Bladder leukoplakia is a rare intravesical lesion that occurs in women around the age of 40. The disease presents as white patches on the bladder mucosa, usually located in the bladder triangle and neck, and occasionally invading the entire bladder mucosa. The main symptoms are urinary frequency, urinary urgency, and urinary pain, which are not easily distinguished from chronic cystitis. Bladder leukoplakia is a response of the normal urinary epithelium to toxic stimuli and is precancerous or predictive of malignant lesions in other areas of the bladder. Therefore, attention should be paid to the diagnosis, monitoring and treatment of this disease.
Treatment of bladder leukoplakia 1.First remove chronic causative factors, such as bladder stones should be treated with lithotripsy or surgical stone extraction.
2.Transurethral cystoscopic electrocautery or YAG laser irradiation has certain efficacy, but often cannot be cured, and must be closely followed up.
Radiation therapy can be used as an adjuvant treatment after resection, but it is not effective alone.
4.Direct injection of prednisone acetate or isofluprednisone acetate (flourohydro prednisone) into the lesion using cystoscopy has certain efficacy, and the injection interval is 1 week to 1 month, and can be injected several times.
5.Cryotherapy can also be tried.
6.If necessary, mucosal debridement of the bladder at the site of the lesion can be performed. Partial cystectomy can be considered for suspected malignant changes.
7, bladder perfusion method: Li Yuanzhong et al. (1988-1990) used lyophilized BCG vaccine 120mg plus saline 60ml, bladder perfusion 1 time/week, 6 times; after half a month once a total of 6 times. A total of 5 cases were treated for 2 courses of therapy, and 4 cases were cured, and no recurrence was seen in the follow-up of 6 months to 1 year. The treatment mechanism is presumed to be related to activation of specific and non-specific immune mechanisms in vivo, enhancement of the body’s immunity, and the toxic effect of causing severe local inflammation causing ischemia, necrosis, and shedding of superficial tissue cells of the lesion, followed by migrating epithelial repair. The side effects of this treatment are that patients may experience urinary frequency, urinary urgency, burning pain and effort to urinate, as well as discomfort from hypothermia after instillation, but all of them can be relieved within 24h. Lyophilized BCG (BCG vaccine) instillation is simple to perform, but the long-term effects remain to be observed.