Squamous cell carcinoma in a long-standing suprapubic cystostomy: a urological oddball

Squamous cell carcinoma (SCC) rarely accounts for 2-5% of urinary bladder cancer. Chronic irritation of the bladder from infection or indwelling catheter is a risk factor for SCC. Only a handful of cases of suprapubic cystostomy (SPC) site SCC have been reported and have been always seen in paraplegics or urethral stricture requiring long-standing catheterization. We report a case of a 69-year-old male with an indwelling (SPC) of 25 years duration for a urethral stricture who presented with a fungating growth around the SPC site enveloping the catheter confirmed to be squamous cell carcinoma. Imaging revealed involvement of abdominal wall and urinary bladder with no metastatic spread. He underwent wide local excision (WLE) of the lesion with radical cystectomy and ileal conduit reconstruction with bilateral ilio-inguinal lymphadenectomy and pedicled anterolateral thigh flap for abdominal wall reconstruction. He received adjuvant radiotherapy and was found to be recurrence free at 3 months. Among the cases previously reported, 9 of the 12 cases were treated surgically with 4 of those combined with partial cystectomy and 4 with radical cystectomy. SPC site SCC tends to be localized around the catheter and into the abdominal tract and wide surgical excision offers the best hope for cure. Regular cystoscopy and biopsy from bladder around the catheter site can help early detection and the treatment should be personalized to each patient.