Risk of bladder cancer in patients with spina bifida: Case reports and review of the literature

Abstract

PURPOSE: This article presents four cases of patients with spina bifida who developed bladder cancer while under our care and provides a literature review on the incidence, initial presentation, possible etiologies, and role for screening for bladder cancer in the neurogenic bladder population. METHODS: Case reports of four patients are presented followed by a literature review of the current available studies. RESULTS: Patients with spina bifida present with bladder cancer at an atypically young age with very advanced disease. The dire prognosis associated with bladder cancer in these patients demands that we provide better treatment, diagnosis, and prevention modalities. However, the potential morbidity, financial burden, and lack of proven benefit discourage cystoscopic screening in this patient population. Until we have more data on how to best serve spina bifida patients, this population should receive careful and regular urologic follow-up. CONCLUSION: Given the atypical young age of presentation and very advanced nature of bladder cancer in the spina bifida population, the authors strongly recommend that any new bladder changes, such as including increased urinary leakage, pain, recurrent infections, or increased gross hematuria, prompt immediate urologic referral for endoscopic evaluation and biopsy as indicated.

Bladder cancer in patients with spina bifida: observation from an adult clinic

“…Multiple case series have been published in order to establish the relationship between bladder cancer and neurogenic diseases. The largest series reported are from patients with SCI and only short case series about SB patients with bladder cancer were reported [4,8]. The main risk factors for bladder cancer described in this population were indwelling catheters, urinary tract infections, and bladder calculi [5,8].…”

“…Previous reports described an association between dorsal and high-lumbar lesion levels and higher frequency of bladder augmentation [3]. However, most etiological theories propose the chronic irritation of the urothelium in patients with neurogenic bladder and the need of long-term catheterization as the predisposing factors to oncogenic transformation [3,8]. Thus, the neurogenic bladder and the type of bladder management could be responsible for cancer regardless of the lesion level.…”

“…The incidence of bladder cancer for patients with spinal cord injury (SCI) varies between 0.1 and 10% [5], whereas the incidence in normal population is 0.14-0.2‰ [6]. Intermittent or permanent catheterization, chronic urinary tract infections, urothelial inflammation, bladder calculi, and bladder augmentation surgery have been described as predisposing factors for bladder cancer [7,8].…”

Care for Adults with Spina Bifida: Current State and Future Directions

“…40 Chronic inflammation poses a risk for the development of cancer, therefore patients with SB may be particularly at risk. 41 Median age of diagnosis of bladder cancer in this population is reported to be 37 years old, and 6 months is the median survival period. 40 Even though this diagnosis may be infrequent among individuals with SB, a high index of suspicion should be maintained with long-term urological care and immediate evaluation is necessary for any urological changes.…”

“…40 Even though this diagnosis may be infrequent among individuals with SB, a high index of suspicion should be maintained with long-term urological care and immediate evaluation is necessary for any urological changes. 41 The rates of testicular cancer in this population are not described.…”