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Photograph of bladder biopsy (H-6004/98): This 18-year old male sustained T-5 paraplegia in a car accident eighteen months ago. He manages his bladder by intermittent catheterisation. He developed bladder stones of unusual shape. The nidus of these stones was hair. Most probably, genital hair was introduced inadvertently into the bladder during self-catheterisation. Histology shows mild chronic inflammation only. There is no acute inflammation or ulceration. The inflammatory infiltrate consists mainly of lymphocytes with occasional plasma cells and mast cells, which is rather patchy and confined to the sub-epithelial zone. Only occasional lymphocytes are present within the urothelium, which is mildly hyperplastic. There is no squamous metaplasia and no evidence of dysplasia. There is also mild oedema and congestion, which may be due to bladder stones.
Source publication
In spinal cord injury (SCI) patients, no correlation was found between the number of bladder infections per year, the period since injury, the neurologic level of the spinal cord lesion and the histopathology of the urinary bladder mucosa. The use of chronic indwelling urethral and/or suprapubic catheters in SCI patients is often associated with in...
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Citations
... Initial symptoms of urothelial carcinoma of the bladder (UCB) include microhematuria, painless macrohematuria, and/ or irritative voiding symptoms, and require further were in line with the findings which determined that bladder tumors spread by implantation in abdominal wounds, denuded epithelium, resected prostatic fossa, or traumatized urethra; implantation occurs most often with high-grade tumors [7]. Squamous cell carcinoma arising from a suprapubic cystostomy tract (SCC-SCT) is a relatively rare bladder malignancy, which is known to have a close association with long-term inflammation and mechanical irritation from the suprapubic catheter [8]. ...
... Initial symptoms of urothelial carcinoma of the bladder (UCB) include microhematuria, painless macrohematuria, and/ or irritative voiding symptoms, and require further were in line with the findings which determined that bladder tumors spread by implantation in abdominal wounds, denuded epithelium, resected prostatic fossa, or traumatized urethra; implantation occurs most often with high-grade tumors [7]. Squamous cell carcinoma arising from a suprapubic cystostomy tract (SCC-SCT) is a relatively rare bladder malignancy, which is known to have a close association with long-term inflammation and mechanical irritation from the suprapubic catheter [8]. ...
Background: Bladder tumors are the most common neoplasm of the lower urinary tract. Bladder carcinoma arising from a suprapubic cystostomy tract is a relatively rare. Some patients with bladder tumors have difficult urethral access for urinary retention due to inaccessible urethra. Most people think cystostomy in patient with bladder cancer can cause seeding and upstaging to suprapubic cystostomy tract. This study aim of suprapubic cystostomy can cause seeding and upstaging of bladder cancer. Methods: Literature obtained from the search results of Pubmed, Medscape, Science Direct, Scopus, Cochrane Library, and Google Scholar electronic databases with the keywords used are “suprapubic catheter and bladder cancer”, “suprapubic catheter and bladder tumor”, “suprapubic catheter and bladder carcinoma”, “suprapubic cystotomy and bladder carcinoma”, and “suprapubic catheter and bladder cancer upstaging” with no time limits. Results: Eighty two articles were obtained from the electronic database. Following all the inclusion and exclusion criteria, the final selection considered 5 literature with 16 patient eligible for this literature review. The five literature involved a total of 16 bladder cancer patients with a suprapubic catheter. The duration of suprapubic catheter insertion was between 1 to 3 months. As long as it is within the specified time and from the location of cancer, literature result there will be no seeding and upgrading in the suprapubic cystostomy tract. In our case report we have patient with duration suprapubic cystostomy 1 months wih no seeding and upgrading cancer. Conclusion: Although SPC is an effective, inexpensive, easy mode of access for bladder tumors with difficult urethral access for urinary retention due to inaccessible urethra, it also presents a risk of SPC tract bladder cancer, mostly SCC and TCC. It is important to be aware of any suspicious signs and symptoms, duration time of use suprapubic cystostomy and location of the cancer.
... As a consequence of negligence and misjudgment of clinical infections, treatment delay is very likely to happen and thus increase hospitalization days and costs [9]. CIC performed with voiding diary helps restore and retain the function and compliance of the bladder, as well as release the intravesical pressure and increase the blood flow of the bladder wall, enabling the bladder to perform antibacterial activities and lessen the chance of complications [10][11][12][13][14][15][16][17]. Voiding diary is a simple and primary tool used to understand urinary tract function and assess urinary symptoms, with a view to providing doctors with sufficient data for an appropriate clinical diagnosis. ...
