Prophylactic Radical Cystectomy for the Management of Keratinizing Squamous Metaplasia of the Bladder in a Man With Tetraplegia

Abstract

Background/Objective: To report a case of keratinizing squamous metaplasia of the bladder treated with radical cystectomy.Design: Case report and discussion of management options.Methods: Keratinizing squamous metaplasia of the bladder is a rare entity that can result from chronic irritative stimuli involving the bladder. It is considered a premalignant condition associated with invasive squamous cell carcinoma. A case report is presented describing the diagnosis and management of keratinizing squamous metaplasia of the bladder in a tetraplegic man with a chronic indwelling urinary catheter.Results: Radical cystectomy with an Indiana continent reservoir was performed after cystoscopy with biopsy confirmed keratinizing squamous metaplasia. Final pathology revealed focal erosion and diffuse keratinizing squamous metaplasia of the bladder with prostatic adenocarcinoma as an incidental finding. Conclusions:Patients with spinal cord injury who use indwelling catheters for bladder management are at higher risk of developing keratinizing squamous metaplasia. Surveillance for early detection of this entity is recommended. Prophylactic cystectomy is sometimes warranted; however, observation and frequent cystoscopic surveillance to identify potential malignant transformation can be an alternative strategy. An interdisciplinary approach is recommended before consideration of bladder resection.

Keratinizing squamous metaplasia of the bladder: Our experience and current approaches

“…However, the serious consequences on quality of life dictate the need to make patients fully aware of the associated implications. 7 When KSM is limited to an area of the bladder, annual cystoscopy with transurethral resection and histological examination is the treatment of choice 1 as in our patient. Moreover, he underwent intravesical instillation of hyaluronic acid that had already proved effective in the treatment of patients with interstitial cystitis.…”

Urological pathology causing free air under the diaphragm?

“…Prophylactic cystectomy has been suggested in selected patients with long-life expectancy and extensive bladder involvement (> 50%). 4 Our case highlights the importance of close, long-term endoscopic surveillance for keratinising squamous metaplasia with regular biopsies and emphasises the value of radiological imaging with ultrasonograhy or CT for early diagnosis of malignant transformation in a silently advancing disease. Such a pre-existent established bladder pathology should be taken into account in assessing patients presenting with an unusual clinical picture.…”

“…Keratinising squamous metaplasia is a premalignant condition 4 associated with invasive squamous cell carcinoma and results from chronic irritative stimuli involving the bladder namely bladder stones, recurrent urinary tract infections and chronic in-dwelling urinary catheters. 2,4 Squamous cell carcinoma developing secondary to implantation of PTFE in the bladder in the absence of chronic/recurrent urinary tract infection has also been reported.…”

Conservative Management of Unusual Keratinising Squamous Metaplasia of the Bladder in a 28-Year-Old Female and Overview of the Literature

“…Chronic irritation is known to play an important role in the etiopathogenesis of KSM, and recurrent urinary infections seem to be the most important risk factor [ 1 , 4 ]. The use of long-term catheterization, urinary lithiasis, chronic urinary tract obstruction, urinary fistulae, bladder exstrophy, neurogenic bladder, previous bladder surgery, pelvic radiotherapy, parasite colonization, and vitamin A deficiency are also associated with this disease [ 1 , 2 , 5 , 6 ]. Only in a few cases no previous irritation or infectious factors are identified.…”