The Use of Urine Cytology for Diagnosing Bladder Cancer in Spinal Cord Injured Patients

Stonehill, William H.; Goldman, Howard B.; Dmochowski, Roger R.

doi:10.1097/00005392-199706000-00021

Cited by 11 publications

(18 citation statements)

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“…The aim of long-term bladder rehabilitation of SCI patients, including yearly cytology and biopsies, is the prevention of bladder infections and avoidance of urinary complications. 3 In our series there was no signi®cant statistical dierence between the number of infections, the period since the injury, the neurologic level of the spinal cord lesion and the histopathology. These results show that none of these variables have aected the histopathological in¯ammation type.…”

Section: Discussionmentioning

confidence: 45%

Urinary bladder biopsies in spinal cord injured patients

et al. 2001

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Study design: A series of 94 urinary bladder biopsies in spinal cord injured (SCI) patients were histopathologically and statistically analysed. Objectives: The following hypotheses were examined: (1) The number of clinical bladder infections per year in each patient does not in¯uence the histopathological type of in¯ammation of the urinary bladder; (2) The duration of the spinal cord lesion does not have a strong eect on the type of in¯ammation; (3) The dierent neurological levels (upper and lower motor neuron lesions) do not relate to a speci®c histopathology. Settings: All patients received their treatment at the Swiss Paraplegic Centre in Nottwil, near Lucerne (Switzerland). Methods: The samples were taken from the bladder fundus during endoscopic urologic operations. Histopathological standard procedures were carried out. Statistical analysis including Kruskal ± Wallis and Chi-square tests were performed. Results: Histopathological analysis showed abnormal alterations of the urinary bladder mucosa in 86 SCI-patients: (91.5%). 63 cases (67.0%) showed a chronic type and 23 cases (24.5%) showed a subacute type of in¯ammation. A normal urinary bladder was found in eight cases (8.5%). The three hypotheses were statistically not rejected. Conclusion: Results demonstrated no correlation between the number of bladder infections per year, the period since injury, the neurologic level of the spinal cord lesion and the histopathology of the urinary bladder mucosa.

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Section: Discussionmentioning

confidence: 45%

Urinary bladder biopsies in spinal cord injured patients

et al. 2001

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“…21 The prevailing belief is that indwelling catheters, particularly when used for 410 years, are a risk factor for bladder cancer. [28][29][30] Most series of SCI patients with bladder cancer show that a high proportion used indwelling catheters (50-100%). 4,7,9,10,13,[16][17][18] Data from the US National Spinal Cord Injury Database suggest that although intermittent catheterization has increased in popularity since the 1970s, few patients continue to use it over long-term follow-up, whereas patients who use an indwelling catheter are likely to continue to use this strategy long term.…”

Section: Risk Factors For Development Of Bladder Cancer In Sci Patientsmentioning

confidence: 99%

“…Urinalysis has been studied as a screening tool among older males in the general population; 36 however, its usefulness in the SCI population is limited because of the difficulty in interpreting the results in SCI patients (because of chronic bacteriuria and hematuria from catheter use). Stonehill et al 30 sought to determine the effectiveness of urine cytology at detecting bladder cancer in SCI patients. Two hundred and eight SCI patients (primarily managed with indwelling catheters) had urine cytologies analyzed, and then bladder biopsies performed.…”

Section: Risk Factors For Development Of Bladder Cancer In Sci Patientsmentioning

confidence: 99%

“…The usefulness of cytology likely depends on the ability of the cytopathologist to interpret samples with background inflammation. 30 In the general population, screening cystoscopies are the standard of care after an initial diagnosis of noninvasive bladder cancer. Many series have advocated the use of cystoscopy as an annual screening tool in specific groups of SCI patients 7,9,11,13,17,38 others have suggested yearly cytology.…”

Section: Risk Factors For Development Of Bladder Cancer In Sci Patientsmentioning

confidence: 99%

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Bladder cancer in individuals with spinal cord injuries

et al. 2013

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Study design: Prospective scoping review. Objectives: To conduct a scoping review of all the literature related to bladder cancer in individuals with spinal cord injuries (SCI). Methods: Literature search of the databases Pubmed, CINAHL, ProQuest, PsychINFO and Scopus up to and including August 2012. Articles related to bladder cancer among SCI patients were identified, and data pertaining to epidemiology, risk factors, screening, prevention and management was reviewed and summarized. Results: An association between bladder cancer and SCI was first reported in the 1960s, with some case reports suggesting an alarmingly high rate among SCI patients. More recent epidemiological studies have reported this risk to be substantially lower. However, bladder cancer in SCI patients tends to present at an earlier age and at a more advanced pathological stage than bladder cancer in the general population. Presenting symptoms may be atypical, and early recognition is important to improve prognosis with surgical resection. Several risk factors have been identified, including indwelling catheters, urinary tract infections and bladder calculi. Screening of SCI patients for bladder cancer is routinely recommended in many SCI management guidelines and by expert consensus; however, evidence for screening tools and protocols is lacking. Conclusion: Bladder cancer is a rare, and potentially lethal occurrence in SCI patients. Physicians need to have a high index of suspicion for bladder cancer, particularly among SCI patients managed with long-term indwelling catheters.

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“…Urine cytology has been used in screening for bladder cancer in cohorts of men exposed to occupational bladder carcinogens, but did not have a clinical impact on the development of cancer. 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.…”

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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The Use of Urine Cytology for Diagnosing Bladder Cancer in Spinal Cord Injured Patients

Cited by 11 publications

References 0 publications

Urinary bladder biopsies in spinal cord injured patients

Urinary bladder biopsies in spinal cord injured patients

Bladder cancer in individuals with spinal cord injuries

Screening cystoscopy in chronically catheterized spinal cord injury patients

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