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Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
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Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Koukourikis P, Papaioannou M, Pervana S, Apostolidis A. Exploring the DNA Methylation Profile of Genes Associated with Bladder Cancer in Bladder Tissue of Patients with Neurogenic Lower Urinary Tract Dysfunction. Int J Mol Sci 2024; 25:5660. [PMID: 38891848 PMCID: PMC11171624 DOI: 10.3390/ijms25115660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/12/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
DNA methylation is an epigenetic process that commonly occurs in genes' promoters and results in the transcriptional silencing of genes. DNA methylation is a frequent event in bladder cancer, participating in tumor initiation and progression. Bladder cancer is a major health issue in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD), although the pathogenetic mechanisms of the disease remain unclear. In this population, bladder cancer is characterized by aggressive histopathology, advanced stage during diagnosis, and high mortality rates. To assess the DNA methylation profiles of five genes' promoters previously known to be associated with bladder cancer in bladder tissue of NLUTD patients, we conducted a prospective study recruiting NLUTD patients from the neuro-urology unit of a public teaching hospital. Cystoscopy combined with biopsy for bladder cancer screening was performed in all patients following written informed consent being obtained. Quantitative methylation-specific PCR was used to determine the methylation status of RASSF1, RARβ, DAPK, hTERT, and APC genes' promoters in bladder tissue samples. Twenty-four patients suffering from mixed NLUTD etiology for a median duration of 10 (IQR: 12) years were recruited in this study. DNA hypermethylation was detected in at least one gene of the panel in all tissue samples. RAR-β was hypermethylated in 91.7% samples, RASSF and DAPK were hypermethylated in 83.3% samples, APC 37.5% samples, and TERT in none of the tissue samples. In 45.8% of the samples, three genes of the panel were hypermethylated, in 29.2% four genes were hypermethylated, and in 16.7% and in 8.3% of the samples, two and one gene were hypermethylated, respectively. The number of hypermethylated genes of the panel was significantly associated with recurrent UTIs (p = 0.0048). No other significant association was found between DNA hypermethylation or the number of hypermethylated genes and the clinical characteristics of the patients. Histopathological findings were normal in 8.3% of patients, while chronic inflammation was found in 83.3% of patients and squamous cell metaplasia in 16.7% of patients. In this study, we observed high rates of DNA hypermethylation of genes associated with bladder cancer in NLUTD patients, suggesting an epigenetic field effect and possible risk of bladder cancer development. Recurrent UTIs seem to be associated with increased DNA hypermethylation. Further research is needed to evaluate the impact of recurrent UTIs and chronic inflammation in DNA hypermethylation and bladder cancer etiopathogenesis in NLUTD patients.
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Affiliation(s)
- Periklis Koukourikis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece;
| | - Maria Papaioannou
- Department of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stavroula Pervana
- Department of Pathology, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece;
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece;
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3
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Wang XL, Wang YX, Chen JZ, Liu XY, Liu X, Zhong QK, Zhao ZL, Shi ZD, Han CH. Clinical characteristics and molecular mechanisms underlying bladder cancer in individuals with spinal cord injury: a systematic review. BMC Urol 2024; 24:111. [PMID: 38778291 PMCID: PMC11110351 DOI: 10.1186/s12894-024-01457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patients with spinal cord injury have a relatively high risk for bladder cancer and often complicated with bladder cancer in advanced stages, and the degree of aggressiveness of malignancy is high. Most of the literature is based on disease clinical features while, our study reviews the clinical characteristics and molecular mechanisms of spinal cord injury patients with bladder cancer, so that it might help clinicians better recognize and manage these patients. METHOD We searched PubMed, Web of Science and Embase, using retrieval type like ("Neurogenic Lower Urinary Tract Dysfunction" OR "Spinal cord injury" OR "Spinal Cord Trauma") AND ("bladder cancer" OR "bladder neoplasm" OR "bladder carcinoma" OR "Urinary Bladder Neoplasms" OR "Bladder Tumor"). In Web of Science, the retrieval type was searched as "Topic", and in PubMed and Embase, as "All Field". The methodological quality of eligible studies and their risk of bias were assessed using the Newcastle-Ottawa scale. This article is registered in PROSPERO with the CBD number: CRD42024508514. RESULT In WOS, we searched 219 related papers, in PubMed, 122 and in Embase, 363. Thus, a total of 254 articles were included after passing the screening, within a time range between 1960 and 2023. A comprehensive analysis of the data showed that the mortality and incidence rates of bladder cancer in spinal cord injury patients were higher than that of the general population, and the most frequent pathological type was squamous cell carcinoma. In parallel to long-term urinary tract infection and indwelling catheterization, the role of molecules such as NO, MiR 1949 and Rb 1. was found to be crucial pathogenetically. CONCLUSION This review highlights the risk of bladder cancer in SCI patients, comprehensively addressing the clinical characteristics and related molecular mechanisms. However, given that there are few studies on the molecular mechanisms of bladder cancer in spinal cord injury, further research is needed to expand the understanding of the disease.
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Affiliation(s)
- Xin-Lei Wang
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yi-Xuan Wang
- Suzhou High School of Jiangsu Province, Suzhou, Jiangsu, China
| | - Jun-Zhi Chen
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xin-Yu Liu
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xing Liu
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Qi-Kai Zhong
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Zi-Lin Zhao
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Zhen-Duo Shi
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
- Department of Urology, Xuzhou Central Hospital, Jiefang South Road, No. 199, Xuzhou, Jiangsu, China.
- School of Life Sciences, Jiangsu Normal University, Xuzhou, Jiangsu, China.
- Jiangsu Provincial Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Xuzhou City Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Jiangsu, China.
| | - Cong-Hui Han
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
- School of Life Sciences, Jiangsu Normal University, Xuzhou, Jiangsu, China.
- Jiangsu Provincial Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Xuzhou City Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Jiangsu, China.
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Kurze I, Jaekel AK. [Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis]. Aktuelle Urol 2024. [PMID: 38653466 DOI: 10.1055/a-2281-7924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.
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Affiliation(s)
- Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Anke K Jaekel
- Klinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
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5
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Böthig R, Schöps W, Kowald B, Golka K. [Oncological relevance of neuro-urological diseases]. Aktuelle Urol 2024. [PMID: 38599592 DOI: 10.1055/a-2269-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Apart from a few exceptions, there is currently little scientific evidence on the oncological relevance of neuro-urological diseases. Most research has been conducted into the association between long-term spinal cord injury with its consequences for the lower urinary tract and the occurrence of bladder cancer. These cancers differ in many ways from bladder cancers in patients without spinal cord injury: patients are 20 years younger on average, tumours are very often already muscle-invasive and poorly differentiated with a high proportion of squamous cell carcinomas, and the prognosis is poor. These characteristics also occur in spinal cord injury patients without permanent catheter drainage of the urinary bladder. Although the pathophysiological association has not been clarified in detail, the presence of a neurogenic bladder appears to be the decisive link between spinal cord injury and the occurrence of bladder cancer. Pathological pressure conditions in the urinary bladder and frequent urinary tract infections or asymptomatic bacteriuria resulting from neurogenic lower urinary tract dysfunction could be the decisive pathophysiological factors. In this respect, urinary bladder cancer in persons with a chronic spinal cord injury represents a model tumour after denervation. The clinically important question of screening requires future interdisciplinary research approaches.
