Bladder mucosal leukoplakia (bladder leukoplakia) is a cystoscopic manifestation of chronic cystitis, and bladder mucosal metaplasia – squamous epithelial metaplasia of the bladder mucosa – is usually considered a rare disease with a high rate of misdiagnosis and underdiagnosis, which has been increasing in recent years. In the past, there was a lack of clear understanding of the etiology, pathological mechanisms, and clinical features of bladder leukoplakia, and there was no definite conclusion about whether bladder leukoplakia is protective, destructive, or pathological, some believe that it is a normal variation of the urinary tract epithelium, some believe that it is due to long-term chronic inflammation or obstruction, and some believe that it is a precancerous lesion. Domestic reports account for 6.0% to 13.75% of the total number of cystoscopies Etiology of bladder mucosal leukoplakia: unclear, closely related to long-term chronic irritation, lower urinary tract infection, obstruction and proliferative lesions. Clinical manifestations: no characteristic, mainly bladder irritation symptoms, urinary urgency, frequency, painful urination, lower abdominal discomfort, visual or microscopic hematuria, urinary tract obstruction symptoms. The symptoms can last for several years to decades. The urine culture is mostly free of bacterial growth, and antimicrobial treatment is not effective. Typical cystoscopic manifestations: the lesion is mainly located in the bladder triangle and bladder neck; it is grayish white irregular patchy changes, slightly higher than the normal mucosa, with clear margins and starfish-like extension to the surrounding area, and sometimes active bleeding spots can be seen on the surface; the vascular texture of the white spot gradually decreases or disappears as the thickness of the keratinized layer increases; there is often congestion in the bladder neck and urethra; the lesion can be located at the opening of both ureters, but the orifice is clear, and it rarely causes obstruction. The bladder volume is normal, and the detached keratinous epithelium and keratinous debris can be seen in the bladder suspended in water, presenting a “snowstorm” scene, also known as drifting snow syndrome. Diagnostic criteria for bladder leukoplakia: ① Clinical manifestations: intermittent recurrent urinary frequency, urinary urgency, or with painful urination, hematuria, discomfort and pain in the lower abdomen. ②Cystoscopy: white patches of bladder mucosa with clear borders were found, and the vascular texture on them was significantly reduced or disappeared. ③Pathological examination: squamous epithelial metaplasia of bladder mucosa, incomplete keratinization or keratinization of the superficial epithelium. ⑤ Electron microscopy: squamous epithelial metaplasia of the bladder mucosa, nuclei are naive, intracytoplasmic tensin fibers are abundant, and abundant bridging grain structures are seen at the site of attachment Treatment: Transurethral electrodesiccation. The extent of excision was 0.5 cm from the lesioned tissue and deep to the superficial muscular layer. Postoperative intravesical drug infusion is controversial. The disease is prone to recurrence and should be followed up closely after surgery with regular cystoscopy Clinically, cystoscopy and pathology should be performed promptly in patients diagnosed with chronic urinary tract infection with poor antibiotic treatment. Such patients are likely to have lesions of bladder mucosal leukoplakia, and cystoscopy and pathology are effective means of diagnosing bladder mucosal leukoplakia.