15. Screening for Bladder Cancer in SCI Patients

Routine screening for bladder cancer is recommended, especially in those with indwelling or suprapubic catheters and other risk factors.

The Problem

The risk of a bladder cancer and mortality are significantly increased in the spinal cord injured (SCI) population, particularly those using indwelling or suprapubic catheters for bladder management. Bladder cancer in SCI may have an atypical presentation because symptoms are masked by paralysis. Furthermore, hematuria is not a reliable symptom marker since it can often be associated with catheterization or urinary tract infection. Bladder cancer tends to be detected at younger ages in the SCI population than in the general population – typically in the mid-50s. It has also often reached an advanced stage by time of diagnosis, resulting in an aggressive form of the disease.

Evidence-based Best Practice

Risk factors for bladder cancer with SCI include: indwelling or suprapubic catheter use, chronic UTI, bladder stones, increased urine contact time, altered immunological function – in addition to the usual population risk factors — smoking, workplace exposure, pelvic radiation.

There is no evidence-based guideline for bladder cancer screening, however most studies recommend semi-annual to annual cytology and cystoscopy. Sensitivity for diagnosing bladder cancer with cystoscopy is estimated at 64% and using cytology at 36%. Used in combination, these routine office procedures can assist in early detection of bladder cancer, resulting in a survival advantage. Biopsy may be needed for definitive diagnosis.

Key Reference

Qu, L. G., & Lawrentschuk, N. (2019). Bladder cancer surveillance in patients with spinal cord injuries. BJU International, 123(3), 379-380. doi:10.1111/bju.14582

Actionable Nuggets (4th ed., 2019)

Additional References (since 2016)

Böthig, R., Kurze, I., Fiebag, K., Kaufmann, A., Schöps, W., Kadhum, T., . . . Golka, K. (2017). Clinical characteristics of bladder cancer in patients with spinal cord injury: The experience from a single centre.International Urology and Nephrology, 49(6), 983-994. doi:10.1007/s11255-017-1570-6

Gui-Zhong, L., & Li-Bo, M. (2017). Bladder cancer in individuals with spinal cord injuries: A meta-analysis.Spinal Cord, 55(4), 341-345. doi:10.1038/sc.2016.151

Ismail, S., Karsenty, G., Chartier-Kastler, E., Cussenot, O., Compérat, E., Rouprêt, M., & Phé, V. (2018). Prevalence, management, and prognosis of bladder cancer in patients with neurogenic bladder: A systematic review.Neurourology and Urodynamics, 37(4), 1386-1395. doi:10.1002/nau.23457