Cystitis Cystica et Glandularis: A Dual Case Report and Review of Contemporary Management.

Cystitis cystica et glandularis (CCG) is a benign bladder condition driven by chronic mucosal irritation. Although often incidental, extensive disease can cause distal ureteric obstruction and produce radiological and cystoscopic appearances that closely mimic bladder malignancy, creating significant diagnostic and management challenges.  We report two men with histologically confirmed CCG whose clinical courses differed markedly. The first presented with bilateral hydronephrosis and bladder distortion, initially suspicious for urothelial carcinoma. Despite repeated resections, stenting and nephrostomy drainage, obstruction persisted and bilateral ureteric reimplantation was ultimately required to preserve renal function. The second presented with recurrent urinary infections and voiding dysfunction refractory to antibiotics. Despite bilateral hydronephrosis, mercaptoacetyltriglycine (MAG3) renography excluded true obstruction. His symptoms reflected a non-prostatic outflow problem, and conservative management was pursued; however, with ongoing symptoms, cystectomy remains under consideration. These cases highlight that clinical outcomes are determined primarily by the level and functional significance of obstruction, rather than histological subtype alone, and that early multidisciplinary assessment and individualised management are key to minimising morbidity.