Vaidyanathan Subramanian, Soni Bakul M, Singh Gurpreet, Hughes Peter L, Mansour Paul, Oo Tun
Regional Spinal Injuries Centre, Town Lane, Southport, Merseyside PR8 6PN, UK.
Patient Saf Surg. 2011 Jul 29;5:19. doi: 10.1186/1754-9493-5-19.
It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice.
Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery.
We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.
文献中众所周知，影像学检查对浅表性膀胱癌的诊断几乎没有价值。然而，膀胱癌诊断的知识与实际临床实践之间存在很大差距。
一名四肢瘫痪男性患者的膀胱癌诊断延迟，原因是依赖阴性的软性膀胱镜检查和单次活检、膀胱超声检查阴性以及骨盆计算机断层扫描。膀胱镜检查安排困难也导致该患者血尿发作与确立膀胱恶性肿瘤组织学诊断之间延迟了近十个月。经尿道切除术与膀胱切除术之间的时间间隔为42天。这种延迟主要是由于手术安排。
我们从该病例中了解到，医生应意识到阴性软性膀胱镜检查和单次活检、尿液细胞学检查、膀胱超声检查以及骨盆计算机断层扫描在脊髓损伤患者膀胱癌诊断中的局限性。当高度怀疑膀胱癌时，必须考虑在全身麻醉下进行随机膀胱活检。T-6以上病变的脊髓损伤患者可能会发生自主神经反射异常；因此，在进行膀胱镜检查和膀胱活检时，应做好充分准备以预防或处理自主神经反射异常。出现血尿的脊髓损伤患者应在检查和手术安排中享有最高优先级。
