Bladder cancer in individuals with spinal cord injuries: a meta-analysis.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Urology, Beijing Jishuitan Hospital, Beijing, China.
L
L
Gui-Zhong
Department of Urology, Beijing Jishuitan Hospital, Beijing, China.
M
M
Li-Bo
D006801:Humans; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000628:therapy