Primary Study On The Characteristics Of Female Bladder Leukoplakia And Its Correlation With Mycoplasma Infection

Objective:The main purpose of this study was to investigate the clinical features and risk factors of bladder leukoplakia,and to verify the association between mycoplasma infection and the occurrence of bladder leukoplakia.Finally,it provides a clinical basis for us to determine whether the chronic infection of ureaplasma urealyticum(UU)can be used as a potential pathogen associated with bladder leukoplakia for the early diagnosis and treatment of bladder leukoplakia.Method:We analyzed the clinical data of 43 patients with bladder leukoplakia in the Department of Female Urology of the Second Affiliated Hospital of the University of South China from June 2016 to September 2020,and set them as the experimental group(group A).In addition,we analyzed the clinical data of 193 female urological patients without vesical mucosal leukoplakia who were treated at the same time.Among these cases,case-control study method was adopted to pair them with experimental group according to baseline data(1:2).Finally,86 cases were selected as control group(group B).Then we compared the detection rate of mycoplasma infection and the influencing factors of bladder leukoplakia between the two groups,and analyzed the correlation between them.All clinical data were statistically analyzed by SPSS 26.0software.Result:Statistical analysis of the clinical symptoms of 43 patients in the experimental group showed that most of them were frequent urination,urgent urination,urination pain,accompanied by hematuria,poor urination,lower abdominal discomfort,etc.,and a few were accompanied by anxiety,insomnia,depression and other psychological symptoms.Microscopic observation showed that 27 cases of mucosal leukoplakia invaded both the bladder neck and the bladder triangle,13 cases only invaded the bladder triangle,and 3 cases only invaded the bladder neck.In addition,in all patients,3 cases had a combined violation of the ureteral opening.Most of the patients in the experimental group were sensitive to doxycycline,vectomycin and crossamycin.In this study,43 cases were all hyperplastic in postoperative pathology.The pathology showed squamous metaplasia of the bladder mucosa,which may be accompanied by superficial keratosis or incomplete keratosis.We compared the group A and group B by univariate analysis(chi-square test),the results showed that the positive rate of mycoplasma and the rate of recurrent urinary tract infections in group A were significantly higher than those in group B(both p < 0.05).Then we compared them by multivariate logistic regression analysis,the results showed that the patient’s history of recurrent urinary tract infection was a risk factor for bladder leukoplakia(OR=6.892,P < 0.05).The sensitivity and specificity of urethral secretions screening for mycoplasma infection as a diagnostic test for bladder leukoplatosis was only 60.47% and 48.57%.The sensitivity and specificity of cystoscopy as a diagnostic test for bladder leukoplatosis was 88.37% and 80.00%.The parallel test of the above two screening tests can increase the sensitivity to 93.02% and reduce the rate of missed diagnosis.The specificity of serial test can be increased to 91.43% and the misdiagnosis rate can be reduced.Conclusion:Ⅰ.The bladder leukoplakia is more common in middle-aged women,the clinical symptoms are urinary irritation symptoms(frequency of urination,urgency of urination,dysuria),sometimes accompanied by hematuria and abdominal discomfort.The cystoscopic examination showed that leukoplakia lesions were mostly found in the trigonometry of the bladder which could be accompanied by follicular cystitis and glandular cystitis.and the pathological type is more common in the proliferative type.Ⅱ.The diagnostic points of bladder leukoplakia include the typical urinary irritation symptoms,cystoscopy showing white spots or plaques-like lesions,and biopsy pathology showing transitional squamous metaplasia with or without keratosis.Ⅲ.The mycoplasma infection in urinary tract may be an indirect factor in the pathogenesis of bladder leukoplakia.Ⅳ.The history of chronic urinary tract infection and pre-menopause are the risk factors for the incidence of bladder leukoplakia.Ⅴ.The detection rate of cystoscopy for bladder leukoplakia can be close to 90%.For patients with repeated urinary irritation,cystoscopy should be improved to evaluate the condition,and biopsy should be used if necessary.For patients with recurrent urinary tract irritation who are not responding to conventional anti-infective treatments,screening for mycoplasma infection and further treatment are recommended and should be performed.