Lower urinary tract involvement in patients with newly diagnosed autoimmune bullous dermatoses: an urethrocystoscopic study.
BACKGROUND
To date, there are no published data assessing lower urinary tract involvement in patients with autoimmune bullous dermatoses (ABD).


METHODS
Fourteen of 30 consecutive patients diagnosed with ABD between October 2007 and December 2008 consented to undergo a diagnostic video-recorded urethrocystoscopy: 9 patients (7 women and 2 men) with pemphigus vulgaris, 4 patients (2 women and 2 men) with bullous pemphigoid and 1 female patient with mucous membrane pemphigoid.


RESULTS
None of the 14 patients complained of lower urinary tract symptoms. Urethrocystoscopy disclosed characteristic lower urinary tract lesions in almost every patient with ABD (13 of 14 patients; 93%). Two, partly overlapped, pathologic patterns prevailed: (a) nonkeratinizing squamous metaplasia (SM) found in 64% of the patients, including 2 of 4 men; (b) mucosal inflammation of the bladder base/trigone that extended-especially among male patients-to the proximal urethra (64% of the patients). SM prevailed among patients with pemphigus vulgaris, inflammatory lesions among patients with bullous pemphigoid (P = 0.003) and involvement of proximal urethra among male patients (P = 0.004), irrespective of the particular ABD diagnosis.


CONCLUSIONS
The authors present, to the best of their knowledge, for the first time in the literature, urethrocystoscopic evidence that inflammatory urothelial lesions of the bladder and proximal urethra confounded with nonkeratinizing SM of the trigone are an almost invariable finding in patients with ABD. Studies focusing on the elucidation of the pathomechanism of bladder lesions in these patients may contribute to the better understanding of both the pathophysiology of the bullous skin diseases and the pathobiology of the bladder urothelium.
Tsiriopoulos
Ioannis
I
Department of Urology, University of Ioannina Medical School and University Hospital of Ioannina, Greece.
Kiorpelidou
Despoina
D
Gaitanis
Georgios
G
Sofikitis
Nikolaos
N
Bassukas
Ioannis D
ID
D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000473:pathology; D003556:Cystitis / Q000473:pathology; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000473:pathology; D010391:Pemphigoid, Bullous / Q000473:pathology; D010392:Pemphigus / Q000473:pathology; D011446:Prospective Studies; D012737:Sex Factors; D012872:Skin Diseases, Vesiculobullous / Q000473:pathology*; D014521:Urethra / Q000473:pathology*; D014526:Urethritis / Q000473:pathology; D001743:Urinary Bladder / Q000473:pathology*; D019459:Urothelium / Q000473:pathology