Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury

Objectives. Patients with spinal cord injury (SCI) and chronic indwelling c atheters are known to be at increased risk of bladder malignancy. "Decathet erization'' by clean intermittent catheterization, external condom catheter ization, or spontaneous voiding is thought to reduce the risk by decreasing the chronic mucosal irritation and rate of infection. We examined two Depa rtment of Veterans Affairs (DVA) data bases to test this theory. Methods. A population-based retrospective analysis of invasive treatments f or carcinoma of the bladder in all DVA hospitals was conducted using comput erized inpatient files from fiscal years 1988 to 1992. Results. One hundred thirty patients with bladder malignancy were identifie d from a pool of 33,565 patients with SCI (0.39%). All 130 patients underwe nt either radical cystectomy (n = 63, 48%) or transurethral resection of bl adder tumor (n = 67, 52%). The 30-day perioperative mortality and overall 5 -year survival rates were 2 (1.5%) and 49 (38%) of 130, respectively. Of th e 130 patients analyzed, 42 (32%) had adequate data available regarding tum or pathologic findings and method of bladder management for analysis. The a verage age at diagnosis was 57.3 years. The histologic finding was transiti onal cell carcinoma in 23 (55%), squamous cell carcinoma in 14 (33%), and a denocarcinoma in 4 (10%) of 42. Bladder management was an indwelling urethr al catheter in 18 (43%), suprapubic catheter in 8 (19%), clean intermittent catheterization in 8 (19%), and condom catheter in 6 (14%) of 42 patients. Squamous cell carcinoma was more common in patients with indwelling urethr al catheters and suprapubic tubes (11 of 26, 42%) than in those using clean intermittent catheterization, condom catheterization, or spontaneous voidi ng (3 of 16, 19%). Conclusions. Bladder cancer was diagnosed in approximately 0.39% of this la rge SCI population during a 5-year period. Most cancers (55%) were transiti onal cell carcinomas. Squamous cell carcinoma was more common in patients w ith SCI and indwelling catheters than those without chronic catheterization . These data continue to suggest that avoidance of indwelling catheters, wh en feasible, is the preferred method of bladder management in patients with SCI. (C) 1999, Elsevier Science Inc. All rights reserved.