Screening cystoscopy in chronically catheterized spinal cord injury patients

Abstract

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.

Contemporary Role of Suprapubic Cystostomy in Treatment of Neuropathic Bladder Dysfunction in Spinal Cord Injured Patients

“…36 Inherent in the treatment of neurogenic bladder dysfunction consisting of indwelling catheters is the necessity for life-long surveillance cystoscopy, urinary cytology 37 and upper tract imaging. Authors have previously described various schedules for surveillance cystoscopy, ranging from annual examination, to every 3 months in those with a history of bladder stones, 38 or those with significant squamous metaplasia. 39,40 A recent retrospective analysis by Hamid 41 which examined the role of surveillance cystoscopy and biopsy did not demonstrate evidence to support more than annual cystoscopic examination, with the biopsy only of suspicious lesions.…”

Bladder cancer in individuals with spinal cord injuries

“…A urological screening program was carried out in 500 SCI patients; cystoscopy was carried out in those who used some form of urinary catheter for at least 5 or 10 years (depending on smoking status). 35 No cancers were detected with the screening protocol. Three patients from this cohort were diagnosed with bladder cancer outside of the screening protocol; two of these patients did not meet the criteria for yearly cystoscopy, as they used external urine collection devices, and the remaining patient had a normal cystoscopy and biopsy 4 months before their diagnosis as part of the screening protocol.…”

Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction

“…Several studies demonstrated that screening cystoscopy alone is not sufficiently sensitive and specific to be used as a surveillance tool in SCI patients. Yang and Clowers did not detect a single tumor in 59 patients undergoing a total of 156 cystoscopies, the majority of which had to be performed under general anesthesia, 12 as especially patients with an SCI above the level of Th10 are at risk for autonomic dysreflexia, a potentially life-threatening complication. 13 Particularly in patients with indwelling catheters, bladder tumor detection merely based on the endoscopic appearance is virtually impossible, as it is not possible to reliably distinguish the morphologic alterations caused by the catheters from bladder tumors.…”