الفهرس 
Materials and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
This study was carried out to detect the effect of the
foreign bodies in the urinary bladder especially most of our patients have chronic bilharzial cystitis .
Thirty patients with foreign bodies in the urinary bladder were included, 21 patients with cystoscopic evidence of bilharzial cystitis (10 with urethral catheters, 5 with ureteral stints and 6 patients with bladder stones) and 9 patients with normal bladders ( 5 patients with urethral catheters and 4 patients with bladder stones.
A urine sample was taken from each patient just before removal of the foreign body for viable bacterial count and culture with identification of the organisms.
All patients were cystoscoped once before application of the catheters and ureteral stints and just after removal of the foreign bodies (patients with bladder stones were cystoscoped once at the time of removal of the stones).
Biopsies were obtained from all patients from the maximal area of reaction and 4 quadrants of the bladder for histopathological examination.
The results of the urine revealed the presence of significant bacteriuria in all patients and the most common organisms were E.coli and pseudomonas especially in all
bilharzial patients.
The results of histopathological examination of the biopsies revealed:
In 21 bilharzial patients with foreign bodies :
1)Inflammatory infiltrate :
Found in 100% of biopsies which was chronic inflammatory infiltrate with predominance of eosinophils in cases with catheters and stints while no eosinophils in cases with bladder stones.
2)Hyperplasia:
Found in 68.5% of biopsies with papillary formation in the maximal sites of reactions to the foreign body.
3)Mild dysplasia:
Found in 9.5% of biopsies and was confined to the biopsies obtained from the maximal site of reaction to the foreign body.
4)Severe dysplasia:
Found in 5.6% of biopsies and confined to the biopsies obtained from the maximal site of reaction to the foreign body.
5)Squamous Metaplasia:
Found in 1.9% of biopsies obtained from the maximal site of reaction to the foreign body.
In 9 patients with normal bladders with foreign bodies:
1)Inflammatory infiltrate:
Found in 100% of biopsies also was chronic inflammatory infiltrate with predominance of eosinophils in cases with urethral catheters and no eosinophils in cases with bladder stones.
2)Hyperplasia:
Found in 37.7% of biopsies with papillary formation in the maximal site of reaction in 7 out of 9 cases.
Neither squamous metaplasia nor dysplasia was found in the nonbilharzial patients.
The presence of other proliferative lesions such as Brunn’s nests, cystitis cystica and cystitis glandularis was a frequent event in bilharzial and normal bladders with foreign bodies with greater incidence in bilharzial bladders.
These proliferative lesions may have a precancerous role when atypia of the cells is found (EI-Bolkainyetal,1981).
In patients with urethral catheters and stints, urothelial abnormalities occurred very earlier than with bladder stones, possibly due to the toxic irritative effect of catheters aalpetaL1984
The aggressive behavior of the urothelium in the bilharzial patients is due possibly to the association of several risk factors in those patients which are, chronic bilharzial cystitis, associated chronic bacterial infection
and probable carcinogens in urine.
Finally, urothelial hyperplasia and dysplasia are probably relevant to the development of bladder tumours in patients with chronic irritation with catheters and stones especially in presence of chronic bilharzial cystitis and this needs further assessment.