Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
Department of Urology, University Hospital Bern, Bern, Switzerland.
Spinal Cord Ser Cases. 2024 Sep 14;10(1):67. doi: 10.1038/s41394-024-00680-z.
Patients with spinal cord injury/disorder (SCI/D) and neurogenic lower urinary tract dysfunction (NLUTD) are on a 16-28 folder higher risk for bladder cancer [1]. Whereas in the general population 90% of bladder tumors are transitional cell carcinoma (TCC) patients with NLUTD have a shift to squamous cell carcinoma with 36,8% and only 46.3% TCC [2]. In addition, there is a significant increase in the bladder cancer-specific death rate in SCI patients (3rd most common) compared to the general population (10th most common) [2]. Chronic inflammation and mechanical irritation by permanent indwelling catheters are discussed as risk factors for developing bladder cancer. Typical symptoms of bladder cancer are often absent in patients with NLUTD and a reliable screening has not been established.
We present a case series of six patients with SCI and with squamous cell carcinoma diagnosed in the last 5 years in our institution. In five patients, bladder management was performed by indwelling suprapubic catheters, one patient used reflex voiding. Three patients were diagnosed during the regular, annual neuro-urological check-up, the remaining due to increasing spasticity and autonomic dysregulation. Subsequently, five patients underwent cystectomy with ileal conduit or uretercutaneostomy, one patient refused further surgical treatment. Four patients died within one year after diagnosis.
Squamous cell carcinoma of the bladder is more common in patients with NLUTD. Chronic inflammation and mechanical irritation may be the reasons for carcinoma genesis. A regular check including cystoscopy is strongly recommended to detect tumor development early.
脊髓损伤/疾病（SCI/D）和神经源性下尿路功能障碍（NLUTD）患者患膀胱癌的风险增加 16-28 倍[1]。而在普通人群中，90%的膀胱肿瘤为移行细胞癌（TCC），NLUTD 患者的肿瘤类型转变为鳞状细胞癌，占 36.8%，仅有 46.3%为 TCC[2]。此外，SCI 患者膀胱癌特异性死亡率显著升高（位列第三），高于普通人群（位列第十）[2]。永久性留置导尿管引起的慢性炎症和机械刺激被认为是膀胱癌发生的危险因素。NLUTD 患者的膀胱癌典型症状常不明显，也尚未建立可靠的筛查方法。
我们报告了在过去 5 年中，在我们机构诊断出的 6 例 SCI 合并鳞状细胞癌的患者病例系列。在 5 例患者中，膀胱管理通过留置耻骨上导尿管进行，1 例患者使用反射性排尿。3 例患者在常规年度神经泌尿科检查中被诊断出，其余患者由于痉挛和自主神经功能障碍加重而被诊断出。随后，5 例患者接受了膀胱切除术和回肠造口术或输尿管造口术，1 例患者拒绝进一步手术治疗。4 例患者在诊断后 1 年内死亡。
NLUTD 患者中更常见的是膀胱鳞状细胞癌。慢性炎症和机械刺激可能是癌发生的原因。强烈建议进行包括膀胱镜检查在内的定期检查，以早期发现肿瘤的发展。
