We present an updated clinical profile of bladder SCC and a review of NB-SCC therapeutic approaches, including RC, neoadjuvant and adjuvant treatments, radiotherapy, chemotherapy, and immunotherapy.
Peer-reviewed English language reports from to present assessing SCC management were included. Two authors independently screened and extracted the data. Of the articles screened, 10 met the pre-defined inclusion criteria. RC was performed in seven of the 10 studies. Although radiotherapy alone yielded poor outcomes, preoperative radiotherapy and RC were associated with improved survival.
Based on current literature, there is insufficient evidence to Rami shaaban wife sexual dysfunction a treatment recommendation for NB-SCC. Whilst RC is the standard of care, the role of preoperative radiotherapy should be revisited and compared to RC alone.
Additional studies incorporating multimodal approaches, contemporary radiation techniques, and systemic therapies are warranted.
Immunotherapy as a treatment for bladder SCC has yet to be investigated. Owing to its higher incidence, TCC has historically received the most research attention, whilst other histopathological types including SCC have been understudied. The search, which was conducted in Februaryincluded all
Rami shaaban wife sexual dysfunction language publications from January to January A total of entries were generated from the initial screen after combining the results from both databases and removing duplicates.
Articles were assessed for validity and selected for inclusion and exclusion by the first and senior authors, who reached consensus after discussion with the other authors. Of the studies queried, 10 met the pre-defined eligibility criteria Fig. Seven studies involved RC as the treatment for NB-SCC, with some incorporating the use of radiation in addition to RC, whilst the remaining studies used radiotherapy alone and chemotherapy alone as "Rami shaaban wife sexual dysfunction" Table 2 .
Preoperative radiotherapy with RC was associated with improved outcomes, although the comparison group in these studies was irradiation alone. There was no evidence that chemotherapy improves survival over RC. No studies assessing immunotherapy as a treatment for bladder SCC were retrieved. Level IV and poorer evidence was excluded. Given the rarity of SCC and lack of high-quality studies, the discussion below incorporates related studies such as those of B-SCC and TCC in order to most accurately characterise the rationale of specific treatments and the current understanding of SCC management.
Schistosomiasis is considered the major predisposing factor for B-SCC and is responsible for the high incidence of SCC in these regions . B-SCC displays an average age of diagnosis in the fifth decade and a male to female ratio of about 5: With the increasing use of preventative measures involving snail control and anti-bilharzial drugs, the histopathological profile of bladder cancer has evolved significantly in the past three decades.
In Western countries, where NB-SCC is the predominant subtype, patients are typically diagnosed in the seventh decade and have poor survival outcomes . NB-SCC has been associated with neurogenic bladder dysfunction and chronic bladder irritation from various causes, including prolonged indwelling catheterisation, BOO, and urinary stasis . A large study of 43, patients with SCI from Central Europe identified no significant difference in risk of bladder cancer between patients with SCI and the general population, suggesting the link to bladder cancer was primarily related to indwelling catheters, UTIs, and exposure to carcinogens .
Bladder irritants, UTIs, and chronic inflammation are thought Rami shaaban wife sexual dysfunction create an environment abundant in growth factors and cytokines favouring cell proliferation, migration, angiogenesis, and inhibition of apoptosis, resulting in squamous metaplasia, dysplasia, and cancer . The stresses to the bladder mucosa resulting from UTIs, catheterisation, and other bladder irritants may therefore drive inflammation and carcinogenic changes that facilitate squamous metaplasia
Rami shaaban wife sexual dysfunction SCC progression.
Squamous metaplasia involves non-keratinising or keratinising whitish plaques floating on an inflamed urothelium and has been linked to SCC . Clinical features of squamous metaplasia include haematuria, urgency, frequency, and obstruction, similar to symptoms of SCC . Keratinising squamous metaplasia has been observed in a majority 28 out of 45 of cases of NB-SCC but has also been suggested as a normal histological variation in female patients.
At this time, there is insufficient evidence to suggest that squamous metaplasia is a pre-malignant finding and aggressive surgical treatment is not recommended. In B-SCC, several aetiological studies have suggested that the bacterial and viral infections associated with bilharziasis, rather than the parasite itself, are responsible for bladder carcinogenesis .