The role of vaginal ectopia of the external urethral orifice in the development of morphologic changes bladder of the mucosa in women

Abstract

Objective. To evaluate morphological changes in the bladder mucosa against the background of vaginal ectopia of the external urethral orifice and/or urethral hypermobility in women, efficacy and safety of transposition of the external urethral orifice as a method of surgical treatment of postcoital cystitis.Materials and methods. The study group included 29 patients undergoing surgical treatment for chronic recurrent postcoital cystitis in the form of transposition of the external orifice of the urethra according to B.K. Komiakov. Before surgical treatment, all studied patients underwent cystoscopy with bladder biopsy. The obtained biopsy specimens were fixed in buffered formalin, further processed in increasing concentrations of alcohols, and embedded in paraffin blocks according to the standard technique. Sections were obtained from the blocks and mounted on histologic slides and stained with hematoxylin and eosin. The follow-up time was 12 months after surgical treatment.Results. Histologic confirmation of squamous cell metaplasia was revealed in 2/29 (6.8%) patients in the bladder fundus projection and in 23/29 (79.3%) in the Lieto triangle projection, lymphoid infiltration was determined in 14/29 (48.2%) patients in the fundus projection and in 21/29 (72.4%) in the Lieto triangle projection. The combined squamous cell metaplasia and lymphoid infiltration was detected in 16/29 (55,2%) patients in the Lieto triangle projection and in 1 (3,4%) patient in the bladder fundus projection. At follow-up examination, 28 patients had no recurrence of postcoital cystitis. Inflammatory changes of the bladder mucosa underwent regression in 20 patients in control cystoscopy. Morphologically, lymphoid infiltration was detected in 1/29 (3.4%) patients, and squamous cell metaplasia was determined in 5/29 (17.2%) patients.Conclusion. As a result of long-term inflammatory process in the bladder in the course of frequent recurrences of postcoital cystitis, the bladder wall undergoes morphologic changes that require mandatory morphologic verification. By surgical release of pathogenetic factor - vaginal ectopia of the external urethral orifice and/or urethral hypermobility, it is possible to achieve regression of morphologic changes in the bladder mucosa.