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Affiliation(s)
- Ralf Böthig
- Abt. Neuro-Urologie, Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Hamburg, Germany
| | | | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
| | - Klaus Golka
- Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Dortmund, Germany
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Le Garrec D, Chesnel C, Teng M, Lagnau P, Brouchet M, Chea M, Amarenco G, Hentzen C. [Intermittent catheterization: What are the environmental impacts and how can they be reduced?]. Prog Urol 2023; 33:533-540. [PMID: 37596127 DOI: 10.1016/j.purol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION If the use of intermittent catheterization has revolutionized the prognosis of neuro-urology patients, it seems necessary to question the ecological cost of single-use catheters, in a process of decarbonization of the health sector. The aim of this work is to identify the environmental impact of intermittent catheterization and potential solutions to reduce it. METHODS A review of the literature on the environmental impact of intermittent catheterizations was conducted. Potential solutions to reduce this impact and possible alternatives were then studied based on data from the literature. RESULTS Only two studies were identified. The first estimated the amount of waste generated by intermittent catheterization in the USA to be between 4400 and 38,964 tons per year. The second study showed a higher overall environmental impact of thermoplastic polyurethane (TPU) catheters than polyvinyl chloride (PVC) catheters and catheters made from polyolefin material. Reuse of catheters would reduce the amount of waste, but the paucity of data does not allow us to determine if the incidence of urinary tract infection would be affected. Alternative micturition methods, in addition to the complications they may cause, require the use of collection bags or pads, which also have an environmental impact. Other treatments for dysuria exist, but the evidence is limited and does not cover all patient populations. CONCLUSION With limited alternatives, it appears essential to develop more environmentally friendly catheters.
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Affiliation(s)
- D Le Garrec
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France.
| | - C Chesnel
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Teng
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - P Lagnau
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Brouchet
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Chea
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - G Amarenco
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - C Hentzen
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
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Satgé D, Nishi M, Trétarre B. Assessing cancer in people with profound and multiple disabilities. BMC Cancer 2023; 23:798. [PMID: 37626285 PMCID: PMC10463777 DOI: 10.1186/s12885-023-11313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Cancers are as common in individuals with intellectual disabilities as in the general population (GP). For the subgroup of people with profound and multiple disabilities (PMD) who present with both severe intellectual disability and major motor disorders, the frequency and distribution of cancers are currently not known, preventing proper cancer surveillance. METHODS We carried out a systematic and synthetic review of the medical literature, including a focused search of Japanese data. RESULTS The total risk of cancer in individuals with PMD is thought to be lower than in the GP, possibly due to a shorter life expectancy. They have reduced exposure to cancer risk factors, such as alcohol, tobacco, sunlight, human papillomavirus infection, occupational toxins, and being overweight. On the other hand, individuals with PMD present a greater frequency of gastroesophageal reflux disease, Helicobacter pylori gastritis, chronic cystitis, and cryptorchidism, which increase the risk for cancer of the esophagus, stomach, urinary bladder, and testes. In addition, certain genetic disorders underlying compromised motor and cognitive functions are associated with higher risk of childhood cancers. An analysis of 135 cancers in persons with PMD in Japan suggested that they present a particular tumor profile, with certain cancers rarer than in the GP, whereas cancers of the digestive tract are frequent. Cancers of the digestive tract occurred significantly earlier than in the GP (colon: average age 48.3 years vs. 71.3 years in the GP, esophagus: 39 years vs. 72 years in the GP). An increasing number of therapeutic successes in children and adults with PMD have been reported in different countries when cancers are discovered early. CONCLUSION Individuals with PMD must be appropriately monitored for cancer. Screenings for breast and colon cancer, as well as regular monitoring of the esophagus, stomach, urinary bladder, and testicles, are necessary. Population-based epidemiological studies are needed to better understand risk factors, frequency, and distribution of cancers in the PMD population.
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Affiliation(s)
- Daniel Satgé
- Oncodéfi, 209 Avenue des Apothicaires, Parc Euromédecine, Montpellier, 34090, France.
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France.
| | - Motoi Nishi
- Department of Fundamental Health Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Brigitte Trétarre
- Oncodéfi, 209 Avenue des Apothicaires, Parc Euromédecine, Montpellier, 34090, France
- Registre des Cancers de l'Hérault, 208 Avenue des Apothicaires, Montpellier, 34090, France
- Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, France
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Jubber I, Ong S, Bukavina L, Black PC, Compérat E, Kamat AM, Kiemeney L, Lawrentschuk N, Lerner SP, Meeks JJ, Moch H, Necchi A, Panebianco V, Sridhar SS, Znaor A, Catto JWF, Cumberbatch MG. Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors. Eur Urol 2023; 84:176-190. [PMID: 37198015 DOI: 10.1016/j.eururo.2023.03.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 05/19/2023]
Abstract
CONTEXT Bladder cancer (BC) is common worldwide and poses a significant public health challenge. External risk factors and the wider exposome (totality of exposure from external and internal factors) contribute significantly to the development of BC. Therefore, establishing a clear understanding of these risk factors is the key to prevention. OBJECTIVE To perform an up-to-date systematic review of BC's epidemiology and external risk factors. EVIDENCE ACQUISITION Two reviewers (I.J. and S.O.) performed a systematic review using PubMed and Embase in January 2022 and updated it in September 2022. The search was restricted to 4 yr since our previous review in 2018. EVIDENCE SYNTHESIS Our search identified 5177 articles and a total of 349 full-text manuscripts. GLOBOCAN data from 2020 revealed an incidence of 573 000 new BC cases and 213 000 deaths worldwide in 2020. The 5-yr prevalence worldwide in 2020 was 1 721 000. Tobacco smoking and occupational exposures (aromatic amines and polycyclic aromatic hydrocarbons) are the most substantial risk factors. In addition, correlative evidence exists for several risk factors, including specific dietary factors, imbalanced microbiome, gene-environment risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy. CONCLUSIONS We present a contemporary overview of the epidemiology of BC and the current evidence for BC risk factors. Smoking and specific occupational exposures are the most established risk factors. There is emerging evidence for specific dietary factors, imbalanced microbiome, gene-external risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy. Further high-quality evidence is required to confirm initial findings and further understand cancer prevention. PATIENT SUMMARY Bladder cancer is common, and the most substantial risk factors are smoking and workplace exposure to suspected carcinogens. On-going research to identify avoidable risk factors could reduce the number of people who get bladder cancer.
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Affiliation(s)
- Ibrahim Jubber
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - Sean Ong
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nathan Lawrentschuk
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Seth P Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Joshua J Meeks
- Departments of Urology and Biochemistry, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ariana Znaor
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marcus G Cumberbatch
- Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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9
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Koukourikis P, Papaioannou M, Papanikolaou D, Apostolidis A. Urine Biomarkers in the Management of Adult Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13030468. [PMID: 36766573 PMCID: PMC9914312 DOI: 10.3390/diagnostics13030468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction requires lifelong surveillance and management for the perseveration of patients' quality of life and the prevention of significant morbidity and mortality. Urine biomarkers are an attractive noninvasive method of surveillance for these patients. The aim of this systematic review is to search for and critically appraise studies that investigate the clinical usefulness of urine biomarkers in the management of neurogenic lower urinary tract dysfunction (NLUTD) in adults. METHODS This review was conducted according to PRISMA and MOOSE guidelines. Search strategy included PubMed, CENTRAL, and Scopus (until October 2022). Studies investigating potential urine biomarkers for the management of adults with NLUTD were included. RESULTS Fifteen studies fulfilled the criteria. To date, a variety of different urine molecules have been investigated for the diagnosis and management of neurogenic overactive bladder and detrusor overactivity (nerve growth factor, brain-derived neurotrophic factor, prostaglandin E2, prostaglandin F2α, transformation growth factor β-1, tissue inhibitor metalloproteinase-2, matrix metalloproteinase-2, substance P, microRNA), diagnosis of vesicoureteral reflux (exosomal vitronectin), urinary tract infection (neutrophil gelatinase-associated lipocalin, interleukin 6) and bladder cancer screening (cytology, BTA stat, survivin) in neurological patients. CONCLUSION Further studies are needed to specify the utility of each molecule in the management algorithm of adult NLUTD.
