Cancer Resources > Cancer News > 2002 > April

Increased bladder cancer risk in spinal cord injury linked with indwelling catheters

Megan Rauscher

Last Updated: 2002-04-02 11:35:43 EST (Reuters Health)

NEW YORK (Reuters Health) - Individuals with spinal cord injury are at increased risk for bladder cancer, and indwelling catheter use is largely to blame. That is according to results of an historical cohort study published in the March Archives of Physical Medicine and Rehabilitation.

Dr. Suzanne L. Groah, of the Santa Clara Valley Medical Center in San Jose, California, and others grouped 3670 spinal cord injured patients according to bladder management technique and followed them for the development of bladder cancer. The group contributed 39,729 person-years of follow-up.

Twenty-four spinal cord injured patients developed bladder cancer during follow-up and 21 were included in the final analysis. Of these, 15 occurred in patients using indwelling catheters only, three occurred in patients using both indwelling and nonindwelling methods, and three developed in those using only nonindwelling methods.

In analyses adjusted for age and gender, spinal cord injured patients were 15.2 times more likely to develop bladder cancer than the general population. Spinal cord injured patients using an indwelling catheter alone had a 25-fold greater risk of bladder cancer than the general population. The bladder cancer mortality rate was also significantly higher in spinal cord injured patients than in the general population.

The adjusted relative risk of bladder cancer was 4.9 in spinal cord injured patients relying solely on indwelling catheters compared with those using nonindwelling methods of bladder management.

"We were not necessarily surprised that indwelling catheters contribute to the development of bladder cancer in spinal cord injury, although the strength of the association is alarming," Dr. Groah told Reuters Health.

Bladder cancer occurred in patients as young as 29 and in those using indwelling catheters for 12 or more years, the researchers note in their report. The mean age at diagnosis was 48 years, and the mean time to occurrence after spinal cord injury was 20 years. In contrast, in the general population, the disease does not usually appear before age 60.

Dr. Groah emphasized that it would be wrong to conclude that indwelling catheters should never be used in spinal cord injured patients. "That is not the message at all," she said. Physicians and spinal cord injured patients should use this information to make an informed decision regarding long-term bladder management, she said.

"For example, since it takes on average 12 to 20 years for the development of bladder cancer, it does not make sense to not allow an older individual with a more severe injury to have an indwelling catheter that may significantly decrease his or her need for assistance or attendant care," Dr. Groah noted.

On the other hand, a "20-year-old with quadriplegia needs to be fully aware of the risk of bladder cancer before opting for an indwelling catheter, since this person is more likely to survive long enough to be affected by the disease," she said.

Arch Phys Med Rehabil 2002;83:346-351.

Copyright © 2010 Reuters Limited. All rights reserved.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.