Do We Need Surveillance Urethro-Cystoscopy in Patients with Neurogenic Lower Urinary Tract Dysfunction?

Abstract

PurposeTo examine the value of surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction (NLUTD) in regard to the conflicting literature as it is generally agreed that patients with NLUTD are at increased risk for bladder cancer.Materials and MethodsIn a cross-sectional study, a consecutive series of 129 patients (50 females, 79 males, mean age 51, range 18–88) suffering from NLUTD for at least 5 years was prospectively investigated using urethro-cystoscopy and bladder washing cytology at a single university spinal cord injury (SCI) center.ResultsDue to suspicious urethro-cystoscopy and/or bladder washing cytology findings, 13 (10%) of 129 patients underwent transurethral resection of the bladder lesion and/or random bladder biopsies. Overall, 9 relevant histological findings were found in 5% (7/129) of our patients: bladder melanosis (n = 1), nephrogenic adenoma (n = 3), keratinizing squamous metaplasia (n = 1), intestinal metaplasia (n = 3), and muscle-invasive adenocarcinoma of the bladder (n = 1).ConclusionsUsing surveillance urethro-cystoscopy, we found relevant histological findings in 5% of our patients suffering from NLUTD for at least 5 years. Thus, surveillance urethro-cystoscopy might be warranted, although the ideal starting point and frequency remain to be determined in further prospective studies.

EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management

“…There is an increased risk for secondary malignancies in patients with neurogenic bladder with and even without enteric bladder augmentations. 19,20,[98][99][100][101][102][103][104] Therefore, patients need to be informed about this risk. The most significant symptom of developing malignancy is macroscopic hematuria as well as changes in the upper urinary tract.…”

Reliability of urinary cytology and cystoscopy for the screening and diagnosis of bladder cancer in patients with neurogenic bladder: A systematic review

“…The 15 remaining articles, published between 1966 and 2015, were included in this systematic review and fully analyzed. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

“…[13][14][15][16][17][18][19][20][21][22][23][24]26 Mean time from neurological disease onset FIGURE 1 PRISMA flow chart FIGURE 2 Risk of bias assessment ranged from 13 to 29.1 years. 15,19,[22][23][24]27 The neurological conditions were SCI in the vast majority of patients (proportion of SCI patients ranged from 69% to 100% [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] ) with a patient with myelitis in one series, 22 some patients with multiple sclerosis, spina bifida, or cerebral palsy in another series. 27 In all studies, patients with a previous history of bladder cancer were excluded.…”

“…15,19,[22][23][24]27 The neurological conditions were SCI in the vast majority of patients (proportion of SCI patients ranged from 69% to 100% [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] ) with a patient with myelitis in one series, 22 some patients with multiple sclerosis, spina bifida, or cerebral palsy in another series. 27 In all studies, patients with a previous history of bladder cancer were excluded. Six studies used both cystoscopy and urinary cytology for screening bladder cancer.…”

“…Six studies used both cystoscopy and urinary cytology for screening bladder cancer. [13][14][15][16][17]23,27 Six studies evaluated cystoscopy alone 15,[19][20][21][22]24 one used cystoscopy sometimes coupled with urinary cytology, 25 one evaluated urinary cytology sometimes coupled with cystoscopy 22 and one focused on urinary cytology alone. 18…”