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Affiliation(s)
- Periklis Koukourikis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, Thessaloniki 56429, Greece
| | - Maria Papaioannou
- Department of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Dimitrios Papanikolaou
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, Thessaloniki 56429, Greece
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, Thessaloniki 56429, Greece
- Correspondence: ; Tel.: +30-2310-991-476; Fax: +30-2310-681-022
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10
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Neuzillet Y, Pradère B, Xylinas E, Allory Y, Audenet F, Loriot Y, Masson-Lecomte A, Roumiguié M, Seisen T, Traxer O, Leon P, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Non-muscle-invasive bladder cancer (NMIBC). Prog Urol 2022; 32:1102-1140. [PMID: 36400479 DOI: 10.1016/j.purol.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update the ccAFU recommendations for the management of bladder tumours that do not infiltrate the bladder muscle (NBMIC). METHODS A systematic review (Medline) of the literature from 2020 to 2022 was performed, taking account of the diagnosis, treatment options and surveillance of NMIBC, while evaluating the references with their levels of evidence. RESULTS The diagnosis of NMIBC (Ta, T1, CIS) is made after complete full-thickness tumour resection. The use of bladder fluorescence and the indication of a second look (4-6 weeks) help to improve the initial diagnosis. The EORTC score is used to assess the risk of recurrence and/or tumour progression. Through the stratification of patients in low, intermediate and high-risk categories, adjuvant treatment can be proposed: intravesical chemotherapy (immediate postoperative, initiation regimen) or BCG (initiation and maintenance regimen) instillations, or even the indication of cystectomy for BCG-resistant patients. CONCLUSION Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and treatment of NMIBC.
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Affiliation(s)
- Y Neuzillet
- Service d'Urologie, hôpital Foch, Université Paris Saclay, Suresnes, France.
| | - B Pradère
- Service d'Urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - E Xylinas
- Service d'Urologie, Hôpital Bichat-Claude Bernard AP-HP, Université Paris Cité, Paris, France
| | - Y Allory
- Service d'Anatomopathologie, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - F Audenet
- Service d'Urologie, Hôpital Européen Georges-Pompidou AP-HP Centre, Université Paris Cité, Paris, France
| | - Y Loriot
- Service d'Oncologie Médicale, Institut Gustave Roussy, Villejuif, France
| | - A Masson-Lecomte
- Service d'Urologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - M Roumiguié
- Service d'Urologie, CHU de Toulouse, UPS, Université de Toulouse, Toulouse, France
| | - T Seisen
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - O Traxer
- Sorbonne Université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, Urologie, Hôpital Tenon, 75020 Paris, France
| | - P Leon
- Service d'Urologie, clinique Pasteur, Royan, France
| | - M Roupret
- Sorbonne Université, GRC 5 Predictive Onco-Uro, AP-HP, Urologie, Hôpital Pitié-Salpetrière, 75013 Paris, France
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11
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Robotic versus open cystectomy with ileal conduit for the management of neurogenic bladder: a comparative study. World J Urol 2022; 40:2963-2970. [DOI: 10.1007/s00345-022-04190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/06/2022] [Indexed: 12/01/2022] Open
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12
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Jouma Alhejazi T, Bdeiwi H, Sukkari MW, Ibrahim M, Sukari A, Alloush H. Femoral metastasis in previously treated bladder cancer patient: A case report. Clin Case Rep 2022; 10:e6357. [PMID: 36177084 PMCID: PMC9474905 DOI: 10.1002/ccr3.6357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Although treated appropriately, bladder cancer can recur and metastasize. We are reporting the case of a patient with a well‐cured bladder cancer who presented after 14 months with femoral pain which turned out to be a bony metastasis. The patient underwent surgical excision followed by chemotherapy. Secondary bone metastases from a primary transitional carcinoma in the bladder are very rare. In this case, we present a femoral metastasis from a primary urothelial carcinoma in the bladder that had been successfully treated 14 months earlier.
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Affiliation(s)
| | - Hassan Bdeiwi
- Faculty of Medicine University of Aleppo Aleppo Syria
| | | | | | - Ammar Sukari
- Department of Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Hani Alloush
- Department of Orthopedic Surgery Faculty of Medicine, Aleppo University Hospital, University of Aleppo Aleppo Syria
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13
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Bladder Cancer in Neurogenic Patients. World J Urol 2022; 40:1895-1896. [PMID: 35802141 DOI: 10.1007/s00345-022-04089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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14
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Cancrini F, Michel F, Cussenot O, Alshehhi H, Comperat E, Phé V. Bladder carcinomas in patients with neurogenic bladder and urinary schistosomiasis: are they the same tumors? World J Urol 2022; 40:1949-1959. [PMID: 35091808 DOI: 10.1007/s00345-022-03941-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of our study was to evaluate and compare the expression of different immunohistochemical markers in Bladder Carcinomas (BC) in patients with Neurogenic Bladder (NB) and Urinary Schistosomiasis (US) infection. MATERIALS AND METHODS We collected tissue samples from patients with Neurogenic Bladder and Bladder Carcinoma (NBC Group) and from patients with Urinary Schistosomiasis infection and Bladder Carcinoma (SBC Group). We compared to these two groups to control samples from resection from patients with Urinary Schistosomiasis without Bladder Carcinoma (US Group); we also investigate patients' characteristics according to urothelial transitional cell carcinoma (TCC), and squamous cell carcinoma (SCC) histopathological differentiation. The expression of markers in all groups (CK7, CK14, CK20, FoxP3, GATA3, STAG2, CD3, CD8, Ki67, and P53) was analyzed using immunohistochemistry of tissue micro-array sections (TMA). RESULTS Overall, 136 patients were included in the study (n = 72 in the NBC group, n = 33 in the SBC group, and n = 31 in the US group). In the TCC subgroup, the expression of CK7, CK14, CK20, and Ki67 was significantly higher compared to US controls (p 0.002; p < 0.001; p 0.036; p < 0.001). In the SCC subgroup, the expression of CK7, CK14, and CK20 was significantly higher compared to US controls (p 0.007; p < 0.001; p 0.005). Both in TCC and SCC subgroups, no difference in the expression of any tested markers was found comparing NBC and SBC groups. In US group, a significant higher expression of STAG2 was found compared to SCC subgroup (p 0.005). CONCLUSION Based on our results, the profile of immunohistochemical biomarkers' expression in both NBC and SBC groups is similar.
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Affiliation(s)
- Fabiana Cancrini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza Univeristà di Roma, Sant 'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy. .,Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Floriane Michel
- Department of Urology and Kidney Transplantation, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, La Conception Hospital, Marseille, France.,Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Cussenot
- Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hussa Alshehhi
- Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pathology, Tenon Hospital, AP-HP. Sorbonne University, Paris, France
| | - Eva Comperat
- Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pathology, Tenon Hospital, AP-HP. Sorbonne University, Paris, France
| | - Véronique Phé
- Sorbonne University, GRC n°5, ONCOTYPE-URO, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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15
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Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med 2022; 12:968. [PMID: 35743752 PMCID: PMC9225534 DOI: 10.3390/jpm12060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 12/14/2022] Open
Abstract
Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management. The kidneys and the ureters, representing the upper urinary tract system, can be at risk related to dyssynergy between the urethral sphincters and high pressures that lead to potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD). Recent guidelines for diagnosis, evaluation, treatment and follow up of the neurogenic bladder will be reviewed and options provided for risk stratification and management. Mechanical, pharmacological, neurolysis and surgical management will be discussed.
