Contrary to morbidity rates for many secondary conditions in spinal cord injured individuals, the overall incidence of bladder and prostate cancer is reported to be lower by 12 and 33%, respectively for a cohort of people with SCI vs non-SCI (Lee et al 2014; n=27,2005). Although Nahm et al. (2015, n=45,486) did not confirm lower rates of bladder cancer in people with SCI, they did report that people with SCI are not at increased risk compared to people with SCI. However, this large US database did reveal increased bladder cancer mortality in people with more severe injuries (e.g. AIS A, B, C) with AIS D individuals, who typically do not have problems with neurogenic bladder or UTIs, having the risk of mortality as the general population. This group did not observe an increased mortality rate in ventilator dependent or high cervical injury individuals and postulated that their overall shortened life expectancy might have bypassed the development of bladder cancer. These results advocate for screening strategies to identify at-risk groups with contributing factors for bladder cancer related deaths. Urethro-cystoscopy and/or bladder washing cytology and histology are relevant screening strategies that report 10% and 5%, respectively, identification rates in individuals with at least 5 years’ history of neurogenic lower urinary tract dysfunction (Sammer et al. 2015).
Compared to the general population, individuals with SCI have a higher risk of bladder stone formation (Chen et al. 2002; Bartel et al. 2014). Secondary complications arising from urinary stasis, hypercalciuria due to immobilization, and long-term catheter use are all contributing factors to the higher prevalence of bladder stone formation in people with SCI. Bartel et al. (2014) associated bladder stones in individuals using suprapubic catheters (SPC, 11%), transurethral catheters (TC, 6.6%), intermittent catheterization (IC, 2%) and reflex micturition (RM, 1.1%). The time interval to bladder stone development for TC, SPC, IC, and RM was 31, 59, 116 months and 211 months, respectively. Similarly, recurrence rates were 40, 28, 22 and 0%, respectively. Conversely, time to recurrence for the TC group was the longest at 31 months and 26 and 14 months for IC and SPC groups, respectively. Once a stone required treatment, Eyre et al. (2015) reported overall complication rates ranging from 0% to 11% to 25% following washout, stone punch and electrohydraulic lithotripsy (EHL) techniques, respectively. Combining stone punch and EHL yielded significantly higher overall rate of complications (38%, p=0.046), which was further exacerbated when these combined procedures were carried out on individuals with cervical-level injuries (p=0.032). Having a complication, a combined procedure, and age contributed to significantly longer lengths of stay (p<0.001) than when stone punch alone is chosen.
Endoscopic application of bulking agents is a treatment option for vesicoureteral reflux (VUR) in individuals with chronic SCI. Virseda et al. (2014) found that the greatest success was achieved after neurogenic detrusor overactivity (NDO) was first eradicated. Otherwise, individuals with NDO experienced a high failure rate even though reflux was independent of involuntary detrusor contraction. Although individual age, presence of stress urinary incontinence (SUI), bilaterality were also thought to be predictive factors of success, multivariate analysis revealed that only degree of reflux and NDO were independent factors affecting success rate for anti- reflux procedures.