Follicular cystitis

Follicular cystitis: Description, Causes and Risk FactorsChronic cystitis characterized by small mucosal nodules due to lymphocytic infiltration.Follicular cystitis is the mucosa of the bladder is studded with nodules of various sizes, containing lymph follicles with germinal centers.Follicular cystitis is typically seen in the background of chronic cystitis. The underlying etiology can be infectious in nature, such as Salmonella (Rod-shaped Gram-negative enterobacteria; cause typhoid fever and food poisoning; can be used as a bioweapon) infection in the urinary tract, but follicular cystitis can also be seen during intravesical chemotherapy, Bacille Calmette-Guerin (BCG) - therapy, or following irradiation to the pubic area.Follicular cystitis MedigooThe disease is common in chronic urinary tract infection. Small brownish nodules observed by cystoscopy, are often surrounded by inflammatory mucosa, but sometimes can be seen in the normal mucosa between nodules. Diseases are common in the trigone of the bladder or the bottom of bladder.In long-standing cases, the mucous membrane becomes very much thickened, affecting its capacity for retaining urine. The surface is not red and velvety, but assumes a purplish or slate color. Its surface is covered with a muco-pus, with here and there an ulcerated patch. There is enlargement of the follicles, and there may be so much obstruction of the ureteral orifices as to cause dilatation of the ureter and pelvis of the kidney, followed by hydronephrosis.Symptoms:Clinically, signs and symptoms are not particularly reliable. Patients may be asymptomatic, or may experience dysuria, frequency, urgency and suprapubic pain.Urine may be grossly cloudy.Diagnosis:Cytologically it differs from chronic cystitis with prominent lymphocytosis by the presence of cellular elements from the germinal centers of lymphoid follicles, reminiscent of the cytologic findings in follicular cervicitis, with possible additional epithelial cytologic atypias from the overlying urothelium, which frequently undergoes reactive changes (hyperplastic, metaplastic, and ulcerative). The practical aspect of recognition of this entity in cytologic specimens is avoiding diagnostic errors of possible malignancy (lymphoid or other), and also of other forms of inflammatory disease, such as granulomatous type, with a different clinical significance.

Follicular Cystitis Treatment:

The treatment is to control the infection, and is symptomatic treatment. There is no single treatment option for follicular cystitis. An effective course of treatment for one patient may not work for another. Antibiotics are prescribed if infection accompanies inflammation of the bladder. Drugs used to treat follicular cystitis are some of the same ones used to treat chronic cystitis. These may include bladder coatings, antidepressants and antihistamines. Antispasmodics and bladder anaesthetics may also be used.Surgical options, such as bladder augmentation or cystectomy, are sometimes considered, but only as a last resort after all other options have been exhausted.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


  1. Dr.Kisor Kumar Pal

    Very useful article,which helped me a lot in reporting histopathology slide.

    • Mary Espinoza

      I had bladder cancer removed in ’15 with 2 series of BCG and have had several bladder infections since the surgery (NONE before 0, zip, zilch, nada) Then in late ’17 Sr DR Garzona, following my reports of pink urine on the toilet paper and then small pieces of blood on the paper, ordered an ultrasound and I saw what I described as popcorn all across the base of the bladder. Pathology came back as “Chronic follicular cystitus” Should I expect to have this cystitus scraped of every couple of years?

      • maisteri

        You have to be examined regularly via cystoscopy at least once a year (recommended every 3-6 months after the bladder cancer treatment). The necessity to perform biopsy will be defined by your doctor. However, it is not related to follicular cystitis rather to the bladder cancer.

  2. Lucy Honeychurch

    I was diagnosed with follicular cystitis in June 2016. Was put on a low does of macrodantin for four months. I also have been taking Cystoprotek. I feel about 95% back to normal again.

    • Sorina Neaverth

      What antibiotic were you put on? I have been suffering with IC since I was 17, but since my forties things have gotten very bad. I am 46 now. I cannot sleep anymore due to frequent urination and the constant urge to pee. The bladder pain is terrible. I wonder if I may have FC instead or in addition to. live in Florida? If so, whom is your doctor?

  3. Gill Linch

    I have just received my cystoscopy report which shows normal ureteric orifices, but cysts and follicles in the trigone area. It is suggested bladder biopsy and ct urogram be performed. It also says patient on cancer pathway, even though the Dr who performed the procedure was 99% sure all was ok. Now I’m scared. He even gave me the choice to have biopsies or not!

    • maisteri

      Follicular cystitis is a bening condition associated with the chronic bladder infection. It is recommended to perform biopsy to make sure that there are no signs of cellular dysplasia, as this disease may precede the development of cancer. However, the presence of follicular cystitis does not mean that you will obligatory experience malignancy.
      You should visit doctor regularly and perform all the necessary tests to track this condition.

  4. D

    Please send me info reg. Focally active chronic follicular type of mild to moderate intensity, I also have a BOSNIAK f CYST right kidney

    • maisteri

      Chronic infection leads to the development of mucosal nodules and lymphoid follicles in some areas of the bladder. Mild to moderate intensity means that the inflammation is quite intense, although not severe which will also influence the symptoms of the disorder.


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