Elsevier

Urology

Volume 59, Issue 2, February 2002, Pages 240-244
Urology

Adult urology
Transitional cell carcinoma in patients with spinal cord injury: a high risk malignancy?

https://doi.org/10.1016/S0090-4295(01)01495-9Get rights and content

Abstract

Objectives. To study bladder cancer incidence in patients with spinal cord injury (SCI) in Germany, Switzerland, and Austria. SCI is associated with neurogenic bladder dysfunction. These patients are at an increased risk of developing bladder malignancies.

Methods. A questionnaire was mailed to all SCI centers in these countries. The number of patients with SCI treated between 1995 and 1999, and the data of all patients with SCI with bladder cancer were recorded.

Results. The charts of 43,561 patients were reviewed. Of these, 48 patients (0.11%) developed bladder cancer. The data of 8 female and 29 male patients were fully available. The mean age was 53.3 years. Bladder management was reflex voiding in 18 patients, intermittent catheterization in 12 patients, and an indwelling catheter in 7 patients. Twelve patients were smokers. The mean time between SCI and the first bladder cancer diagnosis was 22.6 years. Thirty-two percent had superficial cancers, 8% had carcinoma in situ, and 60% presented with muscle-infiltrating tumors; 81% had urothelial cancer and 19% squamous cell cancer. Thirteen patients rarely had urinary tract infections (UTIs), 9 had more than 10 UTIs annually, and 15 had chronic UTIs.

Conclusions. The bladder cancer incidence in patients with SCI and in the general population is comparable. More than 60% of the patients with SCI, however, initially presented with muscle-infiltrating bladder cancer. Indwelling catheters and chronic UTIs were common in patients with bladder cancer. Immunologic pathologic mechanisms and a prolonged exposure to carcinogens may be involved in bladder cancer carcinogenesis in patients with SCI.

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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