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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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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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Koukourikis P, Papaioannou M, Georgopoulos P, Apostolidis I, Pervana S, Apostolidis A. A Study of DNA Methylation of Bladder Cancer Biomarkers in the Urine of Patients with Neurogenic Lower Urinary Tract Dysfunction. BIOLOGY 2023; 12:1126. [PMID: 37627010 PMCID: PMC10452268 DOI: 10.3390/biology12081126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Background: Bladder cancer (BCa) in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) is a significant concern due to its advanced stage at diagnosis and high mortality rate. Currently, there is a scarcity of specific guidelines for BCa screening in these patients. The development of urine biomarkers for BCa seems to be an attractive non-invasive method of screening or risk stratification in this patient population. DNA methylation is an epigenetic modification, resulting in the transcriptional silencing of tumor suppression genes, that is frequently detected in the urine of BCa patients. Objectives: We aimed to investigate DNA hypermethylation in five gene promoters, previously associated with BCa, in the urine of NLUTD patients, and in comparison with healthy controls. Design, setting and participants: This was a prospective case-control study that recruited neurourology outpatients from a public teaching hospital who had suffered from NLUTD for at least 5 years. They all underwent cystoscopy combined with biopsy for BCa screening following written informed consent. DNA was extracted and DNA methylation was assessed for the RASSF1, RARβ, DAPK, TERT and APC gene promoters via quantitative methylation-specific PCR in urine specimens from the patients and controls. Results: Forty-one patients of mixed NLUTD etiology and 35 controls were enrolled. DNA was detected in 36 patients' urine specimens and in those of 22 controls. In the urine specimens, DNA was hypermethylated in at least one of five gene promoters in 17/36 patients and in 3/22 controls (47.22% vs. 13.64%, respectively, p = 0.009). RASSF1 was hypermethylated in 10/17 (58.82%) specimens with detected methylation, APC in 7/17 (41.18%), DAPK in 4/17 (23.53%), RAR-β2 in 3/17 (17.56%) and TERT in none. According to a multivariate logistic regression analysis, NLUTD and male gender were significantly associated with hypermethylation (OR = 7.43, p = 0.007 and OR = 4.21; p = 0.04, respectively). In the tissue specimens, histology revealed TaLG BCa in two patients and urothelial squamous metaplasia in five patients. Chronic bladder inflammation was present in 35/41 bladder biopsies. Conclusions: DNA hypermethylation in a panel of five BCa-associated genes in the urine was significantly more frequent in NLUTD patients than in the controls. Our results warrant further evaluation in longitudinal studies assessing the clinical implications and possible associations between DNA hypermethylation, chronic inflammation and BCa in the NLUTD population.
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Affiliation(s)
- Periklis Koukourikis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
| | - Maria Papaioannou
- Department of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Petros Georgopoulos
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
- Pelvic Floor Unit, Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Ioannis Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
| | - Stavroula Pervana
- Department of Pathology, General Hospital Papageorgiou, 56429 Thessaloniki, Greece;
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, General Hospital ‘Papageorgiou’, 56403 Thessaloniki, Greece; (P.K.); (P.G.); (I.A.)
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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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Tong D, Zhao Y, Tang Y, Ma J, Wang M, Li B, Wang Z, Li C. MiR-487b suppressed inflammation and neuronal apoptosis in spinal cord injury by targeted Ifitm3. Metab Brain Dis 2022; 37:2405-2415. [PMID: 35802304 PMCID: PMC9581865 DOI: 10.1007/s11011-022-01015-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022]
Abstract
Spinal cord injury (SCI) was a serious nerve injury, which involves complex genetic changes. This paper was intended to investigate the function and mechanism of differentially expressed genes in SCI. The three datasets GSE92657, GSE93561 and GSE189070 of SCI from GEO database were used to identify differentially expressed genes (DEGs). We identified the common DEGs in the three datasets GSE92657, GSE93561 and GSE189070 of SCI from GEO database. Next, a protein-protein interaction (PPI) network of DEGs was constructed. Subsequently, the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that DEGs were significantly enriched in immune response, inflammatory response. The expression level of immune-related genes (Arg1, Ccl12, Ccl2, Ifitm2, Ifitm3, and et al.) at different time points of SCI were analyzed in GSE189070 dataset. Next, differentially expressed miRNAs (DE-miRNAs) were identified in SCI compared with normal based on GSE158194 database. DE-miRNA and targeted immune-related genes were predicted by miRwalk, including miR-487b-5p targeted Ifitm3, miR-3072-5p targeted Ccl3, and et al. What's more, the miR-487b was identified and verified to be down-regulated in Lipopolysaccharide (LPS)-induced BV-2 cell model. Further, the miR-487b inhibited cell inflammation and apoptosis in LPS-induced BV2 cell by targeted Ifitm3. For the first time, our results revealed that miR-487b may play an important regulatory role in SCI by targeted Ifitm3 and provide further evidence for SCI research.