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Affiliation(s)
| | | | - Katherine Amin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Raveen Syan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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16
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Böthig R, Schöps W, Zellner M, Fiebag K, Kowald B, Kurze I, Böhme H, Kadhum T, Golka K. [Urinary Bladder Cancer as a Long-term Sequela of Spinal Cord Injury - Relevance to Practice]. Aktuelle Urol 2022; 53:137-147. [PMID: 34933348 DOI: 10.1055/a-1684-9870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Urinary bladder cancer is the second most common tumour disease after lung cancer leading to death in people with a spinal cord injury. This paper provides a comprehensive overview of the differences relevant to urologists between urinary bladder tumours in this population compared with urinary bladder tumours in the general population.People with a spinal cord injury are 1 to 2 decades younger on average at the time of tumour diagnosis than patients without a spinal cord injury. Histopathologic findings at the initial diagnosis of urinary bladder cancer in people with a spinal cord injury are much less favourable than for urinary bladder cancers in the general population. Muscle-invasive tumours and tumours with poor differentiation are much more common, and the proportion of squamous cell carcinomas is significantly higher. The incidence rises after more than 10 years of paralysis. Urinary bladder cancer mortality is significantly elevated and increases with the duration of paralysis. In diagnostic procedures and, in particular, in radical cystectomy, clinically important features have to be considered. For example, urodynamic examinations or cystoscopy may trigger autonomic dysreflexia with hypertensive crises and the risk of life-threatening bradycardia.In the case of radical cystectomy, frequent adhesions and callosities of the urinary bladder, among other things, must be taken into account intraoperatively. Severe paralysis, prolonged intestinal atony and other conditions are frequently observed after the surgical procedure due to neurogenic bowel dysfunction. Correct positioning of the patient immediately after surgery to avoid decubitus and to support breathing, as well as bowel management specific to spinal cord injury, must be strictly observed.Other special features of paraplegic patients with urinary bladder cancer that should also be considered in clinical practice, as well as considerations for screening for urinary bladder tumors, are presented in the article.
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Affiliation(s)
- Ralf Böthig
- Neuro-Urologie, BG Klinikum Hamburg, Hamburg, Germany
| | | | - Michael Zellner
- Abteilung Urologie und Neurourologie, Johannesbad Fachklinik Bad Füssing, Bad Füssing, Germany
| | - Kai Fiebag
- Neuro-Urologie, BG Klinikum Hamburg, Hamburg, Germany
| | | | - Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
| | - Holger Böhme
- Klinik für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Thura Kadhum
- Abt. Psychosomatische Medizin, Mittelrhein-Klinik Fachklinik für psychosomatische Rehabilitation, Boppard - Bad Salzig, Germany
| | - Klaus Golka
- Klinische Arbeitsmedizin, Leibniz-Institut für Arbeitsforschung an der TU Dortmund, Dortmund, Germany
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17
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Incidence of bladder cancer in neuro-urological patients in France: a nationwide study. World J Urol 2022; 40:1921-1927. [PMID: 35182207 DOI: 10.1007/s00345-022-03955-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/30/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the incidence of bladder cancer (BCa) in patients with the main neurological diseases that induce neurogenic lower urinary tract dysfunction, namely, multiple sclerosis (MS), spinal cord injury (SCI) and spina bifida (SB). METHODS We conducted a retrospective analysis of nationwide data from the French Hospital Discharge Database (PMSI) from January 2010 to December 2018. The incidence of BCa was calculated in patients with MS, SCI and SB. Incidence, sex, age, radical cystectomy after BCa diagnosis and in-hospital deaths were compared between the three groups. The Chi2 and Kruskal-Wallis tests were used for qualitative and quantitative data comparisons, respectively. RESULTS Overall, 2015 neuro-urological patients (mean (± SD) age: 65.4 ± 12.3 years) were hospitalized in France between 2010 and 2018 with a new diagnosis of BCa. In neuro-urological patients, BCa was more frequent in men than in women (sex ratio: 3.08). The incidence of BCa in neuro-urological patients was 174.9/100,000 persons/year. The incidence of BCa was 791.1/100,000 persons/year in SCI compared to 56.6 in MS and 113.8 in SB (p < 0.0001). After the initial diagnosis of BCa, 551 (27.3%) patients underwent a radical cystectomy and 613 (30.4%) died in hospital after BCa diagnosis. CONCLUSIONS The incidence of BCa in France between 2010 and 2018 was 174.9/100 000 persons/year, and was particularly high in patients with SCI.
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18
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Michel F, Cancrini F, Cancel-Tassin G, Gamé X, Huyghe E, Rock A, Léon G, Uzan A, Desfemmes FR, Peyronnet B, Fallot J, Léon P, Rolland E, Perrouin-Verbe MA, Wodey J, Capon G, Karsenty G, Rouprêt M, Cussenot O, Alshehhi H, Comperat E, Phé V. A study of the immunohistochemical profile of bladder cancer in neuro-urological patients by the French Association of Urology. World J Urol 2022; 40:1939-1947. [PMID: 35138436 DOI: 10.1007/s00345-022-03942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To establish whether the expression of markers of cell differentiation (CK7, CK14, CK20, GATA3), apoptosis (p53), proliferation (Ki67, STAG2) and peri-tumoural lymphocytes (CD3, CD8), provides specific information about urothelial carcinogenesis in neuro-urological patients with bladder cancer (NBC). METHODS Tissue samples from NBC were retrieved from 15 centres in France and compared to control samples from non neuro-urological patients with bladder cancer (NNBC) and from neuro-urological patients without bladder cancer (NB). The expression of CK7, CK14, CK20, GATA3, p53, Ki67, STAG2, CD3 and CD8 markers was analysed using immunohistochemistry of tissue microarray sections. RESULTS Overall, tissue samples from 124 patients were included in the study (n = 72 NBC, n = 26 NNBC and n = 26 NB). Muscle invasive bladder cancer (MIBC) was found in 52 NBC patients (72.2%) and squamous cell differentiation in 9 (12.5%). In NBC samples, the expression of CK20 and GATA3 was significantly more frequent in NMIBC compared to MIBC (p = 0.015 and p = 0.004, respectively). CK20 and GATA3 were significantly more expressed in NBC compared to NNBC (p < 0.001 and p = 0.010, respectively). The expression of CK14, Ki67, CD3 and CD8 was significantly more frequent in NBC than in NNBC samples (p = 0.005, p < 0.001, p < 0.001 and p < 0.001, respectively). The expression of CD3 and CD8 was similar in NBC and NB samples. CONCLUSION In NBC, markers of basal differentiation, proliferation and peri-tumoural lymphocytes were significantly more expressed compared to NNBC controls. These results suggest the aggressiveness of NBC and the role of chronic inflammation in the carcinogenesis of bladder cancer in neuro-urological patients.
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Affiliation(s)
- Floriane Michel
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 Boulevard Baille, 13005, Marseille, France. .,Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Fabiana Cancrini
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Géraldine Cancel-Tassin
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Gamé
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Eric Huyghe
- Department of Urology, CHU Rangueil, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Aurélien Rock
- Department of Urology, Groupe Hospitalier de L'Institut Catholique Lillois, Lille, France
| | - Grégoire Léon
- Department of Urology and Transplantation, CHU de Caen, Caen, France
| | - Audrey Uzan
- Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Jérémy Fallot
- Department of Urology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Priscilla Léon
- Department of Urology, Clinique Urologie Royan, Royan, France
| | | | | | - Jacques Wodey
- Department of Urology, Clinique Rhône Durance, Avignon, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Hospital, Assistance Publique-Hôpitaux de Marseille, 147 Boulevard Baille, 13005, Marseille, France
| | - Morgan Rouprêt
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Cussenot
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hussa Alshehhi
- Department of Pathology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eva Comperat
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pathology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Sorbonne University, GRC5 Predictive Onco-urology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Urology, Sorbonne University, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Sbizzera M, Descotes F, Arber T, Neuville P, Ruffion A. Bladder cancer detection in patients with neurogenic bladder: are cystoscopy and cytology effective, and are biomarkers pertinent as future diagnostic tools? A scoping review. World J Urol 2022; 40:1897-1913. [PMID: 35119523 DOI: 10.1007/s00345-022-03943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To summarize the current state of knowledge on bladder cancer diagnosis and screening in neurogenic bladder patients, and to explore the potential contribution of biomarkers in this context. METHODS A scoping review was performed to retrieve cystoscopy and urinary cytology performance for bladder cancer detection in neurogenic bladder patients. We also retrieved information of certified urinary biomarkers in bladder cancer detection and their potential application for this specific population. RESULTS A total of 1092 articles were identified; 19 of them were included in the scoping review regarding cytology and cystoscopy performance in patients with neurogenic bladder and 33 were included as related to biomarkers in bladder cancer. No significant study stood out to recommend bladder cancer screening in this specific population using cytology and cystoscopy because of the scarcity of results, low level-of-evidence studies, and lack of studies specifically designed to assess the test performance in this population. Two biomarkers were retained as potential future diagnostic tools: FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection. CONCLUSION There is no sufficient quality data to support cystoscopy and urinary cytology as effective tools for the diagnostic and surveillance of bladder cancer in neurogenic bladder patients. FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection, stand out as candidates of interest for bladder cancer detection in this specific population and should be prospectively tested.
