CCEG is a benign inflammation of the bladder, characterized by von Brunn's nests that grow into the lamina propria forming cysts and/or metaplastically changing into goblet cells.[sup.1] Although a common incidental finding in many bladder investigations, CCEG is usually asymptomatic.[sup.4] There have been previous documented cases of CCEG causing obstruction, reminding us of a rare but potentially important cause for obstruction.[sup.3]-[sup.5] We believe this is the first reported case of recurrent CCEG causing obstruction of the UVJ leading to hydronephrosis and acute azotemia.
The etiology to CCEG is unknown, but it is postulated to be related to chronic irritation and inflammation to the bladder mucosa.[sup.3,6] Many factors have been associated with CCEG, for example, recurrent urinary tract infections, chronic bladder outlet obstruction, neurogenic bladder and recurrent bladder tumours.[sup.2,7] CCEG is a benign metaplastic lesion of the bladder that needs to be definitively diagnosed pathologically.
The treatment of CCEG is usually achieved by treating the underlying cause, however, surgical treatment may be indicated in symptomatic patients, such as in our case.[sup.3] In recurrent cases, one should treat with a high index of suspicion and continue to monitor the area with surveillance cystoscopy and routine urinary cytology.
Normally benign and asymptomatic, CCEG was found to be obstructing the left ureteric orifice, leading to progressive hydronephrosis of the left kidney with ensuing acute azotemia.