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Education - Case Histories |
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| P V S Kumar and A G Timoney
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| A 67-year old man with right renal calculi was referred because of loin pain and persistent bacteruria. Lithotripsy was ineffective and a ureteroscopic extraction was planned. Cystoscopy revealed a flat white eschar-like layer over the right side of the bladder base, occluding the right ureteric orifice. Biopsies confirmed that keratinising squamous metaplasia (leukoplakia) was present and he was put on long term low dose antibiotics. He underwent another cystoscopy two months later with resection of the right ureteric orifice. |
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| Three months later a review cystoscopy and flexible ureterorenoscopy was performed because of persisting bacteruria, and similar findings were noted in the bladder. There were three inaccessible stones due to a deformed pelvic ureteric junction with no evidence of leukoplakia of the upper tract. A renogram revealed a small right kidney with 30% function and no evidence of obstruction. |
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| Comments | ||||
| The pre-malignant potential of squamous metaplasia is well documented (Benson et al. 1984) and there is an association between metaplasia and infection (Van-Velsen et al. 1995). Is there a case for rendering this patient stone free by percutaneous or open surgery or even nephrectomy, to eliminate the infection, allow the metaplasia to regress and thus remove the risk of malignancy? |
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| References | ||||
| Benson, R. C. et al. (1984) J. Urol. 131, 507-511 Van-Velsen, D. et al. (1995) Paraplegia 33, 565-572 |
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