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Affiliation(s)
- Marc Sbizzera
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France.
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Françoise Descotes
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
| | - Théo Arber
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
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20
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Special surgical aspects of radical cystectomy in spinal cord injury patients with bladder cancer. World J Urol 2022; 40:1961-1970. [PMID: 35092468 DOI: 10.1007/s00345-022-03939-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/09/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Radical cystectomy in people with spinal cord injury (SCI) provides numerous additional difficulties, compared to able-bodied people. Therefore, it is important to obtain information from an experienced team about optimally managing these patients. METHODS Surgical procedures, based on the experience of 12 radical cystectomies in SCI patients with bladder cancer between January 1st, 2001, and December 31st, 2020, were recorded and the operative and perioperative clinical data were evaluated. Surgery was performed in a high-volume center by the surgeon most experienced in radical cystectomies, assisted by the neuro-urologist, involved in the care of the patient from the spinal cord center. Furthermore, a checklist based on the experience of the surgeon and the assisting neuro-urologist was developed. RESULTS SCI patients mostly suffered from an advanced disease and were always operated by the same team. The hospital stays ranged from 23 to 134 days (median 42 days). Four of the patients suffered from a postoperative paralytic ileus. Otherwise, both the operation time and the intraoperative blood loss as well as intraoperative and postoperative complications were basically comparable with those in able-bodied patients. The special features of radical cystectomy in SCI bladder cancer patients are described. Furthermore, a checklist addressing preoperative red flags, intra-operative challenges and post-operative challenges is presented. CONCLUSION Radical cystectomy in SCI patients should be performed in a high-volume department by the most experienced surgical team. The inclusion of the urologist caring for the patient from the spinal cord injury center is highly recommended.
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21
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Mühlbauer J, Klotz D, Büttner S, Stein R, Younsi N. Bladder cancer in patients with neurogenic bladder disorder: a comparative study of different etiologies. World J Urol 2022; 40:1929-1937. [PMID: 35034168 DOI: 10.1007/s00345-021-03922-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The objective of this study was to conduct a comparative study of different etiologies of neurogenic bladder disorders (NBDs) in patients with bladder cancer (BC) regarding patient- and tumor-related parameters and their oncological outcome. METHODS Out of 98 patients with bladder tumors and neurogenic disease, 23 patients with BC and NBDs from Jan 1, 2010, to Dec 31, 2020, were included. The different etiologies of NBDs were merged in three groups based on the level of the nervous system (NS)-lesion: (i) central (n = 6), (ii) spinal cord (n = 10), and (iii) peripheral lesions (n = 7). RESULTS Patients with lesions at the spinal cord level were younger at the time of BC diagnosis compared to patients with central or peripheral NS lesions (54 vs. 68 vs. 78 years, p = 0.0219). However, the latency to malignant transformation was more than twice as long (33 vs. 15 years, p = 0.0108). Most tumors were muscle-invasive or locally advanced BCs (62%) and presented lymph node metastases (55%), resulting in a poor mean overall survival of 30.9 ± 3.6 months. No significant differences regarding histopathology, tumor stage, and oncological outcome could be observed between the groups. CONCLUSION Patients with NBDs have a poor prognosis regardless of their etiology or the level of NS lesion. Patients with spinal cord lesions, including congenital NBDs, appear to develop BC at a young age, but compared to other etiologies latency from NBD to BC is longer.
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Affiliation(s)
- Julia Mühlbauer
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - David Klotz
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sylvia Büttner
- Department for Biomathematics and Medical Statistics, Faculty of Medicine Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Raimund Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nina Younsi
- Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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22
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Squamous cell carcinoma of the renal pelvis in a patient with long-term spinal cord injury-a case report. Spinal Cord Ser Cases 2021; 7:102. [PMID: 34845202 DOI: 10.1038/s41394-021-00466-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/27/2021] [Accepted: 11/16/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION For individuals with spinal cord injury/disease (SCI/D) the risk of developing a stone in the upper urinary tract is up to six times higher than in the able-bodied population. Upper urinary tract carcinomas, in general, are rare and account for only 5-10% of all urinary tract carcinomas. It is believed that chronic upper urinary tract irritation caused by e.g., kidney stones or recurrent upper urinary tract infections may be associated with an increased risk of renal squamous cell carcinoma (RSCC). CASE PRESENTATION We report on a 64-year-old male who suffered a spinal cord injury in 1981 resulting in a complete sensory and motor impairment below T6, AIS A. Recurrent left-sided kidney stone disease had to be treated repeatedly from 1984 onwards. Despite repeated surgical attempts, it was ultimately not possible to achieve stone clearance in the long term. Within the concept of life-long surveillance of SCI/D, the patient was examined regularly, including ultrasound examinations of the kidneys. Six months after the last control examination, the patient was admitted to our hospital with a locally advanced tumor of the left kidney, so that only the option of palliative treatment remained. Histologically an RSCC was found. DISCUSSION As people with SCI/D have a higher risk of developing kidney stones, it is of utmost importance to check regularly for stone disease and, if necessary, treat with the aim of long-term stone clearance in order to protect renal function and to avert potentially malignant changes at an early stage.
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23
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Clark C, Haslam C, Malde S, Panicker JN. Urinary catheter management: what neurologists need to know. Pract Neurol 2021; 21:504-514. [PMID: 34753810 DOI: 10.1136/practneurol-2020-002772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.
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Affiliation(s)
- Calum Clark
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK .,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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24
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Hird AE, Saskin R, Liu Y, Lee Y, Ajib K, Matta R, Kodama R, Carr L, Kulkarni GS, Herschorn S, Narod SA, Nam RK. Association between chronic bladder catheterisation and bladder cancer incidence and mortality: a population-based retrospective cohort study in Ontario, Canada. BMJ Open 2021; 11:e050728. [PMID: 34475180 PMCID: PMC8413958 DOI: 10.1136/bmjopen-2021-050728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To compare the risk of bladder cancer and bladder cancer mortality among patients with chronic bladder catheterisation (indwelling or intermittent) to patients from the general population. DESIGN Retrospective cohort study. SETTING Population-based study in Ontario, Canada between 2003 and 2018. PARTICIPANTS Adult patients 18-90 years of age with chronic bladder catheterisation were hard matched to patients from the general population without a history of bladder catheterisation. INTERVENTIONS The presence of a chronic catheter was defined as a minimum of two physician encounters for bladder catheterisation, suprapubic tube insertion or home care for catheter care separated by at least 28 days. Urinary tract infection (UTI) rates were collected. MAIN OUTCOME MEASURES Bladder cancer and bladder cancer-specific mortality after a 1-year lag period were compared between groups. RESULTS We identified 36 903 patients with chronic catheterisation matched to 110 709 patients without a history of catheterisation. Patients were followed for a median of 8.8 years (IQR: 5.2-11.9 years). The median age was 62 years (IQR: 50-71) and 52% were female. More patients in the catheter group developed bladder cancer (393 (1.1%) vs 304 (0.3%),p<0.001). There were 106 (0.3%) bladder cancer deaths in the catheter group and 59 (0.1%) in the comparison group (p<0.001). Chronic catheterisation (adjusted subdistribution HR (sdHR)=4.80, 95% CI: 4.26 to 5.42,p<0.001) and the number of UTIs (adjusted sdHR=1.04 per UTI, 95% CI: 1.04 to 1.05,p<0.001) were independent predictors of bladder cancer. The relative rate of bladder cancer-specific death was more than eightfold higher among patients with chronic catheterisation (adjusted sdHR=8.68, 95% CI: 6.97 to 10.81,p<0.001). Subgroup analysis among patients with neurogenic bladder and bladder calculi similarly revealed an increased risk of bladder cancer diagnosis and mortality. Bladder cancer risk was highest among patients in the two longest catheter duration quintiles (2.9-5.9 and 5.9-15.5 years). CONCLUSIONS This is the first study to quantify the increase in bladder cancer incidence and mortality in a large, diverse cohort of patients with chronic indwelling or intermittent bladder catheterisation. The risk was highest among patients with a chronic catheter beyond 2.9 years.