Background: Clean intermittent catheterization (CIC) is one of the methods currently used to prevent overdistention of the bladder in patients with neurogenic bladder dysfunction (NBD). It is also helpful in preventing urinary tract infection and retaining the function of the bladder. Voiding diary and social behavior are necessary for the patients to maintain their physical and mental health, nevertheless there are currently no good assistant systems to help them achieve these goals. Methods: In this study, we propose a CIC assistant system with the functions of recording and tracking the voided volume and accessible lavatory. The aim of this study is to assess the effects from the 12 patients who joined the proposed system. Information collected from participants included their demographics, past medicals, injury characteristics, current and past bladder managements, and any NBD related complications. Results: The results indicate that most patients felt relieved that they could know the voided volume and track their history easily. Moreover, the accessible lavatory function of the proposed system could reduce time consumption by 43.1% in finding the suitable lavatory, thus the desire and willingness of patients to travel increased from 25% to 75% after using the system. Conclusions: The proposed system could help doctors with clinical diagnoses, and help patients to understand more about the history of their catheterization volume and time period. This study provided essential information and design for future investigation.
... Pelvic lipomatosis is associated with glandular cystitis in 75% of cases, hence it is considered as a risk factor [14]. The association between cystitis glandularis and malignant bladder tumors is estimated to be between 10% and 42% [15]. It has been reported that clinically evident disease with macroscopic findings could be a progression of the disease and premalignant lesions [16]. ...
Cystitis glandularis or glandular metaplasia of the urinary bladder, is a be-nignreactive metaplasia of the urothelium, which occurs in the context of chronic irritation, in less than 2% of the general population. It is a condition in most casesasymptomatic, but also characterized by nonspecific symptoms and paraclinicalfindings, which is why this condition is underdiagnosed. Its evolution is mainly focused on the risk of malignant degeneration. This con-dition affects men much more commonly than women. Two forms of cystitis glandularis are recognized: typical and intestinal form. They differ in their histology, incidence, difficulty of diagnosis, and possible association with adenocarcinoma of the bladder. Diagnosis of certainty is histological by care-ful analysis of chips from bladder endoscopic resection.This rare pathology is managed by endoscopic bladder resection, with repeated cystoscopy as a monitoring tool. Extensive surgical is needed in severe or recurrent cases.We present here-in a case of a female patient having cystitis glandularis present-ing with lower urinary tract symptoms. We review equally data reported in literature. To the best of our knowledge our case represents the fourth case of cystitis glandularis affecting a female patient reported in the English literature so far.
... The theoretical advantages are the avoidance of genital lesions caused by prolonged urethral catheterization [47], but published evidence of the superiority of suprapubic cystostomy over urethral catheterization is lacking [48]. Long-term use of indwelling bladder catheters adversely effects the bladder epithelium and increases the risk 1 3 of bladder cancer [49][50][51][52][53]. Nevertheless, from the point of view of preservation of renal function there seems to be little difference between patients managed with CIC or indwelling catheters. ...
Background
The urologic management of children with spinal cord injury (SCI) differs from that of the adult insofar as the care involves a developing organ system and will be ongoing for years. Preservation of renal function as well as prevention of urinary tract infection in concert with both bladder and bowel continence are the essential guiding principles.
Methods
This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on special considerations in children with spinal cord injuries.
Results
SCI in children is less frequent than in adults and affects mainly older children and teenagers. The etiology of SCI in children is usually motor vehicle accidents. The cervical spine is often injured. The urologic evaluation is similar to that for adults but may involve more frequent radiologic and urodynamic assessment to monitor renal function as the child grows.
Conclusions
Treatment may be divided into medical vs. surgical and mirrors the approach to children who have a neurogenic bladder due to spina bifida. Bladder management should be associated with bowel management to achieve the goals of continence and social acceptability.
... Chronic suprapubic catheterization may rarely give rise to SCC, and in the literature, there are few reported cases. Chronic irritation and metaplasia are proposed to be the pathophysiology in a number of studies [11][12][13]. In 1993, Stroumbakis et al. reported the first patient with SCC on longterm suprapubic cystostomy following urethral stricture [2]. ...
Patients with long-term suprapubic cystostomy can rarely develop squamous cell carcinoma (SCC) of the suprapubic cystostomy tract. In addition to the few reported cases in the literature, this paper reports a case of suprapubic cystostomy SCC in an 88-year-old man without bladder involvement. Vigilance about any abnormal lesion at the site of suprapubic cystostomy is important among health providers and patients for early detection of SCC.
