Leukoplakia Of The Bladder In Women - The First Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Bladder leukoplakia: symptoms and treatment

Leukoplakia of the bladder is accompanied by inflammation of the walls of the organ, but there are no obvious clinical signs of the disease. Therefore, women suffering from this pathology can visit various specialists for a long time, and the diagnosis remains unclear.

Content:

• Leukoplakia of the bladder - what is it
• Causes of occurrence
• Bladder leukoplakia symptoms
• Diagnostics of the leukoplakia of the bladder
• Bladder leukoplakia treatment
• Complications
• Bladder leukoplakia during pregnancy

Leukoplakia of the bladder - what is it

Bladder leukoplakia is a degeneration of normal epithelium into a flat epithelium with the formation of keratinization areas. It will be possible to detect these pathological changes only after a biopsy with a histological examination of the collected tissues.

Leukoplakia can affect various organs in which transitional epithelium is present. Leukoplakia of the bladder and its neck is a serious disease that most often affects women of reproductive age. Pathology is accompanied by intense pain, which negatively affects the patient's well-being. Painful sensations arise from the reason that the altered tissues are sensitive to the effects of the acid contained in the urine.

Bladder leukoplakia has a chronic course.

The disease develops in stages:

• Squamous degeneration. At this stage, the transformation of the single-layer transitional epithelium into the squamous stratified epithelium occurs. The cells themselves do not undergo any changes.
• Squamous metaplasia. At this stage, apoptosis is observed, that is, a change in cells in the transformed stratified squamous epithelium.

• Plaque formation and keratinization of cells

Leukoplakia of the bladder is accompanied by sclerotic processes of the walls of the organ. Over time, it loses its normal contractile function, which causes urinary incontinence. This does not happen with normal inflammation.

Causes of occurrence

Scientists cannot accurately name the reasons for the development of this pathology. Most experts are of the opinion that leukoplakia is the result of abnormal intrauterine development. This means that the walls of the bladder are formed with certain defects even while the fetus is in the uterus. The proof of this theory is the fact that the pathology is diagnosed in patients with anomalies in the development of the bladder.

In addition, there are risk factors that can increase the likelihood of getting sick.

These include:

• Endocrine system diseases. This applies to disorders in the hypothalamus, pituitary gland and ovaries. If the values of estrogen in the woman's body are increased, then this stimulates the epithelium to metaplasia. Sometimes the disease develops while taking hormonal drugs.
• Inflammation of the bladder and organs adjacent to it. Leukoplakia can be provoked by a chronic form of cystitis, stones in the bladder, organ injuries, as well as the ingress of foreign objects into it.
• The presence of a chronic focus of infection in the body, for example, carious teeth or inflamed tonsils.
• Long-term effects of stress on the body, decreased immunity.

The degeneration of epithelial cells of the bladder often occurs under the influence of infection.

If the organ is healthy, then its epithelium will produce mucopolysaccharides. They prevent bacteria from sticking to the surface of the bladder. These same substances protect cells from the damaging effects of uric acid.

When the epithelium of the organ is transformed into a flat one, its protective properties are weakened. This facilitates the penetration of pathogenic flora into the cell walls. The woman develops chronic inflammation. A kind of vicious circle is being formed. Cystitis causes leukoplakia, which, in turn, stimulates the inflammatory process.

Bacteria enter the bladder most often ascending, that is, from the external genital organs.

Therefore, such pathogenic microorganisms can provoke leukoplakia as:

• Gonococci.
• Trichomonas.
• Chlamydia.
• HPV and herpes virus.

Through the blood and lymph, the infection into the bladder gets less often. In this case, other organs can become a source of pathogenic flora: palatine tonsils, kidneys, intestines, uterus, ovaries. In such a situation, leukoplakia develops due to the penetration of staphylococci, streptococci, Escherichia coli, etc. into the bladder.

