Hemangioma, Bladder vs. Hemorrhagic Granular Cystitis
Left picture: It is not a bleeding of the mucous membrane caused by the cystoscope, but a circumscript hemangioma as the cause of the recurrent hematuria. The mucous membrane of the surroundings is inconspicuous except for a blue discoloration in the segment at the left following intravenous application of indigo carmine, which is escaping from the left ureteral orifice. Right picture: The diagnosis is a variant of granular cystitis, which is called hemorrhagic granular cystitis. The ubiquitous redness occurring mainly in the trigonum may be due to an increase of the capillary network, bleedings into the vesicles, or a general bleeding tendency of the mucous membrane; the latter occurs in chronic cystitis already in minor diagnostic manipulations; compare with the operative findings of the mucous membrane of the bladder in the figure at the bottom.
Left picture: Endoscopic findings in a schoolboy with hematuria and inconspicuous additional examinations. At the left lateral bladder wall a longish and clear-red focus is visible which contains localized, somewhat prominent and darker zones. Right picture: Endoscopic findings in a schoolgirl with recurrent microscopical and gross hematuria, recurrent urinary tract infections, and other symptoms such as pollakiuria, stress incontinence and dysuria. On the bladder ground of the right and left side there is extensive redness. The semispherical vesicles in the forefront are covered by a fine network of vessels.