Screening Cystoscopy and Survival of Spinal Cord Injured Patients With Squamous Cell Cancer of the Bladder

Navon, Joseph D.; Soliman, Hani; Khonsari, Fred; Ahlering, Thomas E.

doi:10.1097/00005392-199706000-00020

Cited by 18 publications

(31 citation statements)

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“…Rates of squamous cell carcinoma developing in patients with chronic catheters have been estimated to be 2.3-10%, [12][13][14] with the rates of squamous changes in bladder mucosa as high as 80%. In our study, the overall incidence of both squamous cell carcinoma and transitional cell carcinoma was 0.6%.…”

Section: Discussionmentioning

confidence: 99%

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

et al. 2009

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Objective: Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI. Methods: A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained. Results: In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively. Conclusion: SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.

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Section: Discussionmentioning

confidence: 99%

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

et al. 2009

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“…Both of these findings have been noted in earlier studies. 3,11,[13][14][15][16] The reason for the rapid and aggressive nature of these tumors is unknown. In other populations with bladder cancer, approximately 25% will present with muscle invasive disease, 6 whereas in this study over 1/2 had advanced disease at presentation.…”

Section: Discussionmentioning

confidence: 99%

Bladder cancer in spinal cord injury patients

et al. 2009

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Objective: Spinal cord injury is a known risk factor for bladder cancer. The risk of bladder cancer has been reported at 16-28 times higher than the general population. Earlier studies have identified indwelling catheters as risk factors. We examined the characteristics of bladder cancers in a spinal cord injury (SCI) population. Setting: Long Beach VA Hospital Spinal Cord Injury Unit, Long Beach, California Methods: We reviewed SCI patients seen and diagnosed with bladder tumors between January 1983 and January 2007. Data collected included time since diagnosis, method of diagnosis, form of bladder management, pathologic type, treatment of the tumor, and outcome. Results: A total of 32 patients with bladder cancer were identified out of 1319 seen. Tumors found were 46.9% squamous cell carcinoma (SCC), 31.3% transitional cell carcinoma (TCC), 9.4% adenocarcinoma, and 12.5% mixed TCC and SCC. The primary form of bladder management was 44% urethral catheter for a mean of 33.3 years, 48% external catheter for a mean of 37.4 years, and 8% intermittent catheterization for a mean of 24.5 years. Nineteen patients had a known method of cancer detection with 42% found on screening cystoscopy. Conclusions: The pathologic makeup of the tumors is similar to that reported earlier. Over 50% of patients diagnosed with bladder cancer in our population did not have an indwelling catheter. This suggests that the neurogenic bladder, not the indwelling catheter, may be the risk factor for bladder cancer. Urologists should consider diligent, long-term screening of all patients with SCI for bladder cancer and not just those with indwelling catheters.

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“…The majority of the reported cases of bladder cancer in SCI patients list the tumor stage at the time of diagnosis as T2 or greater, with very few super®cial tumors. 3,8,9 The high stage of the disease at diagnoses would argue for heightened surveillance. But the rapidly progressive nature of the disease, seen in two patients during this study who died within a year of diagnosis and reported by others, 10,11 discounts the utility of practical screening measures.…”

Section: Discussionmentioning

confidence: 99%

“…Screening in patients with long-standing SCI has been reported to be helpful in identifying bladder malignancies in otherwise asymptomatic persons. 3 A screening protocol was instituted in January 1992 at our institution requiring annual cystoscopy to be performed on SCI patients deemed at high risk for the development of bladder cancer. The results of this 6 year screening protocol are reported here, along with discussion of its e cacy and suitability.…”

Section: Introductionmentioning

confidence: 99%

Screening cystoscopy in chronically catheterized spinal cord injury patients

Yang

Clowers

1999

Spinal Cord

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Study design: Retrospective review. Objectives: An annual screening cystoscopy protocol was begun at our institution in an attempt to minimize the morbidity and mortality of bladder cancer in the chronically catheterized spinal cord injured (SCI) population. The objectives of this study are: (1) to present the results of 6 years of screening for primary bladder cancer in this population, and (2) examine the suitability of this protocol based upon accepted principles of cancer screening. Setting: Veterans hospital, Seattle, WA, USA. Methods: SCI patients selected for screening cystoscopy were those who had been continuously catheterized for 10 or more years, or were smokers who had been catheterized for 5 or more years. Biopsies and/or urine cytologies were taken at the surgeon's discretion. Results: Fifty-nine patients underwent 156 cystoscopy procedures from January 1992 through December 1997. The vast majority of patients were at risk for autonomic dysre¯exia, so cystoscopy was performed with anesthesia. No bladder cancers were diagnosed by screening cystoscopy. All bladder biopsies and cytology specimens were benign. During the same period of time four SCI patients presented with symptomatic bladder cancers. Two patients did not ®t the criteria for surveillance, one patient was not being followed by the SCI unit and presented to an outside physician, and one patient had a screening cystoscopy 4 months prior to presenting with bladder cancer. Conclusions: Cystoscopy does not ful®l the accepted criteria for screening for primary bladder cancer in SCI patients. The disease does not appear to be amenable to screening, the population to be screened is not easily de®nable, and the costs are excessive compared to the low cancer detection rate.

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Screening Cystoscopy and Survival of Spinal Cord Injured Patients With Squamous Cell Cancer of the Bladder

Cited by 18 publications

References 0 publications

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

Bladder cancer in spinal cord injury patients

Screening cystoscopy in chronically catheterized spinal cord injury patients

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