Leukoplakia of the urinary bladder: BMJ case report
A 22-year-old man presented with gross haematuria for 7 days. He had a history of voiding lower urinary tract symptoms since undergoing surgery for spinal injury he sustained 2 years previously. On cystoscopy, he had cystitic changes in the entire urinary bladder along with bladder clots that were subsequently evacuated (figure 1).

He also had whitish plaques near both the ureteric orifices (figure 2). The mucosa underneath the plaques was inflamed and bled on manipulation. The efflux from both ureteric orifices was normal. Random bladder biopsies were taken. His urine culture was positive for Escherichia coli, and he was given culture-guided antibiotics.

A contrast enhanced computed tomography (CECT) scan was done which showed thickened bladder walls with normal upper urinary tracts. Histopathological examination revealed keratinising squamous metaplasia of the urinary bladder (figure 3).

On further evaluation, he was diagnosed with neurogenic bladder and was advised clean intermittent self-catheterisation along with annual cystoscopic monitoring to look for any malignant changes.

Learning points
• Keratinising squamous metaplasia of the urinary bladder is a rare condition that occurs due to chronic irritation of urinary bladder usually by bacteria, and predisposing conditions include neurogenic bladder, chronic catheterisation, vitamin A deficiency, urinary fistulas and bladder outlet obstruction.

• Based on available literature, the current recommendation is for close cystoscopic monitoring annually to look for any subsequent malignant changes.

Read more here: http://casereports.bmj.com/content/2018/bcr-2018-227019.full