Bladder leukoplakia is the main cause of chronic cystitis

A huge percentage of all women's visits to a urologist is occupied by the category of patients with complaints of frequent, painful urination, cramps and pelvic pain, which bother for a long time and do not go away after taking antibacterial drugs. All these symptoms represent a characteristic clinical picture of chronic inflammation of the bladder, and the urologist, first of all, will look for an infection as a trigger for the disease. But in a large percentage of cases, the cause may not be an infectious agent, but a much more serious condition - bladder leukoplakia.

Localization of bladder leukoplakia

The term "leukoplakia" comes from the Greek and translates as "white plaque". Leukoplakia of the bladder is a pathological condition in which keratinization of the normal mucous membrane of the bladder occurs. Women are exposed to leukoplakia much more often than men, which is associated with the peculiarities of the structure of the female genitourinary apparatus. The most common localization of leukoplakia in the bladder is the vesical triangle, or Lieto's triangle. This is a section of the mucous membrane located in the bottom of the bladder. Its "acute angles" form the ureters, and the internal opening of the urethra. The peculiarity of Lieto's triangle is that only in this area the mucous membrane is completely smooth, while in the entire bladder it is folded.

Causes of bladder leukoplakia

Leukoplakia of the bladder has long been considered a fairly rare disease, but, given the advent of modern diagnostic methods, this diagnosis is being made more and more often. However, the question of the etiology of leukoplakic changes in the bladder is still not well understood. Leukoplakia is considered a polyetiological disease. The main factors that play a role in the development of leukoplakia include the following conditions:

infectious diseases of the genitourinary system;
bladder injury;
presence of foci of chronic infection of other localization;
endocrinological pathology;
smoking;
weakening of general immunity.

Clinical presentation of bladder leukoplakia

Leukoplakia of the bladder is often diagnosed against the background of symptoms of chronic cystitis. Patients complain of frequent painful urination, and pain occurs not only at the end of urination, which is typical for cystitis caused by an inflammatory process, but throughout the entire act of urination. Patients are disturbed by the imperative urge to urinate, during the act only a few drops of urine are released, such urges bother them at any time of the day or night. A characteristic symptom is severe pelvic pain, arching pain in the bladder area. The standard scheme of therapy with antibacterial drugs is not effective in this case, the patient's condition can be slightly alleviated only by taking antispasmodics.

Methods for diagnosing leukoplakia of the bladder

There are several main points in the diagnosis of bladder leukoplakia. The use of laboratory diagnostic methods and a mandatory examination by a gynecologist for the detection of sexually transmitted infections are necessary. A three-cup test and bacteriological culture of urine is carried out in order to detect infectious agents, as well as to exclude kidney pathology. Ultrasound examination of the kidneys and bladder and urodynamic studies (uroflowmetry, cystometry) provide important information about the functional state of the organs of the urinary system.

The gold standard for diagnosing leukoplakia is an instrumental endoscopic examination - cystoscopy with biopsy. With this study, you can directly see the state of the mucous membrane of the bladder, where the altered area will be visualized as white plaques rising above the unchanged areas of the mucous membrane. Biopsy and histological examination of the altered area is the final step in confirming the diagnosis of leukoplakia of the bladder mucosa.

Treatment of leukoplakia of the bladder

Conservative treatments for chronic cystitis caused by leukoplakia of the bladder are often not effective enough. Of course, if an infection of the genitourinary system or a focus of a chronic infection of another localization is detected, it is imperative to eliminate the infectious agent with antibiotic therapy. Silver preparations (collargol) are instilled into the bladder, which, unfortunately, give only a short-term effect. A relatively new treatment for leukoplakia is irrigation through a catheter of the altered area with glycosaminoglycan analogues (heparin), which promote the process of regeneration of the damaged epithelium.

The most effective treatment for leukoplakia today remains the surgical method - transurethral resection (TUR). The essence of the operation is to excise the altered area of ​​the mucous membrane under cystoscopic control. To date, devices are already being used in Ukraine that help during the operation to visualize even those areas of leukoplakia that cannot be seen with a cystoscope, which helps to exclude the possibility of a recurrence of the disease.

Modern studies have proven that bladder leukoplakia is not a precancerous disease, since keratinized areas are not prone to malignancy. However, long-term inflammation adversely affects the functionality of the bladder. Timely diagnosis and adequate therapy are necessary to prevent the occurrence of possible complications of bladder leukoplakia.