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

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Abstract
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.

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