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Education And Debate

Lesson of the Week: Cystitis and ureteric obstruction in patients taking tiaprofenic acid

BMJ 1994; 309 doi: (Published 03 September 1994) Cite this as: BMJ 1994;309:599
  1. F G Mayall,
  2. R W Blewitt,
  3. W G Staff
  1. Department of Histopathology, Withington Hospital, Manchester M20 8LE Royal Lancaster Infirmary, Lancaster
  1. Correspondence to: Dr Mayall.
  • Accepted 15 June 1994

Three cases of cystitis associated with tiaprofenic acid, a non-steroidal anti-inflammatory drug, have been reported.1 These patients recovered once the drug had been stopped, and none came to any permanent harm. We have encountered eight additional cases. Several of these patients had severe disease, which in one case was life threatening.

Case reports Case 1

A 69 year old woman presented with intolerably painful frequency and sterile haematuria. She had a long history of arthritis and had taken tiaprofenic acid for about two years. Intravenous urography showed normal upper tracts but she had a small contracted bladder with reddened friable mucosa on cystoscopy. Two months later she developed renal failure (blood urea 39 mmol/l, creatinine 236 μmol/l). An ultrasound examination showed bilateral ureteric obstruction and severe hydronephrosis. At surgery both ureters were thickened over their entire length and she had a cystectomy and ureteric diversion into an ileal conduit. The resected bladder was contracted and had a thickened wall. Much of the epithelial surface was ulcerated and replaced by granulation tissue.

Histological examination showed a dense chronic inflammatory infiltrate in the lamina propria with prominent eosinophils. This extended into the epithelium with associated spongiosis and into the muscle of the bladder wall with associated fibrosis. Similar changes were seen in the ureteric off cuts, causing marked luminal stenosis (figure).

Left: off cut of ureter from case 1 showing chronic inflammation reducing the lumen (arrowed) to a slit (haematoxylin and eosin stain). Right: bladder mucosa from case 1 showing chronic inflammation, epithelial spongiosis, and (arrowed) intraepithelial eosinophils recognised by their bilobar nuclei (haematoxylin and eosin stain).

After the operation she stopped taking tiaprofenic acid and her renal function rapidly returned to normal. Several months later she developed haematuria and her renal function deteriorated. …

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