Bladder cancer risk, histological pattern, and surveillance in adults with neurogenic lower urinary tract dysfunction: an updated systematic review and meta-analysis with implications for sub-Saharan Africa

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Abstract Background Neurogenic lower urinary tract dysfunction after spinal cord injury is associated with bladder cancer which is characteristically diagnosed at a younger age, at an advanced stage, and with a disproportionate squamous component. Existing syntheses have not integrated spinal cord injury, spina bifida, and augmentation-cystoplasty substrates, or considered their implications for sub-Saharan Africa, where an independent schistosomal squamous pathway and constrained surveillance infrastructure may coexist. We aimed to provide an updated pooled estimate of bladder cancer occurrence, characterise the histological pattern in neurogenic populations, and appraise the surveillance evidence with explicit regional interpretation. Methods We conducted a systematic review reported in accordance with the PRISMA 2020 statement. MEDLINE/PubMed, Embase, Scopus, and Web of Science were searched from inception to the most recent full month, supplemented by a citation search. Studies reporting bladder cancer occurrence, histology, stage, mortality, risk factors, or surveillance yield in adults with neurogenic lower urinary tract dysfunction were eligible. Two reviewers screened, charted, and appraised studies independently via the Joanna Briggs Institute critical appraisal tools. The cumulative proportions were pooled via Freeman–Tukey double-arcsine transformation within a DerSimonian–Laird random-effects model, with heterogeneity quantified by I². Results Fourteen studies were included, five of which contributed to the primary quantitative synthesis. The pooled cumulative proportion of patients with bladder cancer among the patients in the spinal cord injury cohorts was 0.35% (95% confidence interval 0.16–0.62; I² = 95.9%). The standardised mortality ratios relative to those of the general population ranged from 6.7 to higher values among the catheter-exposed subgroups. Across the studies reporting histology, squamous cell carcinoma accounted for approximately one-fifth and all of the diagnosed neurogenic bladder cancers, a far greater share than the proportion of approximately 5% expected in nonendemic general populations. Disease is frequently muscle invasive or node positive at presentation across spinal cord injury and spina bifida cohorts. Indwelling catheterisation was the most consistently reported risk factor. Surveillance cystoscopy and cytology demonstrated low and inconsistent diagnostic yields. Conclusions Bladder cancer in neurogenic populations is uncommon but disproportionately lethal, with a marked shift towards squamous histology and an advanced stage. The evidence base is dominated by high-income cohorts and is heterogeneous; no included study originated from sub-Saharan Africa, and these quantitative findings should not be extrapolated to the region. The hypothesised convergence of a neurogenic, catheter-driven pathway with endemic urogenital schistosomiasis is biologically plausible but empirically untested, and warrants region-specific cohorts and pragmatic, risk-stratified surveillance research rather than the uncritical transfer of high-income protocols.

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