Squamous Cell Carcinoma of the Suprapubic Cystostomy Tract With Bladder Involvement
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.\nPhysical examination revealed an erythematous lesion in the abdominal wall enveloping the suprapubic catheter. The result of ThinPrep smear urine cytology was suspicious of malignancy. Cystoscopy revealed a bladder mass in the dome. Ultrasound examination of the kidneys did not show any dilatation. On the computed tomographic (CT) scan of the abdomen, a tumor mass surrounding the suprapubic cystostomy tract was clearly visible (). Transurethral biopsy of the bladder mass was performed. 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 ().\nThe 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 (), the patient died of lung metastasis and pneumonia at 6 months after the start of radiation therapy.