most bladder squamous cell carcinomas have been described in paraplegics or in patients with spinal trauma . they are also known to occur in patients with long - term indwelling catheters and during chronic inflammatory states associated with frequent irritation and persistent infection . here we report a case study of a patient who developed a squamous cell carcinoma involving the bladder mucosa from a well - healed suprapubic cystostomy scar after 9 years . a 56-year - old male patient who had a suprapubic foley catheter for 9 years after the formation of an urethrocutaneous fistula presented with a spontaneous suprapubic urinary leak from a well - healed suprapubic cystostomy tract scar . he originally had a urethral stricture that required multiple surgical corrections for 16 years beginning at the age of 28 years . nineteen years later ( at the age of 47 years ) , a urethrocutaneous fistula occurred spontaneously and a suprapubic cystostomy tube was eventually required for urinary diversion . on the computed tomographic ( ct ) scan of the abdomen , a tumor mass surrounding the suprapubic cystostomy tract was clearly visible ( fig . histological examination of the biopsy from the bladder mass revealed squamous cell carcinoma , moderately differentiated , probably originating from the vesicocutaneous fistula tract involving the bladder mucosa ( fig . 2 ) . the patient did not want to undergo aggressive surgical excision of the complete bladder and the abdominal wall and underwent radiation therapy . although a ct scan of the abdomen after radiation therapy showed partial remission ( fig . 3 ) , the patient died of lung metastasis and pneumonia at 6 months after the start of radiation therapy . squamous cell carcinoma is a rare form of carcinoma of the bladder that accounts for only 5% of such carcinomas . it is usually caused by chronic irritation from urinary calculi , long - term indwelling catheters , chronic urinary infections , or bladder diverticula . as many as 80% of paraplegics with chronic infections or indwelling catheters experience squamous changes in the bladder , and about 5% develop squamous cell carcinoma . cigarette smoking is also significantly associated with an increased risk of bladder squamous cell carcinoma . male predominance is far less striking in squamous cell carcinoma ( male to female ratio , 1.3:1 to 1.7:1 ) . there are only four case reports of suprapubic catheter tract squamous cell carcinoma ( two of them involving the bladder ) in the english literature [ 5 - 8 ] . the case reported here is the third case of suprapubic catheter tract squamous cell carcinoma extending into the bladder . we present the published cases of suprapubic catheter tract squamous cell carcinoma in table 1 . the prolonged presence of a tube with continuous irritation of the tract site leading to metaplasia and carcinoma provides a possible mechanism for carcinoma . in the literature , a 10% incidence of squamous cell carcinoma of the bladder has been noted in patients who have had indwelling catheters for more than 10 years . .   found that spinal cord injury patients who have had indwelling catheters for more than 10 years have a 20% prevalence of squamous cell carcinoma of the bladder , and those authors advocated for periodic cystoscopies combined with random bladder biopsies for this category of patients . because this type of cancer is extremely rare , insufficient experience exists to postulate the etiology in cases that present several years later in a well - healed suprapubic catheter tract site . persistent discharge is often attributed to recurrence of stricture , for which cystostomies are frequently performed , leading to missed malignancies . these lesions are usually localized and are best treated by radical excisional surgery because of the rapid death of conservatively treated patients . bladder involvement generally dictates surgical management because long - term survival benefits resulting from radiotherapy or chemotherapy have not been reported to date . however , the patient in our study chose not to undergo planned aggressive surgical excision of the complete bladder and the abdominal wall and was instead treated with radiation therapy . he died 6 months after the start of radiation therapy owing to lung metastasis and pneumonia . several reports suggest that the stage - by - stage prognosis of squamous cell carcinoma is comparable to that of transitional cell carcinoma . the prognosis of suprapubic catheter tract squamous cell carcinoma is comparatively poor because most patients have advanced disease at the time of diagnosis . in conclusion , persistent discharge from a well - healed suprapubic catheter scar site several years after a cystostomy should be grounds for suspicion of this rare clinical entity , and an excisional biopsy should always be performed , especially when no stricture or bladder pathology is detectable on cystoscopy . this case study underscores the need for close monitoring of patients with any type of long - term indwelling catheter .