Urinary bladder cancer as a late sequela of traumatic spinal cord injury

Military Medical Research

Birgitt Kowald¹  Sven Hirschfeld²  Roland Thietje²  Klaus Golka³  Christian Tiburtius⁴  Ralf Böthig⁴  Oliver Balzer⁴  Ines Kurze⁵  Thura Kadhum⁶  Aki Pietsch⁷  Michael Zellner⁸  Martin Forchert⁹  Wolfgang Schöps^1,10 

[1] Biomechanical Laboratory, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany;Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany;Clinical Occupational Medicine, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), 44139, Dortmund, Germany;Department of Neuro-Urology, Centre for Spinal Cord Injuries, BG Klinikum Hamburg, 21033, Hamburg, Germany;Department of Paraplegiology and Neuro-Urology, Centre for Spinal Cord Injuries, Zentralklinik Bad Berka, 99437, Bad Berka, Germany;Department of Psychosomatic Rehabilitation, Mittelrheinklinik Fachklinik, 56154, Boppard-Bad Salzig, Germany;Department of Sports and Rehabilitation Medicine, BG Klinikum Hamburg, 21033, Hamburg, Germany;Department of Urology and Neuro-Urology, Johannesbad Fachklinik, 94072, Bad Füssing, Germany;Staff Position Accident Insurance Law, Statutory Accident Insurance for Wood and Metal (BGHM), 33602, Bielefeld, Germany;Urological Practice, 53757, Sankt Augustin, Germany;

关键词: Traumatic spinal cord injury;    Neurogenic bladder;    Transitional cell carcinoma;    Squamous cell carcinoma;    Survival time;    Battlefield injury;    Medical assessment;   

DOI  :  10.1186/s40779-021-00322-7

来源: Springer

【 摘 要 】

BackgroundTraumatic 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.MethodsA 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.ResultsInitial 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.ConclusionsThe 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.

【 授权许可】

CC BY