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Keratinizing squamous metaplasia may be seen in the urinary bladder in a setting of recurrent urinary tract infections, Schistosomiasis, neurogenic bladder, in-dwelling catheters, repeated bouts of bladder calculi, or other causes of injury to the urothelial lining. Keratinizing squamous metaplasia is a risk factor for development of squamous cell carcinoma and must be reported when found in bladder biopsies. Close follow-up of these patients is recommended.