoscopy (May 2008)

Stiff erythematous sessile mass with ulcerative surface was seen in the left lateral wall of the bladder. The left ureteral orifice was not found and covered by the aforementioned mass but the right ureteral orifice and the other sites of the bladder were normal. In rectal examination, the mass was palpable in the anterior part of rectal wall.



Final pathology of bladder mass revealed the inflammatory pseudotumor and IHC confirmed this pathology.


Follow-up cystoscopy and TURBT (Aug 2008)

The patient underwent transurethral resection of bladder mass located in the same position of previous tumor in left UVJ and marginal tissue. Final pathology of bladder mass revealed inflammatory pseudotumor but the marginal tissues were free of pseudotumor.


During one year period follow-up, she had no recurrence and follow-up imaging was negative for recurrence; but ultrasonography in Aug 2009 revealed new bladder mass in the left lateral wall of bladder.



Sonography (Aug 2009)
Sever hydroureteronephrosis in left side and polypoid mass with diameter 57*19 mm in the distal part of left ureter in left lateral wall of bladder is seen. There is high suspicion to bladder mass invagination to anterior wall of uterus.


CT SCAN (Aug 2009)


CT scan confirmed the recurrence of bladder mass in the same side of previous tumor.


Cystoscopy and TURBT (Aug 2009)

Follow-up cystoscopy showed a sessile mass with ulcerative surface in the origin of left ureteral orifice; so the left ureteral orifice was not found. The other site of the bladder was normal. Then she underwent transurethral resection of the mass.
Final pathology of this mass was positive for inflammatory pseudotumor and random biopsy of the other sites were negative for malignancy.


Two months later , she presented with hematuria  and painful mensturation and diagnostic imaging revealed  recurrence of tumor.


Sonography (Feb 2010)

Sever hydroureteronephrosis in left side and 54*32 mm hypoechoic mass in the left side of bladder near to the left UVJ.


CT SCAN (Mar 2010)


Sever hydronephrosis in left kidney with small abnormal mixed density in the anatomic area of distal left ureter is noted. Uterus is enlarged and mass effect in the bladder is noted.





Please add your comment about this challenging case according to repeat recurrences and unusual pathology and nonfunctional kidney in the same side of bladder tuomor.



Mohammad Hossein Soltani

This comment has been sent by Dr Darab Mehraban to uropractice by mail:

For further management you should go for a partial cystectomy and/or open resection of the mass from inside the bladder. Also, Tamoxifen oral could be of benefit.

Farzaneh Sharifi Aghdas

Dear colleagues,  I  have   had  two  nearly   similar  cases,  one  at   last  was  found  to  be  a  bladder  myoma(origin  from uterus),  she  was  a  young  married  lady, after  the   3rd  bladder tumor   resection, she  underwent  hormonal  blockade  by  decapeptyl  and  then  open  surgery  and   removal   of  myoma,  with  partial   cystectomy. The  second   case  was    lady  with  endometriosis, at  second  turt,  the  endometrium  tissue  was diagnosed,  and  she  went   under hormonal   blockade,  and  then   removing   the  mass  ,with  part  of  bladder.  Both  of  cases, are  symptom  free.  In  this  special  case,  I  think  you  should  condider  genital  tract ,  as  a possible  pathologic  factor.  I  think   a  nephroureterectomy  through   laparoscopy  , is  logic,  and  then  you  can  evaluate  pelvic  cavity,for   continuing   with  laparoscopy  ,or   open  surgery.About   hormonal  blckade before   surgery   you  can  ask  for  comment  of  a  gynecologist, and   as  it  is  not  a  harmful therapy,  you  can  even   do  it  empiric,  without  any documented  proof,  now  available  for   you(  pathology   proof).  I  wish   success  for  you