Adult urologyTransitional cell carcinoma in patients with spinal cord injury: a high risk malignancy?
Section snippets
Material and methods
A standardized questionnaire was mailed to all urologic departments involved in the urologic management of SCI centers in Germany, Switzerland, and Austria. Questionnaires evaluated the number of patients with SCI treated between 1995 and 1999. Furthermore, the number of patients with SCI who developed bladder cancer was recorded. In each individual patient with bladder cancer, patient age at the initial diagnosis, mode of bladder evacuation, number of UTIs annually, duration of indwelling
Cancer incidence
Thirty-one (64.6%) of the 48 centers returned the questionnaires. The data of 43,561 patients were included. Of this study population, 48 patients (0.11%) developed bladder cancer. Complete information was available for 37 (29 males, 8 females) of these 48 patients. The mean age at the time of the initial diagnosis was 53.3 ± 14.7 years. Ten patients (27%) had a cervical lesion, 22 patients (59.5%) a thoracic lesion, and 5 patients (13.5%) a lumbar lesion. SCI was complete in 15 patients
Comment
Until today, no prospective study had evaluated the bladder cancer risk for patients with neurogenic bladder dysfunction. In the largest retrospective study, West and coworkers8 reviewed 33,565 patients with SCI between 1988 and 1992. They found a bladder cancer incidence of 0.39%.8 Bickel et al.9 reported an incidence of 0.32%. The bladder cancer incidence in our study was 0.11%, significantly lower than the incidence in the previous investigations and closely related to the bladder cancer
Conclusions
According to our study, the incidence of bladder tumors in patients with SCI seems to have decreased during the past decade. This might be due at least in part to the avoidance of indwelling catheters, which have to be regarded as an important risk factor for bladder cancer. The prompt recognition and appropriate treatment of UTIs may be another reason for this finding.9 However, the bladder cancers were frequently muscle-invasive tumors and had a poor prognosis. The exact reason for this
Acknowledgements
To the following researchers who provided the data for this survey for their excellent cooperation: U. Bersch (Notwil), U. Bötel (Bochum), R. Bickeböller (Frankfurt/Main), F. Brands (Herne), W. Diederichs (Berlin), C. Durek (Lübeck), H. Ebermayer (Kreischa), M. Goepel (Essen), U. Grigoleit (Murnau), A. J. Gross (Göttingen), G. Haupt (Köln), J. Kutzenbacher (Bad Wildungen), H. Löhmer (Kassel), M. Müller (Herne), H. Palmtag (Sindelfingen), H. J. Piechota (Münster), U. Rabs (Ludwigshafen), R.
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