An indwelling urinary catheter and a history of bladder stones are statistically significant risk factors. Cytology and biopsy are complimentary in the evaluation of urothelial malignancy in this population. A high index of suspicion and thorough evaluation are needed in spinal cord injury patients.

To our knowledge our study represents the largest group of spinal cord injured patients to undergo biopsy evaluation after chronic catheter use. A spectrum of inflammatory and proliferative pathological conditions were identified, which were predominantly inflammatory and squamous. The need to survey ongoing transitional mucosal changes in this population is underscored by the spectrum of histological abnormalities and the significant occurrence of malignant pathologies in our patients.

To our knowledge our study represents the largest group of spinal cord injured patients to undergo biopsy evaluation after chronic catheter use. A spectrum of inflammatory and proliferative pathological conditions were identified, which were predominantly inflammatory and squamous. The need to survey ongoing transitional mucosal changes in this population is underscored by the spectrum of histological abnormalities and the significant occurrence of malignant pathologies in our patients.

The high sensitivity and specificity of multiple cytology studies in this population suggest that cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic (longer than 5 years) indwelling catheters. We recommend a minimum of yearly cytology in all high risk spinal cord injured patients with subsequent biopsies in all patients with any suspicious finding.

The high sensitivity and specificity of multiple cytology studies in this population suggest that cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic (longer than 5 years) indwelling catheters. We recommend a minimum of yearly cytology in all high risk spinal cord injured patients with subsequent biopsies in all patients with any suspicious finding.