Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder

Abstract

Study design Case series. Objectives The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB). Setting An Italian tertiary referral center for NB. Methods We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019. Results We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months. Conclusions BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage.

Suprapubic catheterisation: a study of 1000 elective procedures

“…It is unclear, however, who specifically would benefit from surveillance and what the optimal regimen would be. This question has previously been addressed without a consensus being reached, probably due to the number of patients presenting with bladder cancer in this cohort being low and the latency period between catheterisation and development of cancer being long [21,22].…”

“…The literature recommending bladder surveillance, either in the form of cystoscopy with or without routine biopsy, ultrasonography, cytology or a combination of investigations [21,23], does not agree on one standard approach or at what point surveillance should begin. Neither ultrasonography nor urine cytology have been proven adequate for detecting bladder cancer without cystoscopy and cystoscopy commonly shows abnormalities from chronic catheterisation, which leads to biopsy of a benign bladder.…”