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Affiliation(s)
- Dake Tong
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
| | - Yanyin Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
| | - Jie Ma
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 People’s Republic of China
| | - Miao Wang
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Naval Medical University, 700 North Moyu Road, Shanghai, 201805 China
| | - Bo Li
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Naval Medical University, 700 North Moyu Road, Shanghai, 201805 China
| | - Zhiwei Wang
- Department of Orthopedic Surgery, The Third Affiliated Hospital of Naval Medical University, 700 North Moyu Road, Shanghai, 201805 China
| | - Cheng Li
- Department of Orthopedics, Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433 People’s Republic of China
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Abstract
Context: Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the US. There is paucity of data regarding CRC and the spinal cord injury (SCI) community. Persons with SCI have suboptimal rates of colonoscopies and face extensive barriers to care. The aim of our study was to compare CRC mortality in persons with SCI to CRC mortality in the general population.Design: A prospective follow-up study.Setting: Analysis of the National SCI database.Participants: 54,965 persons with SCI.Interventions: Not applicable.Outcome Measures: Current survival status and causes of death were determined. The expected number of CRC deaths was calculated for the general US population, using ICD-10 codes. Standardized mortality ratios (SMR) were calculated as the ratio of observed to expected CRC deaths stratified by current age, sex, race, time post-injury and neurologic group.Results: The CRC mortality was 146 persons out of 54,965 persons with SCI. The overall SMR was determined to be 1.11 (95% CI [0.94, 1.31]). Among subgroups, one finding was significant and this was for patients with injury level C1-4 with an American Spinal Injury Association Impairment Scale Grade of A, B or C with an SMR of 1.68 ([95% CI [1.03-2.61]).Conclusion: Although persons with SCI receive suboptimal rates of preventative care screenings and report extensive barriers to care, overall, they are not at an increased risk of CRC mortality. The current recommendations for CRC screening should be continued for these individuals while reducing barriers to care.
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Affiliation(s)
- Jenna E. Koblinski
- College of Medicine – Phoenix, University of Arizona, Phoenix, Arizona, USA
| | - Michael J. DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Valentine Nfonsam
- Department of Surgery, University of Arizona Medical Center, Tucson, Arizona, USA,Correspondence to: Valentine Nfonsam, Department of Surgery, University of Arizona Medical Center, 1501 N. Campbell Ave., Tucson, AZ85724,USA; Ph: (520) 6226-1674.
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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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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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DeVivo MJ, Chen Y, Wen H. Cause of Death Trends Among Persons With Spinal Cord Injury in the United States: 1960-2017. Arch Phys Med Rehabil 2021; 103:634-641. [PMID: 34800477 DOI: 10.1016/j.apmr.2021.09.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To identify trends in causes of death after spinal cord injury (SCI) that could enhance understanding of why life expectancy after SCI has not improved in the last 3 decades. DESIGN Cohort study. SETTING Twenty-nine SCI Model Systems and 3 Shriners Hospitals. PARTICIPANTS Individuals with traumatic SCI (N=49,266) enrolled in the SCI Collaborative Survival Study Database between 1973 and 2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Age-standardized cause-specific SCI mortality rates and 95% confidence intervals were calculated for 5 time intervals (1960-1979, 1980-1989, 1990-1999, 2000-2009, and 2010-2017). RESULTS A total of 17,249 deaths occurred in 797,226 person-years of follow-up. Since 2010, the highest mortality rate was for respiratory diseases, followed by heart disease, cancer, infective and parasitic diseases (primarily septicemia), and unintentional injuries. Mortality rates for respiratory diseases, cancer, stroke, urinary diseases, and digestive diseases, initially decreased significantly but remained relatively stable since 1980, whereas essentially no progress occurred for infective and parasitic diseases. Mortality rates for heart disease, pulmonary embolus, and suicide decreased significantly throughout the entire study period, but were offset by increases in mortality rates for endocrine (primarily diabetes), nutritional, and metabolic diseases, as well as unintentional injuries. From 2010 to 2017, the overall age-standardized mortality rate was 3 times higher for individuals with SCI than the general population, ranging from 27% higher for cancer to 9 times higher for infective and parasitic diseases. CONCLUSION Improving life expectancy after SCI will require: (1) reducing mortality rates from respiratory diseases and septicemia that have remained high, (2) reversing current trends in diabetes and unintentional injury deaths, and (3) continuing to reduce mortality from heart disease and other leading causes.
