Highlights of Mayo Clinic studies at 2016 American Urological Association Annual Meeting

May 10, 2016

ROCHESTER, Minn. -- Mayo Clinic physicians will present findings on several studies at the 2016 American Urological Association Annual Meeting, to be held May 6-10 in San Diego. They will be available to discuss their research and findings with reporters covering the conference. Some of the studies to be presented include:

"Risk Factors for Postoperative Complications in Patients Undergoing Partial Nephrectomy"

Embargoed until Monday, May 9, at 1 p.m. EDT

Mayo Clinic urologists have completed a comprehensive institutional review of all patients undergoing a partial nephrectomy between 2001 and 2012.

"Partial nephrectomy has become the treatment of choice for many renal masses. This approach provides a safe and effective way for surgeons to remove localized tumors, while preserving the remainder of the kidney," says the study's lead author Harras Zaid, M.D., a fellow in urologic oncology at Mayo Clinic. "Even though practice patterns have changed over the past decade with increased use of partial nephrectomy and newer minimally invasive technologies, research into outcomes has lagged, especially research identifying predictors of postoperative complications."

Dr. Zaid and his colleagues evaluated logistic regression models to assess predictors of postoperative complications within 30 days of surgery. They identified 1,763 patients who underwent 1,773 partial nephrectomies between 2001 and 2012.

Factors associated with higher rates of early complication included being male, having one kidney, renal insufficiency, and a higher Charlson comorbidity score. The Charlson comorbidity index categorizes a patient's conditions based on standardized measures. The higher the score, the more likely the predicted outcome will result in mortality or higher resource use.

Dr. Zaid says these data may help inform patient counseling prior to partial nephrectomy and help select high-risk candidates for observation or percutaneous ablative procedures.

"Tranexamic Acid May Reduce Need for Blood Transfusion in Patients Undergoing Open Radical Cystectomy"

Embargoed until Friday, May 6, at 1 p.m. EDT

Surgeons at Mayo Clinic instituted a change in clinical practice in April 2013 for certain patients undergoing open radical cystectomy to study whether tranexamic acid might improve outcomes by reducing perioperative blood transfusions.

"About 60 percent of patients undergoing open radical cystectomy receive blood transfusions, which has been associated with poor outcomes, increased risks of disease recurrence and mortality," says Harras Zaid, M.D., the study's lead author. "Tranexamic acid is an antifibrinolytic agent that promotes blood clotting by preventing clots from breaking down and may eliminate the need for blood transfusions."

For the study, patients undergoing radical cystectomy received an intraoperative, intravenous bolus of tranexamic acid followed by continuous infusion. Patients with a history of venous thromboembolism or those who received coronary stents a year prior to their surgery did not receive tranexamic acid.

Researchers defined perioperative blood transfusion as occurring during surgery or within postoperative hospitalization and defined venous thromboembolism as occurring within 30 days of surgery.

Using these definitions, they recorded and compared outcomes to a matched cohort of patients who received radical cystectomy at Mayo Clinic prior to the change in clinical practice.

Researchers studied 103 patients who underwent radical cystectomy at Mayo Clinic between April 2013 and July 2015 and received tranexamic acid. For analysis these patients were matched 1-to-2 to historic controls based on age, preoperative hemoglobin, receipt of neoadjuvant chemotherapy, and stage of cancer. Researchers found that use of intraoperative tranexamic acid associated with a significant reduction in perioperative blood transfusions (31.1 percent versus 57.5 percent, p<0.001) and did not increase the risk of venous thromboembolism.

"Artificial Urinary Sphincter Improves Outcomes for Men with Stress Incontinence"

Embargoed until Tuesday, May 10 at 3:30 p.m. EDT

Men who underwent primary artificial urinary sphincter implantation to treat stress incontinence had improved long-term outcomes according to the results of a 28-year study by Mayo Clinic urologists. "Recognition of long-term success is important for preoperative patient counseling," says the study's lead author Brian Linder, M.D., a urologist at Mayo Clinic.

Researchers identified 1802 male patients with stress urinary incontinence that underwent artificial urinary sphincter placement from 1983 to 2011. Of the 1082 study participants, 60 percent were men who received primary implantations. This group comprised the study cohort.

