Risk of malignancy after augmentation cystoplasty: A systematic review

Abstract

Objectives: To systematically evaluate the evidence regarding the risk of malignancy after augmentation cystoplasty.

Method: A systematic review search was performed through Medline and Embase databases using the following key words: "cancer," "malignant neoplasm," "cystoplasty," and "bladder augmentation" until November 2014. An article was considered relevant to this review if it focused on malignant tumors occurring after augmentation cystoplasty performed for benign bladder disease.

Results: After screening, 57 articles were included in the synthesis. The level of evidence was usually poor and results should be interpreted with caution. The follow-up time probability to develop a malignant tumor(s) after augmentation cystoplasty ranged from 0-5.5% and estimated incidence ranged from 0 to 272.3 per 100,000 patients/year. Adenocarcinoma was the commonest histological type (51.6%). Malignant lesions predominantly occurred at the entero-urinary anastomosis (50%). The mean latency period was 19 years and most malignant lesions were diagnosed more than 10 years after surgery (90%). Long-term surveillance by cystoscopy is still controversial because of its lack of efficiency. Non-invasive techniques have been proposed and need further evaluations. Tumors were often diagnosed at an advanced stage within surveillance protocols, because of urinary tract related symptoms (64.1%). The carcinogenesis pathway is still not clearly understood but several factors are involved.

Conclusion: Augmentation cystoplasty is associated with a risk of malignancy. Studies regarding carcinogenesis and surveillance strategies should be considered to develop a more efficient follow-up protocol and allow early diagnosis. Neurourol. Urodynam. 35:675-682, 2016. © 2015 Wiley Periodicals, Inc.

Keywords: bladder; cancer; carcinogenesis; histological type; latency period; malignant neoplasm; tumor location.