Malignant Vesical Tumors Following Spinal Cord Injury

Bejany, Darwich E.; Lockhart, Jorge L.; Rhamy, Robert K.

doi:10.1016/s0022-5347(17)43651-2

Cited by 120 publications

(64 citation statements)

References 16 publications

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“…Most earlier studies have shown that the relative risk of a bladder neoplasm in the spinal cord injured population is 16-28 times higher than that of the general population. [1][2][3] Recently, this increase has come into some question with a study showing no increase in cancer rates among a spinal cord injured population. 4 The patient population in this study did not undergo formal screening and had a much lower rate of tobacco use than in other studied populations, but it does suggest that further, wellcontrolled studies need to be performed to determine the true incidence of bladder neoplasms in spinal cord injured populations.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Although controlled prospective studies are lacking, several retrospective studies have suggested that the relative risk of a bladder neoplasm is 16-28 times that of a normal population. [1][2][3][4] SCI patients are also known to have a different spectrum of disease than the general population with a significantly higher proportion of squamous cell carcinoma (SCC) compared with transitional cell carcinoma (TCC), and a lower age and a higher stage at diagnosis. 5 We examined the risk factors and characteristic of bladder tumors in an SCI population.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bladder cancer in spinal cord injury patients

et al. 2009

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“…13 A recent study by Stonehill advocates the use of cytology for screening SCI patients, 14 whereas other reports have shown that it is not adequately speci®c due to concurrent in¯ammation from infection and catheterization. 2,15 In recent years, several assays have been introduced as screening mechanisms for recurrent bladder cancer, though none have been indicated for populations at risk without a prior bladder cancer diagnosis. The bladder tumor antigen test (BTA-Stat, Bard Diagnostic Sciences, Inc., Redmond, WA, USA) assays urine for a urothelial basement membrane protein that is released when bladder tumors are present.…”

Section: Discussionmentioning

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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“…Its incidence in the spinal cord injury population has been reported to be 2.3%.2 These tumours are 460 times more common than bladder tumours in the general population. 2 The increased occurrence of bladder tumours correlates with the duration of urothelial inflammation, chronic urinary tract infection, vesical stone, and indwelling catheter drainage of the urinary bladder. It may be desirable to monitor those patients who are at high risk for developing bladder tumours by annual check-ups in clusive of cystoscopy with cold-cup biopsies of all suspicious areas as well as predetermined random sites.…”

Section: Introductionmentioning

confidence: 99%

Comparative pathology of dome and trigone of urinary bladder mucosa in paraplegics and tetraplegics

Velzen

Krishnan²,

Parsons³

et al. 1995

Spinal Cord

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Paraplegic/tetraplegic individuals are prone to develop chronic urinary tract infection, urinary calculi and bladder outlet obstruction, and have a 16 to 28 times higher risk for squamous cell bladder cancer. The preferable method of monitoring those patients who are at high risk of developing vesical neoplasia has been an annual check-up inclusive of cystoscopy and cold cup bladder biopsy of all suspicious areas as well as predetermined random sites. It may be desirable to take a biopsy from one site (when there is no suspicious lesion) with a flexible cystoscope while the patient is sitting in the wheelchair itself in the outpatient clinic instead of multiple biopsies from the dome, trigone and both lateral walls of the urinary bladder taken in the operation theatre set-up using a rigid cystoscope with the patient positioned in lithotomy. Before adopting such a cost-saving and more convenient procedure routinely, we evaluated whether any significant additional histopathological findings are obtained by taking bladder biopsies from the dome and the trigone of the urinary bladder instead of just one, be it dome or trigone in the absence of any visible urothelial lesion in the bladder. In forty consecutive tetraplegic/paraplegic patients who did not have any cystoscopically distinguishable urothelial neoplastic lesion such as papilloma, cold cup biopsies of the dome and the trigone were taken randomly before carrying out any diagnostic or therapeutic procedure, eg electrohydraulic lithotripsy of vesical calculi. All the biopsy specimens were evaluated by a pathologist who was unaware of the clinical details and not involved with the primary diagnosis. In 15 cases, significant additional histopathological finding(s) were recorded in the trigone biopsy which were not seen in the dome biopsy (follicular cystitis: n = 4; squamous metaplasia: n = 4; extensive squamous metaplasia with focal atypia: n = 1; limited focal atypia: n = 1; extensive glandular metaplasia: n = 1; intestinal metaplasia and possibly follicular cystitis: n = 1; and follicular cystitis and intestinal metaplasia: n = 1; mild atypia: n = 1; extensive calcification of epithelial denudation: n = 1). Histopathology of dome biopsies revealed significant additional histopathological finding(s) in nine cases (follicular cystitis: n = 2; squamous metaplasia: n = 2; intestinal metaplasia: n = 1; squamous metaplasia and adeno matoid metaplasia and mild atypia: n = 1; features of interstitial cystitis: n = 1; mild dysplasia: n = 1; mild crypt hyperplasia of urothelium with mild atypia: n = 1). Thus in twenty cases (50% ), significant additional findings were obtained by taking cold cup random biopsy of the dome as well as the trigone in the absence of any visible morphological changes. Although single site biopsy may be less traumatic, more convenient to the patient as well as to the staff, and cost-saving, in the spinal cord injury patients with neuropathic bladder, it may not be diagnostically adequate even in those patients who do not have any cystoscopic ...

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Malignant Vesical Tumors Following Spinal Cord Injury

Cited by 120 publications

References 16 publications

Bladder cancer in spinal cord injury patients

Bladder cancer in spinal cord injury patients

Screening cystoscopy in chronically catheterized spinal cord injury patients

Comparative pathology of dome and trigone of urinary bladder mucosa in paraplegics and tetraplegics

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