Dr. Greenberg on hypogonadism in patients undergoing radical cystectomy

In this video, Daniel Greenberg, MD, highlights the background and notable findings from the study, “The association between hypogonadism, frailty, and postoperative outcomes among men undergoing radical cystectomy,” which was presented at the 24th Annual Fall Scientific Meeting of the Sexual Medicine Society of North America in San Diego, California. Greenberg is a urology resident at Northwestern University in Chicago, Illinois.

Video transcript:

This study is really born out of the idea that when we look at patients who are undergoing radical cystectomy, which is the gold standard treatment for patients with muscle invasive bladder cancer, that a lot of these patients tend to be very frail and have a very high postoperative morbidity and mortality. We know that frailty, currently, which is a measure of functional status of these patients, trends and correlates very well with postoperative outcomes. There's been a number of different interventions aimed at trying to improve patients' frailty in the preoperative setting. We're one of the first to look at hypogonadism, or low testosterone, as a marker for both frailty and also as a biomarker for how these patients do after surgery.

The way that we did this is we use the IBM MarketScan database, which is a large national claims database to identify men from 2012 to 2021, who had undergone radical cystectomy for bladder cancer. We looked at patients who, within 5 years prior to their surgery, had been diagnosed with hypogonadism, or low testosterone. We compared their outcomes to patients who had not received this diagnosis. We also compared their frailty using what we call the hospital frailty risk score, which categorizes patients as low risk, intermediate [risk], or high risk. Our cohort included over 3500 patients. About 6.1% of them had a diagnosis of hypogonadism prior to undergoing radical cystectomy. We showed that on average, these men were more frail compared to patients who did not have a diagnosis of hypogonadism prior to surgery. We did not show however, that hypogonadism was an independent predictor of adverse postoperative outcomes. But within the cohort overall, men who were categorized as high risk or high-risk frailty did have significantly worse postoperative outcomes, meaning a much higher rate of being admitted as an inpatient admission within 90 days or having to visit the emergency department for post operative complication.

This transcription has been edited for clarity.