Benign Bladder Tumours

Epithelial Metaplasia

• Squamous metaplasia
  • Often has a knobby appearance and is covered by white, flaky, easily disrupted material lying on the trigone.
  • ≈40% of women and 5% of men have squamous metaplasia of the bladder, which is usually related to infection, trauma, or surgery; a normal finding in premenopausal females
• Glandular metaplasia
  • Appears as clumps of raised red areas that appear inflammatory
  • Often confused for cancer
• Management
  • No treatment is needed

Leukoplakia

• Similar to squamous metaplasia with the addition of keratin deposition that appears as a white flaky substance floating in the bladder
• Management
  • No treatment is needed

Urothelial papilloma

• Composed of delicate stalks lined by normal-appearing urothelium
• Papillomas may recur, but do not progress or invade

Inverted papilloma

• Associated with chronic inflammation or bladder outlet obstruction
• Can be located throughout the bladder but most commonly on the trigone
• 1% incidence of tumor recurrence, but do not progress or invade
• Management
  • Transurethral resection is the treatment

Nephrogenic Adenoma

• Rare
• Caused by chronic irritation of the urothelium; also associated with trauma, previous surgery, renal transplantation, intravesical chemotherapy, stones, catheters, and infection

Cystitis Cystica and Glandularis

• Common finding in normal bladders
• Usually associated with inflammation or chronic obstruction
• Cystitis glandularis may be associated with pelvic lipomatosis
• Management
  • Regular endoscopic evaluation of patients with these entities is recommended
    • Few case reports of cystitis cystica or glandularis transforming into adenocarcinoma

Leiomyoma

• Occur most commonly in women of childbearing age
• Management
  • Surgical resection is required if the leiomyoma is large or painful

Endometriosis

• Management
  • Can be treated with hormones, TUR, or partial cystectomy

Questions

1. List benign tumours of the bladder

Answers

1. List benign tumours of the bladder
   1. Epithelial metaplasia
   2. Leukoplakia
   3. Papilloma
   4. Inverted papilloma
   5. Nephrogenic adenoma
   6. Cystitis cystica/glandularis
   7. Leiomyoma
   8. Endometriosis

References

• Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 92