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Nephrogenic metaplasia in a female person with spinal cord injury: chronic irritation caused by Foley balloon was aggravated by a large uterine fibroid pressing upon the bladder wall for several years: a case report

Abstract

Introduction

Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia.

Case presentation

A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within the anterior aspect of the uterine body which was pushing the collapsed urinary bladder containing the Foley catheter to the left. The patient decided to avoid surgery to remove the fibroid at that time. Ultrasound scan of the urinary bladder done now, revealed a polypoidal lesion in the left superolateral wall. Superficial enhancing lesion with no invasion of the bladder wall was seen in the CT urography. Cystoscopy showed extensive catheter reaction, and in the centre, a slightly more papillary area, which was resected. Histology revealed inflamed bladder mucosa showing tubular and papillary structures lined by cuboidal epithelial cells; the features were of nephrogenic metaplasia. The tubular and papillary structures were lined by cells showing positive immunohistochemical staining for CK7 and PAX8.

Discussion

Catheter reaction and nephrogenic metaplasia was found in the left superolateral wall of the bladder where the large uterine fibroid was pushing the balloon of the catheter against the bladder wall for more than seven years. The patient decided to undergo surgery to remove the large fibroid and thereby prevent further pressure effects upon the urinary bladder.

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Fig. 5: Bladder biopsy: (Haematoxylin and eosin staining), Inflamed bladder mucosa showing tubular and papillary structures lined by cuboidal epithelial cells.
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Data availability

All relevant clinical data pertaining to this case have been provided. Only the confidential data of the patient such as name, date of birth have been withheld to maintain anonymity of the patient.

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Acknowledgements

The authors are most grateful to all doctors, present and past, who looked after this patient during the 27 years after she sustained spinal cord injury.

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Contributions

VS conceived the idea, collected data, discussed with other authors, wrote the draft; NH performed and interpreted histology and immunohistochemical images; RK performed surgery; PH interpreted radiological images; BMS provided ideas and contributed to preparation of the draft. All authors contributed to the final version of the manuscript.

Corresponding author

Correspondence to Vaidyanathan Subramanian.

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The authors declare no competing interests.

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Subramanian, V., Hasan, N., Khadr, R. et al. Nephrogenic metaplasia in a female person with spinal cord injury: chronic irritation caused by Foley balloon was aggravated by a large uterine fibroid pressing upon the bladder wall for several years: a case report. Spinal Cord Ser Cases 8, 51 (2022). https://doi.org/10.1038/s41394-022-00521-x

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