Metaplasia of the epithelium in the Lieto triangle (the zone of transition of the bladder to the neck) is considered a normal variant. This tissue change occurs under the influence of estrogen. If the epithelium with such metaplasia does not become keratinized and does not lead to the appearance of pathological symptoms, then treatment is not required. The patient is simply being watched.

Bladder leukoplakia symptoms

There are three forms of bladder leukoplakia:

• Flat shape.
• Warty form. Areas of tissue keratinization are expressed to a significant extent.
• Erosive form. The epithelium is covered with ulcerative defects.

Flat leukoplakia may not manifest itself in any way for a long time. With a warty and ulcerative form, a woman suffers from severe symptoms of the disease. If the bladder neck is damaged, then the patient's well-being significantly worsens.

The main symptoms of bladder leukoplakia resemble the clinical picture of cystitis:

• Pain in the pubic area. It pulls and radiates to the lower back.
• The urge to empty the bladder becomes more frequent.
• When the organ is emptied, the woman experiences pain and burning.
• Flakes are visible in the urine, blood can be visualized.
• During intimacy, a woman experiences discomfort.

Impurities in the urine and pain when urinating do not always indicate leukoplakia. A woman can suffer from pain for a long time, and taking tests does not reveal signs of infection and inflammation. Sometimes such patients are diagnosed with an overactive bladder and are prescribed sedatives.

Diagnostics of the leukoplakia of the bladder

The doctor can make a diagnosis only after a comprehensive examination. The obligatory procedure is the histology of organ tissues.

To confirm the disease, diagnostic measures such as:

• Taking anamnesis. The doctor should clarify how often a woman has seizures, whether she has other diseases of internal organs. It is important to find out all the possible predisposing factors of the disease.
• Vaginal examination. It allows you to assess a woman's sexual health.
• Donation of blood, urine and vaginal smear for analysis.
• Biochemical blood test. It is important to check the level of creatinine and urea.
• Research by PCR and ELISA. These diagnostic procedures help identify hidden infections.
• Collection of urine and vaginal smear for bacterial culture.
• Ultrasound of the pelvic organs and kidneys.
• Urodynamic examination (cystometry and urometry). It is performed when the patient indicates a feeling of incomplete emptying of the bladder. The study allows you to assess the tone of the organ and its contractile ability.
• Endoscopic examination of the bladder with a pinched biopsy. This study is highly informative. It makes it possible to assess the size of the lesion, the form of the disease, the condition of the tissues of the organ. Based on the data obtained, a treatment plan is drawn up. Lesions may appear as flat, whitish patches, yellow plaques, or erosion.

An accurate diagnosis can be made only after the biopsy data are obtained. They must confirm the presence of metaplastic changes in the cells of the organ.

The clinical picture of bladder leukoplakia may resemble the symptoms of other diseases, therefore it is important to carry out differential diagnostics with such pathologies as:

• Chronic cystitis. The symptoms of this disease are similar to those of leukoplakia. They can only be distinguished after a cystoscopy with a biopsy. In patients with cystitis, the mucous membrane of the organ is inflamed, but there are no low-lying areas on it.
• Bladder cancer. Often this disease does not give any symptoms at all, but as the pathology progresses, clinical signs appear that resemble leukoplakia. During cystoscopy, ulcerative defects and altered areas of the epithelium will be found on the mucous membrane. However, cells in bladder cancer will be atypical.

It is possible to talk about an accurate diagnosis only after an endoscopic examination of the bladder with a biopsy of the material.

Bladder leukoplakia treatment

Treatment can be both conservative and surgical.

