Bladder Histological Changes Associated With Chronic Indwelling Urinary Catheter

Delnay, Kathleen M.; Stonehill, William H.; Goldman, Howard B.; Jukkola, Alina F.; Dmochowski, Roger R.

doi:10.1097/00005392-199904000-00013

Cited by 42 publications

(53 citation statements)

References 19 publications

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“…25 Finally, as suggested by our data and most relevant to cancer formation, proliferative changes in bladder epithelium may become independent of ongoing infection after long periods of chronic S. haematobium-induced inflammation. [28][29][30] Similar metaplastic changes have been identified in American and European paraplegics in those with long-term catheter-induced bladder infection and irritation, 30,31 and these changes become significantly more common with longer duration (Ն 10 years) of catheterization.…”

Section: Discussionmentioning

confidence: 85%

Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection.

Hodder¹,

Mahmoud²,

Sorenson³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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Abstract. Although there is strong epidemiologic evidence linking Schistosoma haematobium infection with carcinoma of the bladder, the utility of cytologic screening for urinary tract cancer has not been critically evaluated in S. haematobium-endemic populations. The present cross-sectional study examined urine cytology findings among 1,014 residents (ages 1 to 91) of the S. haematobium-endemic Msambweni area of Coast Province, Kenya. Among 705 evaluable cytology specimens, prevalence of inflammation (39%), hyperkeratosis (30%), metaplasia (33%), and frank atypia (0.4%) was notably higher than in previously studied, non-endemic populations. Overall, S. haematobium infection was strongly associated with increased risk for cytologic abnormality (Ͼ 2.8-fold relative risk of metaplasia or hyperkeratosis; P Ͻ 0.001). Age-group analysis confirmed parallel increases in metaplasia and S. haematobium infection prevalence early in life (from age 1 to 15 for both boys and girls). However, above age 20, metaplasia prevalence persisted at 33-45% prevalence despite a decline in infection prevalence and intensity. Prevalence of advanced (moderate or severe) metaplasia showed two age-related peaks: the first at 10-14 years of age (at the time of peak infection), and the second among subjects Ն 60 years old. No cancers were detected in the study population either on cytology or on follow-up ultrasound examination. These data suggest an age-dependent progression of cellular abnormalities in the urinary epithelium that is associated with chronic S. haematobium infection, which becomes independent of concurrent infection intensity as subjects grow older. Implications for cancer screening are discussed.

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Section: Discussionmentioning

confidence: 85%

Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection.

Hodder¹,

Mahmoud²,

Sorenson³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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“…7 Squamous metaplasia is commonly associated (17-25%) with squamous cell carcinoma of the bladder. 8 The epithelial changes (metaplasia) are thought to be the aetiological factor for the high incidence of bladder cancer (mainly squamous cell carcinoma or transitional cell carcinoma with squamous cell elements) in SCI patients. Yalla 9 encountered SCI patients with squamous metaplasia suddenly progressing to invasive squamous cell carcinoma and therefore recommended active surveillance with cytology, cystoscopy and urothelial biopsies even after eliminating potential risk factors, such as indwelling catheters, bladder stones and chronic sepsis.…”

Section: Discussionmentioning

confidence: 99%

Detection of early squamous metaplasia in bladder biopsies of spinal cord injury patients by immunostaining for cytokeratin 14

et al. 2003

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Study design: A prospective, immunohistochemical study of bladder biopsies taken from spinal cord injury (SCI) patients. Objectives: To investigate whether cytokeratin 14 immunostaining may be useful to detect early squamous metaplasia in bladder biopsies from patients with SCI. Setting: Southport, United Kingdom. Methods: Biopsy of bladder mucosa was taken from adults with SCI, while they underwent an elective therapeutic procedure in the urinary tract. A total of, 54 biopsies, which showed transitional epithelium only with no evidence of squamous metaplasia on routine H&E staining, formed the study group. In all, 22 biopsies, which showed squamous metaplasia on routine H&E staining, acted as controls. All biopsies were benign with no evidence of dysplasia or malignancy. Immunohistochemical staining for cytokeratin 14 was performed on all biopsies in a single batch, using a standard avidin-biotin complex method. Results: All control biopsies showed positive immunostaining for cytokeratin 14 in basal and parabasal cells in areas of squamous metaplasia. Of the 54 biopsies, which showed only transitional epithelium on H&E staining, immunohistochemistry for cytokeratin 14 showed no staining in 47 biopsies. The remaining seven biopsies showed positive immunostaining for cytokeratin 14 in the epithelium, in individual cells or clusters of basal cells, revealing unexpected early squamous metaplasia in these biopsies. Conclusion: Immunostaining for cytokeratin 14 identifies an early phenotypic switch from transitional to squamous epithelium in bladder mucosa. Cytokeratin 14 staining is sufficiently sensitive to identify early squamous metaplasia, which is not yet evident on examination of routine H&E stained sections. This early identification may be of use in alerting physicians to change bladder management regimens to prevent predisposition to recurrent urinary infection and progression of squamous metaplasia. A cost/benefit analysis should be performed to assess the feasibility of routine cytokeratin 14 immunostaining of bladder biopsies from SCI patients.

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“…10 CG may be associated with chronic irritation of the bladder, following catheterization, stones, or inflammation. 2 Widespread CG is seen in bladder extrophy, 2 neurogenic bladder, 11 and in association with pelvic lipomatosis. 5 Among other reasons, avitaminosis, allergy, hormonal imbalance, carcinogenic drugs and IgA-mediated immune mechanisms can be enumerated.…”

Section: Discussionmentioning

confidence: 99%

The role of steroid treatment in intractable cystitis glandularis: A case report and literature review

Yüksel

Ürkmez

Erdoğru

et al. 2015

CUAJ

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Cystitis glandularis is a proliferative disease of the urinary bladder epithelium. It is rare in children. We report a case of a 23-yearold female with intractable macroscopic hematuria and severe irritative bladder symptoms persisting for 13 years. The patient, who had undergone open and endoscopic bladder surgery at various medical centres, is currently being followed up at our clinic. Cystoscopy revealed multiple edematous papillary tumours on the bladder neck, trigone, and lateral wall on both sides and she underwent transurethral resection of the bladder tumour. The pathological diagnosis was cystitis glandularis in accordance with the histopathological reports obtained from the other medical centres. Her condition was resistant to transurethral resection, partial cystectomy, intravesical mitomycin, and bacillus Calmette-Guerin (BCG) treatment; it eventually could have affected the upper urinary tract. Oral steroid treatment was given for 6 months; after treatment, her symptoms improved and the cystoscopy revealed a dramatic improvement in her condition.

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Bladder Histological Changes Associated With Chronic Indwelling Urinary Catheter

Cited by 42 publications

References 19 publications

Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection.

Predisposition to urinary tract epithelial metaplasia in Schistosoma haematobium infection.

Detection of early squamous metaplasia in bladder biopsies of spinal cord injury patients by immunostaining for cytokeratin 14

The role of steroid treatment in intractable cystitis glandularis: A case report and literature review

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