This Month in Adult Urology

Abstract

You have accessJournal of UrologyThis Month in Adult Urology1 Jun 2022This Month in Adult Urology D. Robert Siemens D. Robert SiemensD. Robert Siemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002499AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Lower Urinary Tract Symptoms and Increased Mortality in Men Lower urinary tract symptoms (LUTS) are common and frequently associated with significant bother and decreased quality of life in the aging male. However, there is some mounting evidence that severe LUTS could potentially serve as a prognostic factor for premature death with several theoretical relationships. Åkerla et al (page 1285) from Finland further explore this concept among middle-aged and elderly men utilizing population-based surveys spanning 1994–2018.1 Their analysis included 1,167 men and demonstrates an association of daytime frequency and nocturia with increased mortality. Although no cause-effect correlation can be inferred from these observations, the authors interestingly show this link between LUTS and mortality is independent of associated bother, which might be the more usual complaint to drive subsequent investigation and management. Frailty and Adverse Outcomes after Sling Surgery As our population ages, preoperative assessment and prehabilitation will become increasingly important to optimize outcomes for even mildly complex interventions. Increasing evidence has pointed to some evaluation of frailty, rather than simply age and co-morbid illness, as being more useful to assess postoperative sequelae in the elderly. Van Kuiken et al (page 1276) from San Francisco, California examine the impact of frailty on outcomes of sling surgery for stress urinary incontinence in all Medicare beneficiaries over 65 years of age.2 They observed that frailty is associated with an increased risk of 30-day complications, need for repeat procedures as well as 1-year mortality. The authors suggest that frailty should be strongly considered for an elderly woman considering the pros and cons of even such a relatively minor surgical procedure. A practical assessment of frailty such as TUG (Timed Up & Go) could be easily implemented in our clinics. Risk of an Elevated Hematocrit on Testosterone Therapy Despite direction from guidelines, it has been observed that routine assessment of bloodwork after initiation of testosterone therapy (TT) is less than ideal. One important potential adverse outcome that may then be missed is secondary erythrocytosis. Although this can be a common dose-limiting effect, there are few data that examine the association of a rising hematocrit and cardiovascular outcomes for those on TT. Ory et al (page 1295) from Miami, Florida and Halifax, Canada using a multi-institutional database explored these associations and demonstrate that the incidence of major adverse cardiovascular events or venous thromboembolic events was associated with developing erythrocytosis in the first year of TT.3 These results underscore the importance of assuring guideline-concordant followup for men on TT. The Impact of Hematuria after Post-Prostatectomy Radiotherapy Considerations of prostate cancer survivorship issues are paramount when counseling patients, perhaps specifically so when discussing the potential need for post-prostatectomy radiation. Although experientially a frequent occurrence, hematuria following post-prostatectomy radiation is not fully characterized. Turchan et al (page 1236) from Chicago, Illinois add to our understanding with a contemporary, single-institution study that describes in detail the long-term risks of hematuria and patient-reported urinary quality of life in men after salvage radiation.4 They show a relatively high incidence of hematuria, with only 55% of patients remaining free of a significant episode of hematuria, and 15% required some intervention. Unsurprisingly, they show a strong association between hematuria and radiation dose to the bladder as well as anticoagulation/antiplatelet therapy; however, the hematuria was generally self-limited and importantly the patient-reported urinary quality of life was not significantly impacted. Smoking Cessation and Bladder Cancer Recurrence Cigarette smoking is the single greatest preventable cause of disease in many jurisdictions, and after a cancer diagnosis, those who continue to smoke have a significant increase in adverse outcomes. Smoking cessation after a cancer diagnosis in some studies has been associated with improved outcomes such as reduced recurrence, perhaps reversing impaired DNA repair pathways and allowing some recovery of carcinogenesis defense mechanisms. Furberg at al (page 1200) from New York, New York add more detail to this discussion with a prospective study of 354 patients with bladder cancer and assessing biochemically verified post-diagnosis smoking exposure.5 In this cohort, most with higher risk nonmuscle-invasive bladder cancer, smoking exposure was detected in 22% of patients. After a median followup of 3.6 years, the authors were unable to detect any association between post-diagnosis smoking exposure and recurrence risk. Although the authors conclude that late smoking cessation, after the diagnosis of bladder cancer, may not substantially affect early disease recurrence, they stress that smoking cessation remains a critical component of bladder cancer care given the benefits beyond short-term recurrence rates.