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Affiliation(s)
- Amanda E Hird
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Refik Saskin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ying Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Yuna Lee
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Khaled Ajib
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rano Matta
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ronald Kodama
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Carr
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, University Health Network, Toronto, Ontario, Canada
| | - Sender Herschorn
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Toronto, Ontario, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Robert K Nam
- Division of Urology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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25
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Welk B. The argument against screening for bladder cancer in neuro-urological patients. World J Urol 2021; 40:1915-1919. [PMID: 34410468 DOI: 10.1007/s00345-021-03802-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The objective of this article was to present the case against screening people with neuro-urological disease for bladder cancer. METHODS Literature around bladder cancer in neuro-urological patients (primarily spinal cord injured patients [SCI]) was identified. RESULTS Bladder cancer is more common among patients with spinal cord injury, although the absolute risk is still low (between 0.3 and 0.6%). It is generally an aggressive disease, with atypical pathologic subtypes, and a high risk of mortality. It usually presents 15-30 years after SCI, and chronic inflammation of the bladder (due to catheters and urinary infections) may be risk factors. The debate about whether these patients should be screened for bladder cancer has persisted in the literature, and many physicians have justified a yearly cystoscopy as means of screening for bladder cancer. However, when examining the limited direct evidence of screening for bladder cancer, and the requirements for a screening test, it does not appear that bladder cancer screening is a rationale undertaking due to the low incidence, and unclear natural history. However, urologists should continue to be vigilant and appropriately investigate patients with high-risk symptoms such as hematuria, frequent UTIs, scrotal infection, or urethral discharge. CONCLUSION The current literature does not support screening patients with SCI for bladder cancer; however, physicians should have a high-evel of suspicion for symptoms suggestive of bladder cancer, and evaluate these at-risk patients promptly.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics (Urologist), Western University, Room B4-667, St Joseph's Health Care, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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26
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Golka K, Böthig R, Jungmann O, Forchert M, Zellner ME, Schöps W. [Occupational cancers in urology]. Urologe A 2021; 60:1061-1072. [PMID: 34241641 DOI: 10.1007/s00120-021-01597-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Cancers can be triggered by occupational causes. In the field of urology, bladder cancer is by far the most frequent occupationally induced tumor disease. Causes are particularly carcinogenic aromatic amines and carcinogenic polycyclic aromatic hydrocarbons. The frequency of this disease has shifted over the last decades from the classical hazard in the chemical industry to the users. Among a variety of hazardous occupations, hairdressers and painters are the best known. Rarely, renal cell carcinoma can be triggered by high trichloroethylene exposure and mesothelioma of the tunica vaginalis testis by asbestos. If a disease that can be caused by occupational activities has been confirmed (e.g. urinary bladder cancer), the risk factors must be recorded by a complete occupational history from the first employment on in order to be able to report a suspected occupational disease. In addition, spinal cord injury due to occupational and commuting accidents can lead to urinary bladder cancer over the long term.
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Affiliation(s)
- Klaus Golka
- Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Ardeystr. 67, 44139, Dortmund, Deutschland.
| | - Ralf Böthig
- Abteilung Neuro-Urologie, BG Klinikum Hamburg, Hamburg, Deutschland
| | - Olaf Jungmann
- Urologische Klinik Lindenthal, Malteser Krankenhaus St. Hildegardis, Köln, Deutschland
| | - Martin Forchert
- Stabsstelle UV-Recht, Berufsgenossenschaft Holz und Metall, Bielefeld, Deutschland
| | - Micha El Zellner
- Abteilung Urologie und Neurourologie, Johannesbad Fachklinik, Bad Füssing, Deutschland
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27
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Böthig R, Kowald B, Fiebag K, Balzer O, Tiburtius C, Thietje R, Kadhum T, Golka K. Bladder management, severity of injury and period of latency: a descriptive study on 135 patients with spinal cord injury and bladder cancer. Spinal Cord 2021; 59:971-977. [PMID: 34140636 PMCID: PMC8210732 DOI: 10.1038/s41393-021-00651-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022]
Abstract
Study design Longitudinal study. Objectives To describe the severity of spinal cord injury/disease (SCI/D), type and management of neurogenic lower urinary tract dysfunction, tumor characteristics, and bladder cancer latency period in SCI/D patients. Setting Spinal cord injury centers in Germany, Austria, and Switzerland. Methods Data of SCI/D patients diagnosed with bladder cancer were collected between Jan 2012–Dec 2019 in the course of annual surveys in the neuro-urological departments of all 28 centers. Demographic and paralysis-specific data, data on the type and management of neurogenic lower urinary tract dysfunction, and histopathological tumor characteristics were collected. Results Regarding histopathological tumor characteristics, no significant differences were found in 135 individuals with SCI/D when stratified for bladder management without chronic catheterization, SCI/D severity, and ASIA classification. The mean latency period between the onset of SCI/D and the diagnosis of bladder cancer was significantly longer in patients with catheter-free emptying methods compared to patients with intermittent catheterization, and in patients with LMNL (Lower Motor Neuron Lesion) compared to patients with UMNL (Upper Motor Neuron Lesion). Conclusions Urinary bladder carcinomas are late events in the long-term course of SCI/D. Follow-up and approaches to screening must therefore be intensified with increasing duration of long-term SCI.
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Affiliation(s)
- Ralf Böthig
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany.
| | - Birgitt Kowald
- Biomechanical Laboratory, BG Klinikum Hamburg, Hamburg, Germany
| | - Kai Fiebag
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany
| | - Oliver Balzer
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany
| | - Christian Tiburtius
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany
| | - Roland Thietje
- Centre for Spinal Cord Injuries, BG Klinikum Hamburg, Hamburg, Germany
| | - Thura Kadhum
- Specialist Clinic for Psychosomatic Rehabilitation, Mittelrheinklinik, Boppard-Bad Salzig, Germany
| | | | - Klaus Golka
- Clinical Occupational Medicine, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
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28
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Böthig R, Tiburtius C, Schöps W, Zellner M, Balzer O, Kowald B, Hirschfeld S, Thietje R, Pietsch A, Kurze I, Forchert M, Kadhum T, Golka K. Urinary bladder cancer as a late sequela of traumatic spinal cord injury. Mil Med Res 2021; 8:29. [PMID: 33910625 PMCID: PMC8082770 DOI: 10.1186/s40779-021-00322-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is also a combat-related injury that is increasing in modern warfare. The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge, and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI. METHODS A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients. General patient information, latency period, age at initial diagnosis, type of bladder management and survival of SCI patients with bladder cancer were collected and analysed. T category, grading and tumour entity in these patients were compared with those in the general population. Relevant bladder cancer risk factors in SCI patients were analysed. Furthermore, relevant published literature was taken into consideration. RESULTS Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years (SD ± 10.7 years), i.e., approximately 20 years earlier as compared with the general population. These bladder cancers are significantly more frequently muscle invasive (i.e., T category ≥ T2) and present a higher grade at initial diagnosis. Furthermore, SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis. Consequently, the survival time is extremely unfavourable. A very important finding, for practical reasons is that, in the Hamburg study as well as in the literature, urinary bladder cancer is more frequently observed after 10 years or more of SCI. Based on these findings, a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSIONS The results showed that urinary bladder cancer in SCI patients differs considerably from that in able-bodied patients. The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.
