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Thread: SCI Nurse, Dr.Young, Bladder Cancer Screening Questions

  1. #1
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    SCI Nurse, Dr.Young, Bladder Cancer Screening Questions

    After reading KLD's last response in the "SP tube surgery" thread I have some serious concerns. As I have mentioned in several threads I get all my medical care from the VA, and I am just now discovering that I haven't been getting all the reccomened screenings for bladder cancer. I will be 12 years post injury on the 27th of this month, and I have been using foley catheters for at least 10 1/2 years. I have had urodynamics once(before SP 9+ years ago)), and I haven't had any cystoscopy exams since my injury. I only have urinalysis and cultures done during my annual exams at which time I'm sure they are also doing the cytology, but that is only once a year, not the 3 times a year on the cytology KLD stated in the other thread. I also get the KUB xray and renal and bladder ultrasound annually. I have not been seen by a GU doctor since the SP post-op recovery peroid. I need your guidence on what to do now??? I want to make sure I am getting all the bladder cancer screenings, but I don't want to sound as if I'm accusing my doctor of giving me substandard care, I like her, unlike my doctor at the VA SCI center I went to before we moved down here.

    Linda H.

  2. #2
    The cytology test is not 3X a year. It is 3 separate specimens (ideally on 3 separate days) during your annual evaluation. The urine must be fresh, taken from the catheter (not the bag) and must be immediately mixed with cytology preservative (usually blue) solution, and the test run within 4 hours.

    The brand new edition (May 2, 2005) of the VHA Handbook 1176.1, Spinal Cord Injury and Disorders Systems of Care Procedures states on page 18:

    4. Cystoscopy is performed every 10 years for patient with an indwelling catheter for a patient with an indwelling catheter or suprapubic catheter or a patient who has used tobacco products. Other indications for cystoscopy include hematuria, recurrent symptomatic UTI, recurrent asymptomatic bacteruria with a stone-forming organism, pieces of eggshell calculi observed in the urine, or new onset-urinary retention.
    At our center we do not feel once very 10 years is sufficient as we have identified and successfully treated patients for cancer at 12, 13, 14, 15, etc. years post injury. If we had waited until 20 years, those patients would be dead.

    Other urinary system specific annual exam items include:

    <UL TYPE=SQUARE><LI>Annual UA and C&S of urine
    <LI>Annual serum creatinine and BUN
    <LI>Annual anatomic exam (ultrasound or CT) of the entire urinary tract
    <LI>Test of renal function (creatinine clearance or renal scan)
    <LI>Counseling regarding advantages and disadvantages of PSA testing (males only).
    <LI>Urodynamic evaluation as indicated (for example, hydronephrosis, AD of unknown cause, incontinence in the absence of UTI).[/list]

    Also under the section on screening for urologic cancer on page 21 you will find this:
    4)Urological cancer: the increased risk of bladder tumors in SCI veterans, especially in the presence of long-standing indwelling catheter, necessitates constant vigilance. Emphasis is placed on monitoring of urinary cytology and, when indicated, cystoscopy and bladder biopsy. When appropriate, non-invasive tests are to be used.
    .

    If you have concerns that you are not getting care per 1176.1, you should discuss this with your SCI physician and then with your PVA NSO.

    (KLD)

  3. #3
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    Thank you for all of this information. I have printed it all so that I can share it with my health care providers.So far I have been getting all of the other urological test you have listed, outside of the cysto, and cyctology.
    Besides not smoking what else can I do to try to prevent bladder cancer, and would you please tell me what the symptoms of this disease are? After using a foley catheter this long, would it be beneficial to have the mitro surgery to try to prevent getting bladder cancer?
    If I can do anything pro-active to protect myself I want to start doing it a.s.a.p., I have seen the results of this cancer going undetected until it was to late, and I don't want it to happen to me or anyone else when it is so preventable.

    Linda H.

  4. #4
    The problem with bladder cancer is that there are rarely any symptoms until it is quite advanced. This is why such screening is needed. Rarely someone will have bladder bleeding (hematuria) as a symtom, which is why we also recommend that you have cystoscopy after any hematuria episodes.

    There is some indication that the risks for bladder cancer are increased by eating cured and smoked meats, so you may want to cut back on these if you already have a high intake.

    Depending on your bladder capacity, it is never too late to at least discuss a Mitrofanoff. In the VA system, as you know, there is less experience with females with SCI, so you may need to pursue this more actively. If your bladder is quite shrunken (more probable) you would probably have to combine it with an augmentation for it to be successful. What is your level of injury and hand function?

    (KLD)

  5. #5
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    My level is T10-12, and my hands are good outside of having arthritis & C.R.E.S.T. . I do have a history of having extensive abdominal adhesions from gyn. problems(PID) and several surgeries. I was supposed to have a procedure simular to the mitro with the augmentation about 9 years ago, but for some reason I became extremely upset the morning of the surgery. My doctor then suggested doing the SP instead, which was what he wound up doing that day. As far as bladder capacity is concerned I do believe the phrase "thimble bladder" would be about right for me. Although on the rare occasion when my catheter does get clogged I have been know to come close to filling up the tubing for the night bags, however much that is. The subject of going back to do the other surgery has never been raised since then.

    Linda H.

  6. #6
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    Bump

    Linda H.

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