Diagnostic Dilemma in Primary Localized Bladder Amyloidosis (PLBA): an Experience from a Tertiary Care Centre

The objective of this study was to describe the clinical spectrum of primary localized bladder amyloidosis (PLBA), its management options, outcomes, and follow-up. We retrospectively reviewed our medical records for patients with PLBA between April 2013 and April 2021. Patient's demographics, imaging, cystoscopic characteristics, treatment, and outcomes were recorded and analyzed. Serum and urine electrophoresis, abdominal fat aspiration, and rectal biopsy results where available were also recorded. We identified 20 patients with PLBA with a median age of 56 years. Hematuria (80%) was the most common symptom followed by irritative lower urinary tract symptoms (iLUTS) (50%). The bladder lesions were focal, multiple, and diffuse in 4 (20%), 14 (70%), and 2 (10%) patients, respectively. All patients had transurethral resection of the bladder tumor, except for 4 patients with exclusive iLUTS who had cold cup biopsy. At a median follow-up of 43.9 months, 4 patients (20%) developed recurrence with median time to recurrence being 19 months. All the recurrences were managed endoscopically by re-resection and none of the patients required radical surgery. PLBA is a rare entity with varied clinical presentations. Although histologically benign, recurrences can occur and require long-term cystoscopic surveillance.