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Affiliation(s)
- Ralf Böthig
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany.
| | - Christian Tiburtius
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | | | - Michael Zellner
- Department of Urology and Neuro-Urology, Johannesbad Fachklinik, 94072, Bad Füssing, Germany
| | - Oliver Balzer
- Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - Birgitt Kowald
- Biomechanical Laboratory, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - Sven Hirschfeld
- Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - Roland Thietje
- Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - Aki Pietsch
- Department of Sports and Rehabilitation Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany
| | - Ines Kurze
- Department of Paraplegiology and Neuro-Urology, Centre for Spinal Cord Injuries, Zentralklinik Bad Berka, 99437, Bad Berka, Germany
| | - Martin Forchert
- Staff Position Accident Insurance Law, Statutory Accident Insurance for Wood and Metal (BGHM), 33602, Bielefeld, Germany
| | - Thura Kadhum
- Department of Psychosomatic Rehabilitation, Mittelrheinklinik Fachklinik, 56154, Boppard-Bad Salzig, Germany
| | - Klaus Golka
- Clinical Occupational Medicine, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), 44139, Dortmund, Germany
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29
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Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider's Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:108-115. [PMID: 32760189 DOI: 10.46292/sci2602-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.
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Affiliation(s)
- James Milligan
- The Centre for Family Medicine, Kitchener, Ontario, Canada.,McMaster University Department of Family Medicine, Hamilton, Ontario, Canada
| | - Lance L Goetz
- Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Michael J Kennelly
- Carolinas Rehabilitation, Charlotte, North Carolina.,Atrium Health, Charlotte, North Carolina
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Abstract
PURPOSE OF REVIEW To review recent literature related to urologic malignancies in patients with neurogenic lower urinary tract dysfunction (NLUTD). We performed a literature search of electronic databases (PubMed, ScienceDirect, Scopus, and CIANHL), with a focus on articles published between January 2015 and December 2019. RECENT FINDINGS Recent reports demonstrate a lower incidence of bladder cancer in the NLUTD population than previously found, although still significantly higher than the general population. Bladder cancer in patients with NLUTD is usually diagnosed at a younger age, and is associated with higher rates of squamous cell cancer, a higher stage at presentation, and increased mortality. Evidence for screening for bladder cancer in NLUTD is conflicting, with no formal protocols proven for general use. NLUTD has been shown to have a lower rate of prostate cancer, and may be associated with an earlier diagnosis of renal cancer. SUMMARY Genitourinary malignancies, although still rare, are an important source of morbidity and mortality in patients with NLUTD. Physicians should recognize that bladder cancer in NLUTD is often a lethal disease. Further research is needed to assist physicians with early recognition of these malignancies to improve patient outcomes.
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31
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Milligan J, Burns S, Groah S, Howcroft J. A Primary Care Provider's Guide to Preventive Health After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:209-219. [PMID: 33192049 DOI: 10.46292/sci2603-209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: Provide guidance for preventive health and health maintenance after spinal cord injury (SCI) for primary care providers (PCPs). Main message: Individuals with SCI may not receive the same preventive health care as the general population. Additionally, SCI-related secondary conditions may put their health at risk. SCI is considered a complex condition associated with many barriers to receiving quality primary care. Attention to routine preventive care and the unique health considerations of persons with SCI can improve health and quality of life and may prevent unnecessary health care utilization. Conclusion: PCPs are experts in preventive care and continuity of care, however individuals with SCI may not receive the same preventive care due to numerous barriers. This article serves as a quick reference for PCPs.
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Affiliation(s)
- James Milligan
- The Centre for Family Medicine, Kitchener, Ontario, Canada
| | - Stephen Burns
- SCI Service, VA Puget Sound Health Care System, Seattle, Washington.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Suzanne Groah
- MedStar National Rehabilitation Hospital, Washington, DC
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32
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Santiago JE, Cameron AP, Navarrete RA. Addressing Sphincter Dysfunction in the Female with Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sampogna G, Maltagliati M, Galfano A, Bocciardi A, Rocco B, Micali S, Montanari E, Spinelli M. Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder. Spinal Cord Ser Cases 2020; 6:61. [PMID: 32647234 DOI: 10.1038/s41394-020-0302-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB). SETTING An Italian tertiary referral center for NB. METHODS We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019. RESULTS We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months. CONCLUSIONS BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage.
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Affiliation(s)
- Gianluca Sampogna
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, MI, Italy.,Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, MI, Italy
| | - Matteo Maltagliati
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile Sant'Agostino-Estense, Università degli Studi di Modena e Reggio Emilia, Baggiovara, MO, Italy
| | - Antonio Galfano
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, MI, Italy
| | - Aldo Bocciardi
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, MI, Italy
| | - Bernardo Rocco
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile Sant'Agostino-Estense, Università degli Studi di Modena e Reggio Emilia, Baggiovara, MO, Italy
| | - Salvatore Micali
- Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile Sant'Agostino-Estense, Università degli Studi di Modena e Reggio Emilia, Baggiovara, MO, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, MI, Italy
| | - Michele Spinelli
- Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, MI, Italy.
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Bladder cancer in patients with spina bifida: a serious risk. World J Urol 2020; 39:1531-1537. [PMID: 32632554 DOI: 10.1007/s00345-020-03338-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE After bladder augmentation (BA) using bowel segments, it is known that there is a risk for secondary malignancies. It remains unclear whether this also applies to spina bifida (SB) patients without BA. The aim of this study was to analyze the frequency of bladder cancer (BC) in SB at a single tertiary institution and assess the patients' oncologic outcome. METHODS Patients with SB and BC treated from January 2016 until March 2020 were included and corresponding data were collected retrospectively. Endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Among 132 adult patients with SB, four with a median age of 34.5 years (IQR 31.5-36.8, range 31-37) had a BC. None of the patients had undergone BA. Most common symptoms included recurrent urinary tract infections (UTI) (75%) and hydronephrosis (75%). At the time of the diagnosis, tumors were locally advanced (≥ T3) and lymph-node positive in all cases. All patients underwent radical cystectomy with adjuvant chemotherapy in two out of four cases. Histology showed squamous cell carcinomas (SCC) or at least a squamous cell component in all patients. The median PFS was 5.9 months (IQR 5.1-124.5) and the median OS was 8.7 months (IQR 6.3-125.5). CONCLUSIONS SCC in SB can appear at a young age and is usually diagnosed in an advanced tumor stage with poor prognosis despite radical surgical resection. Patients with SB without BA with clinical symptoms, new onset of hematuria, and/or upper tract dilatation should receive a cystoscopy ± further imaging.
