Bladder Cancer and Squamous Metaplasia in Spinal Cord Injury Patients

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Abstract
The influence of long-term indwelling urethral catheterization was studied by random bladder and urethral biopsies in 62 spinal cord injury patients. Six patients (10%) had diffuse squamous cell bladder carcinoma, 4 of whom had no tumor visible endoscopically. Five of the patients with cancer were among 25 patients (20%) managed with an indwelling urethral catheter for more than 10 yr (average 21 yr, range 15-30 yr). The other patient was free of the catheter for 27 yr after suprapubic cystotomy for 4 yr. Gross and microscopic hematuria was associated with cancer. Squamous metaplasia of the bladder was significantly greater in patients catheterized for more than 10 yr (80%), compared to those catheterized for less than 10 yr (42%) and patients without catheters (20%). Urethral squamous metaplasia increased slightly in long-term catheterization patients. Urinary infection was universal and did not distinguish patients with inflammation, metaplasia or cancer. The duration of indwelling catheterization seems to be the major factor in squamous changes in these patients.

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