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Affiliation(s)
- Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
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Adegeest CY, van Gent JAN, Stolwijk-Swüste JM, Post MWM, Vandertop WP, Öner FC, Peul WC, Wengel PVT. Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review. J Neurosurg Spine 2021; 36:632-652. [PMID: 34767527 DOI: 10.3171/2021.7.spine21537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.
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Affiliation(s)
- Charlotte Y Adegeest
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague
| | - Jort A N van Gent
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden
| | - Janneke M Stolwijk-Swüste
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht.,4Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen
| | - William P Vandertop
- 5Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam
| | - F Cumhur Öner
- 6Department of Orthopedic Surgery, University Medical Center Utrecht; and
| | - Wilco C Peul
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
| | - Paula V Ter Wengel
- 2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
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11
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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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12
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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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13
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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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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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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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16
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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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17
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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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18
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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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Teplitsky S, Murphy A, Shenot PJ. Knowledge Gaps in Urologic Care of Female Spinal Cord Injury Patients. Curr Urol Rep 2019; 20:21. [PMID: 30904966 DOI: 10.1007/s11934-019-0884-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients. RECENT FINDINGS Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.
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Affiliation(s)
- Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA
| | - Alana Murphy
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA
| | - Patrick J Shenot
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, Ste 1100, Philadelphia, PA, 19107, USA.
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20
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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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21
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Floyd MS, Khadr RN. Letter to the editor. Int Urol Nephrol 2018; 50:1627-1628. [PMID: 30046965 DOI: 10.1007/s11255-018-1943-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Michael S Floyd
- North West Spinal Cord Injury Unit, Southport & Ormskirk Hospital NHS Trust, Town Lane, Southport, Merseyside, PR8 6PN, UK.
| | - Rauf N Khadr
- North West Spinal Cord Injury Unit, Southport & Ormskirk Hospital NHS Trust, Town Lane, Southport, Merseyside, PR8 6PN, UK
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Beal CA, Krouse MC, Tubbs JT. Development of acute promyelocytic leukemia in a patient with tetraplegia while in inpatient rehabilitation: A case report. J Spinal Cord Med 2018; 41:571-574. [PMID: 28929913 PMCID: PMC6117595 DOI: 10.1080/10790268.2017.1375722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
STUDY DESIGN a single case report. OBJECTIVES To report a case of a patient with tetraplegia who developed acute promyelocytic leukemia (APL) while in inpatient rehabilitation after 10.5 months. SETTING A VA Medical Center Spinal Cord Injury Service and Disorders Unit Case Report: A 47 year-old male with a stage IV sacral pressure ulcer and C4 AIS A complete tetraplegia secondary to a motor vehicle collision, developed fever, thrombocytopenia, and anemia 20 months after his injury while in inpatient rehabilitation and was found to have APL, confirmed following bone marrow biopsy. CONCLUSION There is a wide differential for fever after a spinal cord injury. In this case report, the source of fever was APL. It is important as healthcare providers to not overlook fevers when otherwise common causes do not fit the clinical picture. Additionally, there has been no association found between traumatic spinal cord injury and the development of acute leukemia, however this is the first case report. Therefore, it is important to continue investigating to determine if an association exists.
