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Life expectancy for people with traumatic spinal cord injury (SCI) is increasing due to advances in treatment methods and in neuro-urology. Thus, developing urinary bladder cancer (UBC) is gaining importance. Single-centre retrospective evaluation of consecutive in- and out-patient data with spinal cord injury between January 1st, 1998 and December 31st, 2018 was carried out and data were compared with UBC data of the German population from the German Centre for Cancer Registry Data at Robert Koch Institute. A total of 37 (4 female, 33 male) out of 7004 patients with SCI were diagnosed with histologically proven UBC (median follow-up 85 months). Median age at UBC diagnosis was 54.0 years (general population: 74 years). The SCI patients had significantly (p

Life expectancy for people with spinal cord injury has shown a marked increase due to modern advances in treatment methods and in neuro-urology. However, since life expectancy of people with paralysis increases, the risk of developing of urinary bladder cancer is gaining importance. Single-centre retrospective evaluation of patient data with spinal cord injuries and proven urinary bladder cancer and summary of the literature. Between 1998 and 2014, 24 (3 female, 21 male) out of a total of 6599 patients with spinal cord injury were diagnosed with bladder cancer. The average age at bladder cancer diagnosis was 57.67 years, which is well below the average for bladder cancer cases in the general population (male: 73, female: 77). All but one patient had a latency period between the onset of the spinal paralysis and tumour diagnosis of more than 10 years. The median latency was 29.83 years. The median survival for these patients was 11.5 months. Of the 24 patients, 19 (79%) had muscle invasive bladder cancer at ≥T2 at the time of diagnosis. The type of neurogenic bladder (neurogenic detrusor overactivity or acontractility) and the form of bladder drainage do not appear to influence the risk. Long-term indwelling catheter drainage played only a minor role in the investigated patients. The significantly younger age at onset and the frequency of invasive tumours at diagnosis indicate that spinal cord injury influences bladder cancer risk and prognosis as well. Early detection of bladder cancer in patients with spinal cord injury remains a challenge.

The most common cause of stress incontinence in men is iatrogenically or traumatically induced insufficiency of the external urethral sphincter (e1). The rate of incontinence after radical prostatectomy, as reported in the literature, ranges from just below 1% to 90% (1– 3). This very wide divergence of reported incontinence rates can be traced to differences in operative technique as well as to divergent definitions of incontinence. Prostate surgery has undergone major technical refinements in recent years. The nerves can be preserved more often today than in the past, because the relevant anatomy is better understood. Definitions of “continence” range from total dryness to the use of multiple incontinence pads per day. A further important aspect is the time point at which continence is assessed. Nearly all patients experience transient stress incontinence of the first or second degree. The problem is usually due, at first, to irritative symptoms and the urge incontinence associated with them; this is combined with weakness of the remaining external sphincter muscle, which faces a more difficult task than in the physiological situation, as structures adjacent to it that normally provide additional resistance have been surgically removed. In general, there is a good prognosis for the return of continence within one year after surgery (figure 1) (4, 5). Figure 1 The spontaneous course of urinary incontinence after prostatic surgery (from von Kampen et al. [5]). Stress incontinence markedly impairs the quality of life of the affected men, who regard the need to wear incontinence pads as even more bothersome than postoperative erectile dysfunction (6). As the population as a whole ages, pelvic surgery will become more common and we will be confronted with the problem of postoperative stress incontinence in ever greater numbers of men, despite improvements in surgical and radiotherapeutic technique. The current prevalence of stress incontinence in men is below 1% (7). The desire for social continence is strong, and many different therapeutic innovations have been designed for this purpose. Social continence is defined as the ability of the patient to participate in his normal social activities without limitation. This usually corresponds to the use of no more than one incontinence pad per day. We here present the treatment options for stress incontinence in men and discuss them critically. This article is based on a selective search for relevant literature in the database of the U. S. National Library of Medicine. We performed a general search for the terms “male stress incontinence” and “post-prostatectomy incontinence,” as well as specific searches for each of the individual therapeutic and surgical techniques under discussion. Prospective randomized studies are lacking for many of them, and thus the overall state of the evidence is weak.