45yr old black male, presents with haematuria & symptoms suggestive of UTI,
IVP small shrunken bladder, typical bilharzial calcification, cystoscopy
rather haemorrhagic mucosa, sandy patches and other rather shaggier areas.
Multiple biopsies show only squamous metaplasia plus expected bilharzial
What to do?
Treat for bilharzia and nothing else.
Surveillance cystoscopy for development of Squamous cell carcinoma (if so
Accept he won't regularly attend and offer cystectomy
What I don't know to make a rational decision on this is how many squamous
metaplasias develop in to frank malignancy, is there an intermediate stage
of dysplasia or atypia that will give me warning, how fast do these lesions