... Squamous cell carcinoma arising from a suprapubic cystostomy tract (SCC-SCT) is a relatively rare bladder malignancy, which is known to have a close association with long-term inflammation and mechanical irritation from the suprapubic catheter [1]. We report a case of highly differentiated SCC-SCT involving the bladder in a 61-year-old patient with transplanted kidney. ...
Squamous cell carcinoma arising from a suprapubic cystostomy tract (SCC-SCT) is a relatively rare bladder malignancy. We present a case of highly differentiated SCC-SCT involving the bladder in a 61-year-old patient with transplanted kidney. Abdominal magnetic resonance imaging revealed an anomalous mass (8 cm × 6 cm × 5 cm) surrounding the suprapubic cystostomy and a space-occupying lesion in the bladder. The pathology report revealed highly differentiated SCC. The patient received radiation therapy after he refused aggressive surgical management in 2012. There was no evidence of metastasis at his latest follow-up in early 2015.
... Histological changes to the bladder mucosa have been also linked with chronic indwelling and/or suprapubic catheters in SCI patients (285). This may not be surprising if one compares these findings to those observed in SCI patients, who can achieve more complete, low pressure emptying of the bladder (regular intermittent catheterization or other means). ...
The urothelium, which lines the inner surface of the renal pelvis, the ureters, and the urinary bladder, not only forms a high-resistance barrier to ion, solute and water flux, and pathogens, but also functions as an integral part of a sensory web which receives, amplifies, and transmits information about its external milieu. Urothelial cells have the ability to sense changes in their extracellular environment, and respond to chemical, mechanical and thermal stimuli by releasing various factors such as ATP, nitric oxide, and acetylcholine. They express a variety of receptors and ion channels, including P2X3 purinergic receptors, nicotinic and muscarinic receptors, and TRP channels, which all have been implicated in urothelial-neuronal interactions, and involved in signals that via components in the underlying lamina propria, such as interstitial cells, can be amplified and conveyed to nerves, detrusor muscle cells, and ultimately the central nervous system. The specialized anatomy of the urothelium and underlying structures, and the possible communication mechanisms from urothelial cells to various cell types within the bladder wall are described. Changes in the urothelium/lamina propria ("mucosa") produced by different bladder disorders are discussed, as well as the mucosa as a target for therapeutic interventions.
... This condition has been attributed to chronic inflammation and mechanical stimuli from the catheter. Chronic bladder irritation or infection is often associated with squamous metaplasia [1]. Kaufman et al. [2] reported that squamous metaplasia is more likely in patients with indwelling catheters placed for more than 10 years than in those with indwelling catheters for less than 10 years (80% vs 42%). ...
Patients with spinal cord injury and a chronic indwelling urinary catheter are known to have an increased risk of bladder malignancy. However, squamous cell carcinoma (SCC) of the epidermis around a suprapubic cystostomy is relatively rare. Here, we report a case of lower abdominal SCC arising from the suprapubic cystostomy tract.
A 58-year-old man with a complete spinal cord injury was referred to our hospital with a chief complaint of an abdominal mass. Abdominal enhanced computed tomography (CT) showed a 7-cm mass surrounding the suprapubic cystostomy and bilateral inguinal and para-aortic lymph nodes metastasis. Histopathological examination of percutaneous biopsy specimens was performed. The diagnosis was stage IV (cT4N1M1) epidermal SCC, which was treated with palliative external radiation therapy.
The SCC in this case was thought to arise from mechanical stimulus of the suprapubic cystostomy. Physicians and patients should pay careful attention to any signs of neoplasms with long-term indwelling catheters, such as skin changes around the suprapubic cystostomy site. This case presentation is only the fourth report of SCC arising from the suprapubic cystostomy tract in the literature. In cases of unresectable tumors and contraindications to chemotherapy, palliative radiotherapy may lead to disease remission and symptom relief.
... CIC has been successful in a large number of adults and children on follow up of more than 20 years (Lindenhall, Abrahamsson, Jodal, Olsson, & Sillén, 2007). CISC may be more suitable than the use of an indwelling urinary catheter in patients who require long-term bladder drainage as a means of minimizing the histological changes that can occur in the bladder mucosa, which predispose and lead to malignant transformation (Gould et al., 2009;Vaidyanathan, Mansour, Soni, Singh, & Sett, 2002). However, this may occur because the catheter is not left in place rather than the technique of intermittent catheterization. ...
Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization.