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Böthig R, Schöps W, Zellner M, Fiebag K, Kowald B, Hirschfeld S, Thietje R, Kurze I, Böhme H, Kaufmann A, Jungmann O, Zumbé J, Porres D, Lümmen G, Nehiba M, Kadhum T, Forchert M, Golka K. [Urinary bladder cancer as a late sequela of spinal cord injury : Decision-making aids for assessment of this causal association]. Urologe A 2020; 59:700-709. [PMID: 32020241 DOI: 10.1007/s00120-020-01124-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is to date no convincing literature that has assessed the association between traumatic spinal cord injury (SCI) and the later development of urinary bladder cancer. The aim of this work is to present medical experts as well as the national accident insurance and the social courts decision-making aids based on the latest medical scientific knowledge, for assessment of this causal association. MATERIALS AND METHODS A study conducted between April 1998 and March 2017 in the BG Trauma Hospital Hamburg forms the basis for the decision-making aids. Urinary bladder cancer was diagnosed in 32 out of 6432 treated outpatient and inpatient SCI patients. Furthermore, relevant published literature was taken into consideration for the decision-making aids. RESULTS It was found that urinary bladder cancer in SCI patients occurs at a considerably younger age as compared to the general population, more frequently shows muscle invasive carcinoma with a higher grade at first diagnosis and a higher proportion of the more aggressive squamous cell carcinoma than that of the general population. Correspondingly, the survival time is extremely unfavorable. For medical experts a matrix was compiled where the various influencing factors, either for or against the recognition of an association between SCI and urinary bladder cancer, were weighted according to their relevance. CONCLUSION The results showed that urinary bladder cancer in SCI patients differs considerably from that of able-bodied patients. These differences drastically shorten the survival time. A study on patients with spina bifida, i.e., a congenital spinal cord disorder, corroborates these observations. They indicate histopathological differences that have so far been intangible.
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Affiliation(s)
- R Böthig
- Abteilung Neuro-Urologie, Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland.
| | | | - M Zellner
- Abteilung für Urologie und Neuro-Urologie, Johannesbad Fachklinik, Bad Füssing, Deutschland
| | - K Fiebag
- Abteilung Neuro-Urologie, Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland
| | - B Kowald
- Biomechanisches Labor, BG Klinikum Hamburg, Hamburg, Deutschland
| | - S Hirschfeld
- Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Hamburg, Deutschland
| | - R Thietje
- Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Hamburg, Deutschland
| | - I Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka, Bad Berka, Deutschland
| | - H Böhme
- Klinik für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - A Kaufmann
- Zentrum für Kontinenz und Neuro-Urologie, Krankenhaus St. Franziskus, Kliniken Maria Hilf GmbH, Mönchengladbach, Deutschland
| | - O Jungmann
- Urologische Klinik Lindenthal, Malteser Krankenhaus St. Hildegardis, Köln, Deutschland
| | - J Zumbé
- Klinik für Urologie, Klinikum Leverkusen, Leverkusen, Deutschland
| | - D Porres
- Klinik für Urologie, Klinikum Leverkusen, Leverkusen, Deutschland
| | - G Lümmen
- Urologische Abteilung, St. Josef Hospital, Betriebsstätte St. Josef Troisdorf, GFO Kliniken Troisdorf, Troisdorf, Deutschland
| | - M Nehiba
- Abteilung Neuro-Urologie, Werner-Wicker-Klinik, Bad Wildungen, Deutschland
| | - T Kadhum
- Zentrale Einrichtung Klinische Arbeitsmedizin, Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Dortmund, Deutschland
- Mittelrhein-Klinik Fachklinik für psychosomatische Rehabilitation, Boppard, Bad Salzig, Deutschland
| | - M Forchert
- Berufsgenossenschaft Holz und Metall, Stabsstelle UV-Recht, Bielefeld, Deutschland
| | - K Golka
- Zentrale Einrichtung Klinische Arbeitsmedizin, Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Dortmund, Deutschland
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Cho EK, Jeon SH. Histological Examination of Engineered Mesenchymal Stem Cells Improve Bladder Function in Rat. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Eun Kyung Cho
- Department of Biomedical Laboratory Science, Kyungwoon University, Gumi, Korea
| | - Seung Hwan Jeon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Incidental bladder cancer at initial urological workup of spinal cord injury patients. Spinal Cord Ser Cases 2020; 6:55. [PMID: 32601273 DOI: 10.1038/s41394-020-0307-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
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).
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Traumatic spinal cord injury confers bladder cancer risk to patients managed without permanent urinary catheterization: lessons from a comparison of clinical data with the national database. World J Urol 2020; 38:2827-2834. [PMID: 31932948 DOI: 10.1007/s00345-020-03077-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Life expectancy for people with traumatic spinal cord injury (SCI) is increasing due to advances in treatment methods and in neuro-urology. Thus, developing urinary bladder cancer (UBC) is gaining importance. METHODS Single-centre retrospective evaluation of consecutive in- and out-patient data with spinal cord injury between January 1st, 1998 and December 31st, 2018 was carried out and data were compared with UBC data of the German population from the German Centre for Cancer Registry Data at Robert Koch Institute. RESULTS A total of 37 (4 female, 33 male) out of 7004 patients with SCI were diagnosed with histologically proven UBC (median follow-up 85 months). Median age at UBC diagnosis was 54.0 years (general population: 74 years). The SCI patients had significantly (p < 0.0001, each) more frequent muscle-invasive tumors (81% ≥ T2) and unfavorable grading (76% G3), compared to the general population. Median survival was 13 months for transitional cell carcinoma (n = 31) and 4 months for squamous cell carcinoma (n = 5) (p = 0.0039), resp. The median survival of the 24 cystectomized patients was 15.0 months. Long-term suprapubic or indwelling catheterization was found in only eight patients for a total of only 5.09% (median 15.5 months) of the latency of all patients. No significant differences for T category and grading were observed between the bladder emptying methods intermittent catheterisation and catheter-free voiding. CONCLUSION The results indicate that in patients with SCI bladder management even without permanent catheterization represents a considerable risk for the development of UBC.
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Gambachidze D, Lefèvre C, Chartier-Kastler E, Perrouin Verbe MA, Kerdraon J, Egon G, Even A, Denys P, Castel-Lacanal E, Gamé X, Ruffion A, Hascoet J, Peyronnet B, Chaussard H, Verde KL, Karsenty G, Phé V. Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology committee of the French Association of Urology. Neurourol Urodyn 2019; 38:1713-1720. [PMID: 31141236 DOI: 10.1002/nau.24047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.
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Affiliation(s)
- Dimitri Gambachidze
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Chloë Lefèvre
- Department of Physical Medicine and Rehabilitation, CHU de Nantes, Nantes, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France.,Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Jacques Kerdraon
- Department of Physical Medicine and Rehabilitation, Kerpape Hospital, Ploemeur, France
| | - Guy Egon
- Department of Physical Medicine and Rehabilitation, Rehabilitation Centre of L'Arche, Saint Saturnin, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Xavier Gamé
- Department of Urology, CHU Rangueil, Toulouse, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | - Juliette Hascoet
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | | | - Haude Chaussard
- Department of Orthopedic Surgery, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kévin Lo Verde
- Department of urology, Aix Marseille Université, Marseille, France
| | - Gilles Karsenty
- Department of urology, Aix Marseille Université, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
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Böthig R, Schöps W, Zellner M, Fiebag K, Kowald B, Hirschfeld S, Thietje R, Kurze I, Böhme H, Kaufmann A, Jungmann O, Zumbé J, Porres D, Nehiba M, Kadhum T, Golka K, Forchert M. Ursachenzusammenhang zwischen langjähriger Querschnittlähmung und malignen Harnblasentumoren. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s10039-019-0412-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Perrouin-Verbe MA, Léon P, Denys P, Mongiat-Artus P, Chartier-Kastler E, Phé V. Long-term functional outcomes of augmentation cystoplasty in adult spina bifida patients: A single-center experience in a multidisciplinary team. Neurourol Urodyn 2018; 38:330-337. [PMID: 30350892 DOI: 10.1002/nau.23857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 12/19/2022]
Abstract
AIM To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients. METHODS All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed. RESULTS Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients. CONCLUSION In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
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Affiliation(s)
- Marie-Aimée Perrouin-Verbe
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Priscilla Léon
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | | | - Emmanuel Chartier-Kastler
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Phé
- Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
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