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Affiliation(s)
- Christopher A. Beal
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA,Correspondence to: Christopher A. Beal, DO, Resident Physician, Virginia Commonwealth University Health System, Department of Physical Medicine and Rehabilitation, 1223 E. Marshall St., P.O. Box 980677, Richmond, VA23284-0667, USA.
| | - Michael C. Krouse
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jeffrey T. Tubbs
- Spinal Cord Injury Service and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Eswara JR, Castellan M, González R, Mendieta N, Cendron M. The urological management of children with spinal cord injury. World J Urol 2018; 36:1593-1601. [DOI: 10.1007/s00345-018-2433-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/02/2018] [Indexed: 11/28/2022] Open
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Pannek J, Rademacher F, Wöllner J. Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction. Res Rep Urol 2017; 9:219-223. [PMID: 29238702 PMCID: PMC5716319 DOI: 10.2147/rru.s148429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction Screening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and urine cytology. Materials and methods By a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and urine cytology testing. In patients with suspicious findings either in cytology or cystoscopy, transurethral resection was performed. Results Seventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both cytology and cystoscopy was 83.3%; specificity was 43.7% for cytology and 31.2% for cystoscopy. One bladder tumor was missed by cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed. Conclusion A combination of cystoscopy and urine cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies.
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Affiliation(s)
- Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | | | - Jens Wöllner
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
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Ismail S, Karsenty G, Chartier-Kastler E, Cussenot O, Compérat E, Rouprêt M, Phé V. Prevalence, management, and prognosis of bladder cancer in patients with neurogenic bladder: A systematic review. Neurourol Urodyn 2017; 37:1386-1395. [PMID: 29168217 DOI: 10.1002/nau.23457] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
AIM To perform a systematic review of the literature regarding epidemiology, diagnosis, management and prognosis of bladder cancer in the neuro-urological patient population, in order to serve as a basis for future recommendations and research. METHODS A systematic review was performed according to the PRISMA-Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Statement. Embase was searched for studies providing data on epidemiology, diagnosis, management and prognosis of bladder cancer in neuro-urological patients. RESULTS After screening 637 abstracts, 15 studies (13 retrospective and 2 prospective studies) were included in this study. We identified 332 patients (0.3%) who were diagnosed with bladder cancer. This mostly affected mostly men (59.3%) and spinal cord injured patients (98.8%). Mean age at diagnosis was 56.1 years. Bladder cancer occurred after a long period of evolution of the neurological disease (24.9 years). Gross hematuria was the predominating presenting symptom (31.6% of cases). Indwelling urethral or supra-pubic catheters were used in 44.5% of patients. The most frequent histological subtype of bladder cancer was transitional cell carcinoma (53.1%), followed by squamous cell carcinoma (33.5%). Muscle-invasive bladder cancer was reported in 67.7% of patients. The mean cancer-specific mortality rate was of 47.1%. CONCLUSIONS The prevalence and high mortality rate of bladder cancer in neuro-urological patients underlines the importance of long-term follow-up in this specific population. This highlights the necessity of further studies in this field.
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Affiliation(s)
- Salima Ismail
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Gilles Karsenty
- La Conception Hospital, Department of Urology, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Eva Compérat
- Department of Pathology, Tenon Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Morgan Rouprêt
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris, France.,Groupe de recherche clinique-UPMC n°5, Oncotype-Uro, Institut Universitaire de Cancérologie de l'UPMC, Pierre and Marie Curie Medical School, Sorbonne Universités, Paris, France
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Spinal Cord Injury Model Systems: Review of Program and National Database From 1970 to 2015. Arch Phys Med Rehabil 2017; 97:1797-804. [PMID: 27671806 DOI: 10.1016/j.apmr.2016.02.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 11/20/2022]
Abstract
The Spinal Cord Injury Model Systems (SCIMS) centers have provided continuous, comprehensive multidisciplinary care for persons with spinal cord injury (SCI) in the United States since their inception in 1970. In addition, the research conducted and the analysis of data collected at these centers facilitate advances in the care and the overall quality of life for people with SCI. Over the past 45 years, the SCIMS program and National Spinal Cord Injury Database (NSCID) have undergone major revisions, which must be recognized in the planning, conduct, and interpretation of SCIMS research to prevent misinterpretation of findings. Therefore, we provide herein a brief review of the SCIMS program and the associated NSCID throughout its history, emphasizing changes and accomplishments within the past 15 years, to facilitate a better understanding and interpretation of the data presented in SCIMS research publications, including the articles published in this special issue of the Archives.
