Incidental bladder cancer at initial urological workup of spinal cord injury patients

Abstract

Study design: Retrospective descriptive study.

Objectives: To compare histopathological findings and the long-term course of SCI patients with bladder cancer found incidentally at the initial urological workup to those diagnosed with bladder cancer many years after the onset of SCI.

Setting: Spinal cord injury center in Germany.

Methods: Data and follow-up of consecutive in- and out-patients with SCI admitted at a tertiary spinal cord injury center between January 1, 1998 and December 31, 2018 were screened retrospectively. All patients with acquired SCI were evaluated for pathological findings in the urinary bladder present at the time of SCI on the initial urological workup. Data of 37 long-term SCI patients from the same center with diagnosed bladder cancer and data of the general German population served as reference groups. Descriptive statistics were applied.

Results: In total, four patients with bladder cancer at initial urological workup were assessed. They all had non-muscle invasive bladder cancer. Two of the patients were cystectomized 34 and 106 months after first bladder cancer diagnosis, due to relapsing tumor and progressive renal failure, respectively. In both cases no tumor was found in the resected bladder. All four patients are currently alive with no tumor and a mean follow-up of 105 months.

Conclusions: In incidental bladder cancer observed at the initial urological workup after acquired SCI, the duration of SCI, at least in the first 5 years, does not noticeably contribute to a poor prognosis, i.e., progression to muscle invasive bladder cancer (≥T2) or a higher grading (G3).

Fig. 1. T category and grading in three different groups of bladder cancer patients.

Left column:long-term spinal cord injury patients. Middle column: spinal cord injury patiens at initial urological workup. Right column: general population in Germany (RKI [Robert Koch Institute] data 1999–2016).

Fig. 2. Kaplan–Meier curves of three different groups of bladder cancer patients.

Upper curve: spinal cord injury patients at initial urological workup. Middle curve: general population in Germany (RKI [Robert Koch Institute] data 1999–2016). Lower curve: long-term spinal cord injury patients.

Fig. 3. Kaplan–Meier curves of three different groups of cystectomized patients.

Upper curve: spinal cord injury patients with transitional cell carcinoma at initial urological workup. Middle curve: long-term spinal cord injury patients with transitional cell carcinoma. Lower curve: long-term spinal cord injury patients with squamous cell carcinoma.