Chronic Infections of the Urinary Tract and Bladder Cancer Risk: a Systematic Review

  • Anderson-Otunu, Oghenetejiri (Department of Public Health, Faculty of Health, Social Care and Education, Anglia Ruskin University) ;
  • Akhtar, Saeed (Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, University of Kuwait)
  • Published : 2016.08.01


Literature on the relationship between recurrent urinary tract infections and urinary bladder carcinoma risk has been inconsistent. Therefore, we carried out this systematic review of observational studies to ascertain if there is any association between chronic urinary tract infection and urinary bladder carcinoma. A total of 10 databases were searched using Boolean: CINAHL, PUBMED, Google Scholar, Medline, Science Direct, SCIRUS, Cochrane, UK PubMed central, NHS evidence and WHO-website. The search yielded an initial hit of 3,518 articles and after screening and critical appraisal, seven studies were included for this review. Four articles reported an association between chronic urinary tract infections and bladder cancer while three concluded a weak or no association at least in one gender. Main findings in this review were that most of the studies reported an association between chronic urinary tract infections and bladder cancer risk. However, inferences about the causal association between chronic urinary tract infections and bladder cancer risk should be drawn cautiously considering the methodological limitations of case-control studies included in this review. Therefore, more empirical evidence is needed to determine the causal nature of relationships between chronic urinary tract infections and bladder cancer risk.


  1. Abol-Enein H (2008). Infection: is it a cause of bladder cancer? Scand J Urol Nephrol, 79-84.
  2. Chow WH, Lindblad P, Gridley G, et al (1997). Risk of urinary tract cancers following kidney or ureter stones. J Natl Cancer Inst, 89, 1453-7.
  3. El-Mosalamy H, Salman TM, Ashmawey AM, et al (2012). Role of chronic E. coli infection in the process of bladder cancer- an experimental study. Infect Agent Cancer, 7, 19.
  4. Gonzalez CA, Errezola M, Izarzugaza I, et al (1991). Urinary infection, renal lithiasis and bladder cancer in Spain. Eur J Cancer, 27, 498-500.
  5. Hicks RM, Walters CL, Elsebai I, et al (1977). Demonstration of nitrosamines in human urine: preliminary observations on a possible etiology for bladder cancer in association with chronic urinary tract infections. Proc R Soc Med, 70, 413-7.
  6. Jhamb M, Lin J, Ballow R, et al (2007). Urinary tract diseases and bladder cancer risk: a case-control study. Cancer Causes Control, 18, 839-45.
  7. Jiang X, Castelao JE, Groshen S, et al (2009). Urinary tract infections and reduced risk of bladder cancer in Los Angeles. Br J Cancer, 100, 834-9.
  8. Johansson S, Wahlqvist L (1977). Tumours of urinary bladder and ureter associated with abuse of phenacetin-containing analgesics. Acta Pathologica Microbiologica Scandinavica Section A Pathol, 85, 768-74.
  9. Kantor AF, Hartge P, Hoover RN, et al (1984). Urinary tract infection and risk of bladder cancer. Am J Epidemiol, 119, 6.
  10. Karin M, Greten FR (2005). NF-kappaB: linking inflammation and immunity to cancer development and progression. Nat Rev Immunol, 5, 749-59.
  11. La Vecchia C, Negri E, D’Avanzo B, et al (1991). Genital and urinary tract diseases and bladder cancer. Cancer Res, 51, 629-31.
  12. Lax AJ, Thomas W (2002). How bacteria could cause cancer: one step at a time. Trends Microbiol, 10, 293-9.
  13. Nesi G, Nobili S, Cai T, et al (2015). Chronic inflammation in urothelial bladder cancer. Virchows Arch, 467, 623-33.
  14. Parkin DM (2008). The global burden of urinary bladder cancer. Scand J Urol Nephrol, 12-20.
  15. Pasin E, Josephson DY, Mitra AP, et al (2008). Superficial bladder cancer: an update on etiology, molecular development, classification, and natural history. Rev Urol, 10, 31-43.
  16. Pelucchi C, Bosetti C, Negri E, et al (2006). Mechanisms of disease: The epidemiology of bladder cancer. Nat Clin Pract Urol, 3, 327-40.
  17. Radomski JL, Greenwald D, Hearn WL, et al (1978). Nitrosamine formation in bladder infections and its role in the etiology of bladder cancer. J Urol, 120, 48-50.
  18. Shakhssalim N, Hosseini SY, Basiri A, et al (2010). Prominent bladder cancer risk factors in Iran. Asian Pac J Cancer Prev, 11, 601-6.
  19. Sievert KD, Amend B, Nagele U, et al (2009). Economic aspects of bladder cancer: what are the benefits and costs? World J Urol, 27, 295-300.
  20. Sturgeon SR, Hartge P, Silverman DT, et al (1994). Associations between bladder cancer risk factors and tumor stage and grade at diagnosis. Epidemiol, 5, 218-25.
  21. Vermeulen SH, Hanum N, Grotenhuis AJ, et al (2015). Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study. Br J Cancer, 112, 594-600.