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Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre. Int Urol Nephrol 2017; 49:983-994. [PMID: 28332134 DOI: 10.1007/s11255-017-1570-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Life expectancy for people with spinal cord injury has shown a marked increase due to modern advances in treatment methods and in neuro-urology. However, since life expectancy of people with paralysis increases, the risk of developing of urinary bladder cancer is gaining importance. MATERIALS AND METHODS Single-centre retrospective evaluation of patient data with spinal cord injuries and proven urinary bladder cancer and summary of the literature. RESULTS Between 1998 and 2014, 24 (3 female, 21 male) out of a total of 6599 patients with spinal cord injury were diagnosed with bladder cancer. The average age at bladder cancer diagnosis was 57.67 years, which is well below the average for bladder cancer cases in the general population (male: 73, female: 77). All but one patient had a latency period between the onset of the spinal paralysis and tumour diagnosis of more than 10 years. The median latency was 29.83 years. The median survival for these patients was 11.5 months. Of the 24 patients, 19 (79%) had muscle invasive bladder cancer at ≥T2 at the time of diagnosis. The type of neurogenic bladder (neurogenic detrusor overactivity or acontractility) and the form of bladder drainage do not appear to influence the risk. Long-term indwelling catheter drainage played only a minor role in the investigated patients. CONCLUSIONS The significantly younger age at onset and the frequency of invasive tumours at diagnosis indicate that spinal cord injury influences bladder cancer risk and prognosis as well. Early detection of bladder cancer in patients with spinal cord injury remains a challenge.
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Gui-Zhong L, Li-Bo M. Bladder cancer in individuals with spinal cord injuries: a meta-analysis. Spinal Cord 2016; 55:341-345. [PMID: 27824057 DOI: 10.1038/sc.2016.151] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 09/06/2016] [Accepted: 09/10/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To conduct a scoping review of all the literature related to bladder cancer in individuals with spinal cord injuries (SCIs). METHODS We searched for trials in MEDLINE, EMBASE, CINAHL and the Cochrane Register. Meta-analysis methods were used to evaluate these studies. RESULTS A total of 18 articles were identified and included as the evidence base for analysis. The incidence of bladder cancer in individuals with SCI is 6‰ (95% confidence interval (CI), 5-6‰, I2=49.2%). Mean patient age at bladder cancer diagnosis was 50 years (95% CI, 45-55 years, I2=92.7%). Length of indwelling catheterization of the patient population ranged from 6 to 29 years, with an average of 16 years (95% CI, 12-20 years, I2=94.4%). The interval between SCI and the first diagnosis of bladder cancer was 24 years (95% CI, 21-27 years, I2=85.3%). In the SCI population the estimated percent of squamous cell carcinoma is 36.8% (95% CI, 31.6-42.5%, I2=32.3%). In addition, 46.3% (95% CI, 33.7-59.4%, I2=40.5%) of the bladder cancer histology was traditional transitional cell carcinoma. Other pathological subtypes account for 17.1% (95% CI, 12.8-22.6%, I2=21.5%). The 1-year overall survival rate after treatment of bladder cancer was 62.1% (95% CI, 56.2-66.7%, I2=21.3%). Cystoscopy demonstrated a sensitivity of 64% (95% CI, 49.3-76.5%, I2=37.7%) for detecting bladder cancer. Cytology demonstrated a sensitivity of 36.3% (95% CI, 21.5-54.3%, I2=40.2%) for detecting bladder cancer. CONCLUSION Bladder cancer is a rare and potentially lethal occurrence in SCI patients. Physicians need to have a high index of suspicion for bladder cancer, particularly among SCI patients managed with long-term indwelling catheters.
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Affiliation(s)
- L Gui-Zhong
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
| | - M Li-Bo
- Department of Urology, Beijing Jishuitan Hospital, Beijing, China
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Smith JA. This Month in Adult Urology. J Urol 2015. [DOI: 10.1016/j.juro.2015.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Screening for Bladder Cancer in Individuals with Spinal Cord Injury. J Urol 2015; 193:1880-1. [DOI: 10.1016/j.juro.2015.03.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/23/2022]
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