Vaidyanathan Subramanian1, Noori Hasan2, Rauf Khadr3, Peter Hughes4, Bakul Soni5. 1. Northwest Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK. subramanian.vaidyanathan@nhs.net. 2. Department of Cellular Pathology, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Rainhill, Prescot, L35 5DR, UK. 3. Department of Urology, District General Hospital, Southport, PR8 6PN, UK. 4. Department of Radiology, District General Hospital, Southport, PR8 6PN, UK. 5. Northwest Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK.
Abstract
INTRODUCTION: Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia. CASE PRESENTATION: A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within the anterior aspect of the uterine body which was pushing the collapsed urinary bladder containing the Foley catheter to the left. The patient decided to avoid surgery to remove the fibroid at that time. Ultrasound scan of the urinary bladder done now, revealed a polypoidal lesion in the left superolateral wall. Superficial enhancing lesion with no invasion of the bladder wall was seen in the CT urography. Cystoscopy showed extensive catheter reaction, and in the centre, a slightly more papillary area, which was resected. Histology revealed inflamed bladder mucosa showing tubular and papillary structures lined by cuboidal epithelial cells; the features were of nephrogenic metaplasia. The tubular and papillary structures were lined by cells showing positive immunohistochemical staining for CK7 and PAX8. DISCUSSION: Catheter reaction and nephrogenic metaplasia was found in the left superolateral wall of the bladder where the large uterine fibroid was pushing the balloon of the catheter against the bladder wall for more than seven years. The patient decided to undergo surgery to remove the large fibroid and thereby prevent further pressure effects upon the urinary bladder.
INTRODUCTION: Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia. CASE PRESENTATION: A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within the anterior aspect of the uterine body which was pushing the collapsed urinary bladder containing the Foley catheter to the left. The patient decided to avoid surgery to remove the fibroid at that time. Ultrasound scan of the urinary bladder done now, revealed a polypoidal lesion in the left superolateral wall. Superficial enhancing lesion with no invasion of the bladder wall was seen in the CT urography. Cystoscopy showed extensive catheter reaction, and in the centre, a slightly more papillary area, which was resected. Histology revealed inflamed bladder mucosa showing tubular and papillary structures lined by cuboidal epithelial cells; the features were of nephrogenic metaplasia. The tubular and papillary structures were lined by cells showing positive immunohistochemical staining for CK7 and PAX8. DISCUSSION: Catheter reaction and nephrogenic metaplasia was found in the left superolateral wall of the bladder where the large uterine fibroid was pushing the balloon of the catheter against the bladder wall for more than seven years. The patient decided to undergo surgery to remove the large fibroid and thereby prevent further pressure effects upon the urinary bladder.