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

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‰, I(2)=49.2%). Mean patient age at bladder cancer diagnosis was 50 years (95% CI, 45-55 years, I(2)=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, I(2)=94.4%). The interval between SCI and the first diagnosis of bladder cancer was 24 years (95% CI, 21-27 years, I(2)=85.3%). In the SCI population the estimated percent of squamous cell carcinoma is 36.8% (95% CI, 31.6-42.5%, I(2)=32.3%). In addition, 46.3% (95% CI, 33.7-59.4%, I(2)=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%, I(2)=21.5%). The 1-year overall survival rate after treatment of bladder cancer was 62.1% (95% CI, 56.2-66.7%, I(2)=21.3%). Cystoscopy demonstrated a sensitivity of 64% (95% CI, 49.3-76.5%, I(2)=37.7%) for detecting bladder cancer. Cytology demonstrated a sensitivity of 36.3% (95% CI, 21.5-54.3%, I(2)=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.