Cystectomy in patients with spinal cord injury: indications and long-term outcomes

We evaluated indications and outcomes of cystectomy in patients with spinal cord injury in a urology unit attached to a statewide spinal cord injury service.

We performed a review of all patients with spinal cord injury in our database who underwent cystectomy between 1997 and 2008. Demographic, pathological and perioperative data were collected. Oncological outcomes were documented for those with malignant indications while patient satisfaction was recorded using the Patient Global Impression of Improvement scale for all patients.

Of 2,569 acute spinal cord injury presentations there were 14 patients who underwent cystectomy. Mean patient age was 53 years (range 39 to 72). Of the 14 patients 9 had malignant disease and 5 had benign indications for cystectomy. Overall mean followup was 48 months (median 30.8). Cumulative survival in the malignant cohort was 66.7% with a 33.3% recurrence rate resulting in death. All survivors remained disease-free at a mean of 49 months (median 31). Mean Patient Global Impression of Improvement score was 3 (range 1-very much better to 7-very much worse). In the nonmalignant cohort mean followup was 75 months (median 77). The overall Patient Global Impression of Improvement score in this group was 2.4, suggesting overall positive patient satisfaction.

In patients with spinal cord injury cystectomy is performed almost as often for nonmalignant as for malignant indications. Our data support a more aggressive presentation of cancer with a different pathological profile but not survival compared to normal populations. Centers treating patients with spinal cord injury should consider a lower threshold for the surgical management of bladder cancer where appropriate, especially considering that morbidity, satisfaction and outcome do not appear to be compromised in patients with spinal cord injury.