Pelvic lipomatosis (PL) is proliferative disease characteristic
with overgrowth of normal fat in the perivesical or perirectal
space. Since it was initially described by Fogg and Smyth in
1968, not more than 150 cases in the English literatures and
about 70 cases in native journals had been reported. Despite its
low incidence and benign features, more than 50% of patients are
symptomatic because of mass sensation, compressive neuropathy
or associated chronic cystitis. Some patients will progressively
develop obstructive hydronephrosis due to compression of
excessive fat tissue, and 40% of the patients at a mean of 5 years
after diagnosis of obstruction will progress into renal failure. It is
reported that more than 75% of patients with PL as well suffered
the diseases of cystitis glandularis, cystitis cystica, or cystitis
follicularis. Moreover, it has been learned that proliferative
diseases, especially adenomatous proliferation, are regarded as a
potential precancerosis of adenocarcinoma.
We had some special urodynamic findings in the PL patients
several years before. A total of 29 patients were diagnosed of
pelvic lipomatosis by MRI and/or CT together with Barium
radiography and IVU. Cystitis glandularis was found in 21
patients by biopsy. We divided all the patients into two groups,
pelvic lipomatosis with cystitis glandularis and pure pelvic
lipomatosis (without cystitis glandularis), 21 and 8, respectively.
Twenty-six patients had BOO in the urodynamic study. We
found distinct interesting pressure and flow curve in 13 patients.
It showed that in the first half urination the detrusor pressure was
not high with high urinary flow, but in the latter half urination
the detrusor pressure became very high with very low urinary
flow. We called "Latter Half Section Obstruction"(LHSO) to
this kind of relationship between pressure and flow. There was 1
patient had LHSO in the group of pure pelvic lipomatosis, but
12 patients in the other group, (P=0.044).
In order to understand the relationship between the pelvic
lipomatosis and glandular cystitis, we chose the cases who were ultimately diagnosed as cases of pelvic lipomatosis, then
we retrospectively compared their clinical data with the other
glandular cystitis patients, From 1990 to 2010, a total of 143
male patients were pathologically confirmed as " glandular
cystitis " in the Department of Urology, Peking University First
Hospital, among which 56 patients were finally diagnosed as
pelvic lipomatosis. we compared their clinical data with the
remaining 87 patients to improve the diagnosis and treatment
level of pelvic lipomatosis in the male "glandular cystitis'
patients. The incidence of "hypertension" and "high body
mass index"(BMI>25) in both groups showed no significant
difference; but patients with pelvic lipomatosis had an increased
proportion of "dysuria" and "back pain" in symptoms (P =
0.022); Also the pelvic lipomatosis group had more cases with
"hydronephrosis or hydroureter" and "bladder wall thickening"
by ultrasound than the control group (P <0.001);in cystoscopy,
the pelvic lipomatosis group were found to have a significantly
higher proportion in "extension of the posterior urethra"
and "bladder posterior lip elevation" (P <0.001); after the
transurethral resection of bladder tumor treatment ,the pelvic
lipomatosis group yields a higher alleviation rate on "the upper
urinary tract water "and lower "glandular cystitis recurrence" rate.
We also had some new findings in the analyzing radiological
features of CT and MRI in the PL patients. Significant
difference of bladder shape was found between PL (n=32)
and normal control men (n=25) (P<0.05). The patients in
PL showed a statistically significant increase in SI/AP, rLPU
and RCI (P<0.05), as well as a remarkable decrease in AAP
and bilateral BSA (P<0.05). All patients in PL presented with
various degrees of cystipathy. 29 patients (58 ureters) showed
various degrees of obtruction in unilateral or bilateral ureters
(mild=22, moderate=23, severe=13). So we think that the shape
of bladder is characteristics for diagnosis of pelvis lipomatosis.
High incidence of ureter obstruction and glandular cystitis are
demonstrated in patients of PL.