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Bladder cancer in patients with spina bifida: a serious risk

  • Original Article
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Abstract

Purpose

After bladder augmentation (BA) using bowel segments, it is known that there is a risk for secondary malignancies. It remains unclear whether this also applies to spina bifida (SB) patients without BA. The aim of this study was to analyze the frequency of bladder cancer (BC) in SB at a single tertiary institution and assess the patients’ oncologic outcome.

Methods

Patients with SB and BC treated from January 2016 until March 2020 were included and corresponding data were collected retrospectively. Endpoints were progression-free survival (PFS) and overall survival (OS).

Results

Among 132 adult patients with SB, four with a median age of 34.5 years (IQR 31.5–36.8, range 31–37) had a BC. None of the patients had undergone BA. Most common symptoms included recurrent urinary tract infections (UTI) (75%) and hydronephrosis (75%). At the time of the diagnosis, tumors were locally advanced (≥ T3) and lymph-node positive in all cases. All patients underwent radical cystectomy with adjuvant chemotherapy in two out of four cases. Histology showed squamous cell carcinomas (SCC) or at least a squamous cell component in all patients. The median PFS was 5.9 months (IQR 5.1–124.5) and the median OS was 8.7 months (IQR 6.3–125.5).

Conclusions

SCC in SB can appear at a young age and is usually diagnosed in an advanced tumor stage with poor prognosis despite radical surgical resection. Patients with SB without BA with clinical symptoms, new onset of hematuria, and/or upper tract dilatation should receive a cystoscopy ± further imaging.

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Abbreviations

BA:

Bladder augmentation

BC:

Bladder cancer

BMI:

Body Mass Index

CIC:

Clean intermittent catheterization

IQR:

Inter-quartile range

MVAC:

Methotrexate, vinblastine, adriamycin, and cisplatin

NBD:

Neurogenic bladder dysfunction

OS:

Overall survival

PFS:

Progression-free survival

SB:

Spina bifida

SCC:

Squamous cell carcinoma

SCI:

Spinal cord injury

UICC:

Union for International Cancer Control

UTI:

Urinary tract infections

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Authors and Affiliations

  1. Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Julia Mühlbauer

  2. Department of Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Raimund Stein & Nina Younsi

Authors
  1. Julia Mühlbauer
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  2. Raimund Stein
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  3. Nina Younsi
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Correspondence to Julia Mühlbauer.

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Mühlbauer, J., Stein, R. & Younsi, N. Bladder cancer in patients with spina bifida: a serious risk. World J Urol 39, 1531–1537 (2021). https://doi.org/10.1007/s00345-020-03338-1

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  • DOI: https://doi.org/10.1007/s00345-020-03338-1

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