Actionable Nuggets for SCI (2nd ed., 2013)
Screen for bladder cancer annually in SCI patients with indwelling catheter, hematuria, bladder stones, or recurrent urinary tract infections.
The risk of a bladder cancer in the spinal cord injured (SCI) population is 16-28 times higher than in the general population. Factors that increase this risk include recurrent urinary tract infections, the use of an indwelling catheter, and the occurrence of bladder stones.
Evidence-based Best Practice:
Annual screening cystoscopy should be completed for all individuals with SCI who have indwelling catheters. Cystoscopy should also be completed for any patient with hematuria, recurrent urinary tract infections, or bladder stones.
Cystoscopy is presently the best screening tool for bladder cancer in the SCI population. Screening cystoscopy in SCI patients with risk factors for bladder cancer has been shown to result in an earlier stage at diagnosis and appears to convey a survival advantage. One study showed that 78% of SCI patients presenting with symptoms of bladder cancer were diagnosed at an advanced stage of cancer while only 40% of those diagnosed via screening cystoscopy had an advanced stage of cancer. Five-year survival rates were 50% among those who were not screened, and 100% where screening led to early detection.
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