Abstract
BackgroundAnterior sacral root stimulation combined with sacral posterior rhizotomy restores bladder function in spinal cord-injured patients suffering from hyperactive bladder. After successful implantation of bladder stimulator, urinary infection rate decreases, and patients are able to get rid of indwelling urinary catheters, which in turn reduce the risks for vesical malignancy. We present a spinal cord injury patient with non-functioning Brindley sacral anterior root stimulator, who developed carcinoma of urinary bladder.Case presentationA Caucasian male, who was born in 1943, sustained paraplegia at T-4 (ASIA-B) in 1981. This patient underwent implantation of sacral anterior root stimulator in September 1985. The bladder stimulator started giving trouble since 1996 and the patient went back to using indwelling urethral catheter. In August 2006, this patient passed blood in urine after a routine change of indwelling catheter. Cystoscopy showed unhealthy bladder mucosa. Bladder biopsy revealed carcinoma, which was infiltrating bundles of muscularis propria. Many of the nests showed evidence of squamous differentiation, while others could be transitional or squamous. This patient underwent cystectomy with lymphadenectomy in March 2007 in a hospital nearer his home. Histology showed three nodes involved. This patient has been doing well since the operation.ConclusionOccurrence of vesical malignancy in this patient with non-functioning bladder stimulator is a timely reminder to all health professionals, and health care managers that concerted efforts should be made to rectify a non-functioning sacral anterior root stimulator as soon as possible. Otherwise, facilities should be made available in the community for the spinal cord injury patient to use intermittent catheterisation and thereby, avoid permanent indwelling catheter, vesical calculi and urine infections, which are risk factors for bladder cancer.
Highlights
Anterior sacral root stimulation combined with sacral posterior rhizotomy is a valuable method to restore bladder function in spinal cord-injured patients suffering from hyperactive bladder
Following successful implantation of a sacral anterior root stimulator in a spinal cord injury patient, it is likely that the decreased incidence of urinary infection and absence of long term indwelling catheters would reduce the chances of neoplastic changes in the neuropathic bladder
We present a spinal cord injury patient with non-functioning Brindley sacral anterior root stimulator, who developed carcinoma of urinary bladder
Summary
Occurrence of invasive carcinoma showing squamous differentiation in urinary bladder of this patient, who had non-functioning sacral anterior root stimulator, is a timely reminder to all health professionals, and health care managers that concerted efforts should be made to rectify a non-functioning bladder stimulator as soon as possible.
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