Researchers conducted patient follow-up through office examination, operative reports and written or telephone correspondence. They also evaluated multiple clinical and surgical variables for potential association with treatment failures that were defined as any secondary surgery.

Researchers found no patient-related risk factors that were independently associated with an increased risk of secondary surgery. Secondary-surgery free survival was 90 percent at 1 year, 74 percent at 5 years, 57 percent at 10 years, and 41 percent at 15 years. Patients who received implants had a median age of 71 and median follow-up of 4.1 years. Overall, 31 percent of patients underwent a secondary surgery, including 89 for device infection or erosion, 131 for device malfunction, 89 for urethral atrophy and 29 for pump malposition or tubing complications.

"Proton Pump Inhibitor Use May Increase Complications Following Radical Prostatectomy"

Embargoed until Monday, May 9, at 3:30 p.m. EDT

Recent studies have shown an association between proton pump inhibitor (PPI) use and adverse outcomes including dementia, chronic kidney disease, fractures, and increased mortality following hospital discharge. At the same time, there is little literature regarding the effects of PPIs on surgical outcomes. Urologists at Mayo Clinic sought to assess the impact of PPI use on outcomes following radical prostatectomy.

"PPIs are available both over the counter and with a prescription, and are used to treat gastro esophageal reflux disorder (GERD) and peptic ulcer disease," says Dr. Westerman, the study's lead author Mary Westerman, M.D., a urology fellow at Mayo Clinic. "PPI use has risen dramatically over the past 20 years. Currently, PPIs are the fourth most prescribed class of medication in the U.S., so it's important to know their impact on surgical outcomes."

Researchers identified 9,338 patients who underwent radical prostatectomy at Mayo Clinic from 2001 to 2012. PPI use was defined as having taken a PPI within 90 days preceding surgery.

Overall, 372 (4 percent) of men were taking a PPI at the time of surgery. The median postoperative follow-up was 7.3 years, during which time 81(0.9 percent) of men died of prostate cancer. Men taking a PPI were older (63 years, compared to 61.5 years) and had higher BMIs. They also were more likely to have a higher Charlson comorbidity index score, indicating an increased risk of mortality, at the time of radical prostatectomy. Finally, at the time of radical prostatectomy, patients using PPIs had more pathologically advanced disease and an increased risk of complications.

"More research is needed to determine whether PPI use is a surrogate for decreased overall health or frailty, or if PPIs result in physiologic changes, predisposing patients to more complications," says Dr. Westerman. "It is clear that patients taking PPIs were older, less healthy and had higher risk of disease and their use of PPIs was independently associated with a higher overall complication rate following radical prostatectomy."

"Amateur Athletes Who Use Steroids Experience Side Effects Both on and Off Testosterone"

Embargoed until Tuesday, May 10, at 3:30 p.m. EDT

Since the 1980s, illicit use of androgenic and anabolic steroids has spread from elite athletes into the general population. Despite the high level of steroid use among amateur athletes, little is known about this population. Mayo Clinic researchers sought to identify and characterize patterns of anabolic-androgenic steroids (AAS) in a cohort of this population. "Current estimates are that 1 million to 3 million amateur athletes use steroids in the U.S.," says the study's lead author, Mary Westerman, M.D., a urology fellow at Mayo Clinic.

Researchers issued an anonymous, self-administered questionnaire between February 2015 and June 2015. Links to the survey, hosted on SurveyMonkey, were posted on message boards of websites popular among AAS users. Researchers analyzed 37 questions for the study.

The majority of the 231 respondents who met inclusion were white males, over 25, employed with above average incomes and formal education beyond high school. Ninety-three percent began using AAS after 18, and 81 percent reported using more than 400 mg of testosterone per week. Factors associated with longer duration of use included higher incomes, increased testosterone dosages, being over 35, being married and being self-employed. Seventy-seven percent had routine lab tests, and 38 percent reported having laboratory abnormalities at some point. Nearly all respondents experienced subjective side effects on and off testosterone.

"The population of AAS users is disparate from other drug abusers," says Dr. Westerman. "Lab abnormalities and side effects are common in this population, and health care professionals should take this into account when counseling these patients."
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