The present cross sectional study was carried out to analyze the histopathological changes in the urinary bladder affected by Schistosoma haematobium among 54 patients (aged between 20-60 years; 40 males, 14 females; 44 from rural, 10 from urban areas) attending Sohag University Hospital, Egypt from October 2015 to March 2016. 10% formalin fixed biopsy specimens were examined from which sections of 5 μm were prepared and examined microscopically. Mid-stream urine samples were collected from the patients after a slight physical exercise immediately transported to the Parasitological Laboratory to be examined for S. haematobium eggs. Histopathological examination revealed squamous metaplasia of the urinary bladder in 38/54 cases (70.4%); 20/54 (37%) non- keratinizing metaplasia, 18/54 (33.3%) keratinizing metaplasia and invasive squamous carcinoma in 11/54 (20.4%). It was concluded that Schistosoma haematobium is still one of the major risks of developing squamous cell metaplasia of the urinary bladder in Egypt which was found to be of high statistically significance in both males and females in rural areas. In this study, bladder squamous
metaplasia was subdivided into non-keratinizing with less malignant potential, keratinizing with a definite affinity to carcinogenesis and invasive severe forms; but these subdivisions were found to be statistically not significant in relation to gender, age and locality, although they were of importance for the proper and successful management of the encountered cases.