Bladder Cancer in Patients with a Spinal Cord Injury, pp. 549-564
Authors: Ja Hyeon Ku, Cheol Kwak and Hyeon Hoe Kim
Abstract: Since the life expectancy of patients with a spinal cord injury (SCI) has steadily improved over the last few decades, the long-term health related risks have become increasingly important. Patients with a SCI are reported to have a higher incidence of bladder cancer compared to the general population, and persons with a SCI are at especially high risk for squamous cell carcinomas. The risk factors for bladder cancer that are directly related to the neurogenic bladder of patients with a SCI are the prolonged use of an indwelling catheter, recurrent infections and bladder stone formation. Several authors have postulated that the histological changes to the urothelium vary with neuropathic bladder management strategies. However, there has been considerable variation in the quoted crude incidence rates of the development of cancer; therefore, the magnitude of the risk has not been clearly defined. The variation in measured incidence rates, for bladder cancer, in this population is partly a result of different study designs. Bladder cancer research in patients with a SCI has been limited by the challenges inherent in following a large cohort of individuals with a SCI long enough for bladder cancer to develop. Therefore, the natural history of bladder cancer in patients with a SCI is poorly understood. Current guidelines regarding the optimal surveillance schedule have yet to be defined, and refined with randomized prospective analyses. The aim of this study was to review published articles with respect to the development of bladder cancer in this population.