Conservative therapy

To cope with pathology, an integrated approach is needed:

• Prescribing antibacterial drugs. Antibiotics are used in long courses that can last up to 3 months. In the course of treatment, the drugs are changed, choosing the optimal drug. The course is stopped only after the bacterial culture of urine three times gives negative results. The drugs of choice are Norfloxacin, Ciprofloxacin and Levofloxacin. They have minimal side effects and are able to effectively eliminate the pathogenic flora in the bladder.
• Preparations for the relief of inflammation. If it is intense, corticosteroids such as Prednisolone may be used.
• Preparations for increasing immunity: Interferon, Lavomax.
• Installations. Irrigation of the urinary bladder is carried out with mucopolysaccharide analogs. They allow you to protect the mucous membrane of the organ from the damaging effects of uric acid and microbial flora. Such funds are injected directly into the organ using a catheter. Treatment should be prolonged. Its specific timing depends on how much the walls of the bladder are affected. For installations using Heparin, Hyaluronic acid and Chondroitin sulfate.
• Physiotherapy treatment. It allows you to speed up recovery, reduce inflammation, and prevent the formation of scars and adhesions. The most effective methods of treatment: laser therapy, electrophoresis with hormonal drugs, magnetotherapy, microwave therapy.

Surgery

If conservative therapy fails to achieve the desired effect, the patient is prepared for surgery.

The indications for its implementation are:

• Persistent inflammation, accompanied by a violation of the contractility of the bladder.
• Stage 2 or 3 leukoplakia, which was confirmed by histological examination.
• Severe pain, which cannot be eliminated by drugs.
• The presence of atypical cells. This condition threatens with a cancerous tumor of the organ.

Types of surgical intervention:

• TUR (transurethral resection of the bladder). During the procedure, the affected areas of the mucous membrane are removed. For this, use a special loop. The device is inserted through the urethra using endoscopic equipment for this purpose. This procedure allows you to maintain the integrity of the bladder.
• Laser coagulation of the bladder. During the operation, only the mucous structures damaged by the disease are removed. The muscular layer of the organ is not touched, that is, healthy tissues do not suffer with this type of intervention. The patient is recovering quickly, the rehabilitation period is one month.
• Laser ablation. In this case, the tissues of the organ are not cauterized, the thermal effect is not aggressive. The impact is point-like, healthy tissues are not affected. The likelihood of developing complications is minimal. Rehabilitation after such a procedure is quick.

On the second day after the operation, the woman is allowed to go home. The process of urination returns to normal within 7 days. During this time, a woman may experience pain and discomfort.

Diet

To improve the effectiveness of treatment, the patient must follow a diet. Food and drinks must be selected in such a way that they do not irritate the mucous membranes of the organ. Food is steamed or boiled.

Recommended products:

• Fresh sweet fruits.
• Fresh and boiled vegetables. White cabbage, cauliflower, tomatoes, garlic, onion, sorrel and radish are removed from the menu.
• Low fat fish and meat.
• Milk and fermented milk drinks.
• Porridge.

You need to drink about 2 liters of water per day. This will allow faster removal of bacteria from the bladder and reduce the effect of uric acid on the walls of the organ. You can drink herbal teas, black and green tea without sugar, fruit drinks with lingonberries and cranberries, clean water, still mineral water.

It is forbidden to eat:

• Seasonings.
• Spicy dishes.
• Marinades and salinity.
• Rich soups.
• Smoked products.
• Fried foods.
• Strong tea, coffee, spirits.

Complications

After undergoing treatment, a woman will need to be tested regularly. From time to time she undergoes a cystoscopy of the organ. This will eliminate the recurrence of pathology.

Possible complications include:

• Malignancy with the development of a cancerous tumor.
• Loss of normal bladder function. The tissues of the organ stop contracting and cannot hold urine.
• Renal failure With the development of this complication, the woman may die.

Bladder leukoplakia during pregnancy

Leukoplakia can complicate pregnancy. If the disease worsens in the early stages, then the risk of miscarriage or abnormalities in fetal development increases.

When the disease occurs in the second half of pregnancy, it threatens with premature birth, placental abruption and intrauterine infection of the fetus. If a woman's health deteriorates significantly, then she is prescribed antibiotics. The rest of the treatment can only be carried out after childbirth.

Chronic cystitis can lead to leukoplakia as well as provoke its development. These pathologies are closely related. Therefore, with frequent exacerbations of the disease, you need to go to an appointment with a urologist and undergo a comprehensive examination.

Author of the article: Lebedev Andrey Sergeevich | Urologist

Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.