Sylvester Comprehensive Cancer Center and Miller School Urologists Showcase Wide Range of Research Topics at AUA2021

Leading urology experts from Sylvester Comprehensive Cancer Center and the University of Miami Miller School of Medicine Department of Urology presented more than 20 abstracts on a spectrum of topics at this year’s American Urological Association annual meeting, AUA 2021.

The breadth of topics, which also included studies on stone and benign prostate diseases, urology workforce issues, health care disparities and COVID-19’s impact on men’s health, highlights how committed the University of Miami is to find new ways to improve patients’ urologic health, said Mark L. Gonzalgo, M.D., Ph.D., professor and vice chair of urology at the Miller School.

“Our participation at AUA is a testament to the high-quality research that we do at the Miller School,” Dr. Gonzalgo said.

Prostate Cancer Disparities

Chad R. Ritch, M.D., M.B.A., a urologic oncologist, researcher at Sylvester Comprehensive Cancer Center, and associate professor of urology at the Miller School, was part of an AUA media event highlighting research on racial disparities in prostate cancer. Dr. Ritch talked about research he and  colleagues authored on racial disparities in the treatment of advanced prostate cancer.

“We looked at the National Cancer Database on racial disparities in the treatment of castration-resistant prostate cancer, which is an advanced type of prostate cancer that is the most lethal to men,” Dr. Ritch said. “We know that Black men have a higher rate of dying from prostate cancer compared to white men. The hypothesis of the study was that it could potentially be related to less frequent use of more advanced or novel therapies in prostate cancer care.”

Dr. Ritch and colleagues found that immunotherapy, which has been widely available for castration-resistant prostate cancer since 2010, appeared to be more prominently used in white men compared to Black men from 2010 to 2015. The finding could help explain the worse outcomes among some Black prostate cancer patients.

Updating the Nation’s Urologists on Non-Muscle Invasive Bladder Cancer

Dr. Ritch also was among the instructors in the AUA teaching course “Guidelines and Beyond: Case Based Approach to Non-Muscle Invasive Bladder Cancer,” which was presented virtually to more than 100 participants.

A recognized expert in non-muscle invasive bladder cancer, Dr. Ritch is part of the panel that writes the evidence based AUA guidelines on how urologists should manage and treat non-muscle invasive bladder cancer.

Women in Urology Leadership

Raveen Syan, M.D., assistant professor of clinical urology who specializes in female pelvic medicine and reconstructive surgery at the Miller School, was among the authors of the study “Do Women have a Seat at the Table? Evaluating Board of Directors in AUA Subspeciality Societies for Gender Equality.”

While only 10% of all practicing urologists in the 2019 AUA census data are females, women are a growing part of the urology workforce. More than half of urology applicants in the 2021 urology match were women, according to the study presented in a virtual podium presentation at AUA by Daniel Gonzalez, a medical student at the Miller School.

Potential Disparities in Common Women’s Procedures

Dr. Syan was senior author of the AUA presentation of “Socioeconomic Predictors of Receiving a Vaginal Hysterectomy Compared to Open and Laparoscopic/Robotic Approaches for Treatment of Apical Prolapse: An Analysis of over 38,000 Women in the Healthcare Cost and Utilization Project (HCUP).” Miller School medical student Sirpi Nackeeran presented the study during an AUA virtual podium presentation.

There are multiple approaches to uterus removal. When the cervix or upper vagina falls into the vagina, a condition called apical prolapse, the recommended treatment is a vaginal approach to uterus removal because it has the lowest morbidity and quickest recovery. But use of this approach remains low, according to Dr. Syan.

“We studied a nationwide database of all women with uterine prolapse who received a hysterectomy. We found that women were more likely to get a vaginal hysterectomy if they were younger, of higher income, treated at a large urban hospital, and in the southern area of the U.S.,” Dr. Syan said. “This suggests that younger, wealthier women with greater access to large urban hospitals are more likely to receive the recommended vaginal hysterectomy than women of older age and lower income, with less access to specialists. This study is the first to our knowledge demonstrating that there may be socioeconomic factors that influence the type of surgery a patient receives and demonstrates disparities in care.”

Dr. Syan was among the authors of the AUA presented study “Evaluating the association of racial and socioeconomic disparities and frailty on post-operative complications among patients undergoing apical pelvic organ prolapse procedures.”

The authors of this study, including senior author Katherine Amin, M.D., assistant professor of clinical urology at the Miller School, looked at the association between socioeconomic factors, frailty, and postoperative complications among patients who underwent pelvic organ prolapse surgery. Frailty is an important factor to consider when determining the safety of this common surgery.

Using a national inpatient database, the investigators identified more than 9,000 women who had pelvic organ prolapse repair, of which 12.7% were frail and 12.2% had complications. They found that predictors of frailty among women undergoing pelvic organ prolapse surgery were white race, older age, Medicare payer status, and large, urban hospital location.

“Although frailty and Medicare payer status were associated with complications, race and hospital size were not. Paradoxically, patients at rural hospitals were more likely to experience complications despite being less frail overall,” according to the study presented at AUA.

Plant-based Diets and Men’s Health

Urology resident Ali Mouzannar, M.D., presented and was among the authors of “Impact of Plant-Based Diet on PSA Level: Data from the National Health and Nutrition Examination Survey (NHANES),” a study looking at the dietary habits of nearly 1,400 men with documented PSA levels in the NHANES database.

“This study was presented at AUA as a podium presentation in addition to being featured in an AUA press release,” Dr. Mouzannar said. “We looked at a large database to see if there was any association between prostate-specific antigen (PSA) levels and showed PSA levels tended to be lower in men who consumed diets rich in healthy plant-based foods.”

Miller School urology resident Ruben Blachman-Braun, M.D., M.Sc., presented and authored “Plant-based diets are associated with decreased risk of erectile dysfunction,” which found that there is a positive impact from eating more plant-based foods and less animal protein on erectile function.

“In essence, eating a plant-based diet does not negatively impact men’s sexual health,” Dr. Blachman-Braun said.

COVID’s Impact on Men’s Health

And it’s no surprise that AUA2021 highlighted research looking at COVID-19’s impact on health care delivery, as well as urology.

Miller School medical student Eliyahu Kresch gave a virtual podium presentation on a study he authored with Miller School researchers called “SARS?CoV?2 endothelial dysfunction can cause erectile dysfunction: histopathological, immunohistochemical and ultrastructural study of the human penis.”

“We studied two patients with a history of COVID-19 who received penile prostheses,” Kresch said. “Tissue specimens that we took while doing the surgery revealed there were COVID particles in the tissue, making this the first study to demonstrate the presence of COVID-19 virus in the penis long after the initial infection in humans. Our study also suggests that widespread endothelial cell dysfunction from COVID-19 infection can contribute to subsequent erectile dysfunction.”

The September AUA meeting is archived at AUA2021 Annual Meeting | AUA2021 (swapcard.com).

Tags: American Urological Association, Department of Urology, Dr. Ali Mouzannar, Dr. Chad Ritch, Dr. Raveen Syan, Sylverster Comprehensive Cancer Center