Associate Professor of Urology and Preventive Medicine, Keck School of Medicine; Staff Urologist, USC/Norris Cancer Center, Los Angeles, California
Keratinizing squamous metaplasia in and of itself is not a worrisome finding. Some studies have shown that concurrent carcinoma (transitional cell carcinoma, squamous cell carcinoma, or adenocarcinoma) of the bladder was found in 10% to 20% of patients with squamous metaplasia, but the malignant lesion was usually noted to arise in the nonmetaplastic portions of the epithelium. Because both squamous metaplasia and certain types of bladder cancer can be caused by chronic inflammation, it is not surprising that these 2 entities may occur in the same patient. However, the way to lower the patient's risk of developing cancer is not to remove the squamous metaplasia, but to eliminate the source of the chronic inflammation.
In this case, it sounds as if the patient is having low-grade recurrent urinary tract infections (UTIs) likely due to the incomplete emptying of the diverticulum. By report, the patient's symptoms respond to antibiotics, implying that he had a UTI. One of the indications for surgical removal of a bladder diverticulum is recurrent UTIs. I would obtain a cystogram, if this has not been done already, to see if the diverticulum empties with voiding and to better understand the bladder anatomy. I would then likely proceed with diverticulectomy. This would remove the source of the patient's chronic infections and inflammation, preventing him from experiencing future symptomatic UTIs and potentially reducing his future risk of developing bladder cancer due to chronic irritation.
