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Hypogonadism, frailty, and postoperative outcomes among men undergoing partial nephrectomy
Alon Lazarovich1, Daniel R Greenberg2, Stephen P Rhodes3
1Department of Surgery, Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
The Canadian Journal of Urology
|December 15, 2024
Summary
Hypogonadism is common in men undergoing partial nephrectomy and linked to frailty. Testosterone replacement therapy may reduce postoperative risks in frail, hypogonadal men, suggesting screening is beneficial.
Area of Science:
- Urology
- Andrology
- Geriatrics
Background:
- Hypogonadism affects 8.9% of men undergoing partial nephrectomy (PN).
- Hypogonadal men exhibit significantly higher frailty scores compared to eugonadal men.
- Frailty, not hypogonadism itself, correlates with adverse postoperative outcomes.
Purpose of the Study:
- To assess hypogonadism prevalence in men undergoing PN.
- To investigate the association between hypogonadism, frailty, and postoperative outcomes.
- To evaluate the impact of testosterone replacement therapy (TRT) on outcomes in hypogonadal men.
Main Methods:
- Retrospective analysis of 9,105 men undergoing PN (2012-2021) using Merative Marketscan.
- Hypogonadism defined by diagnosis within 5 years prior to PN; frailty assessed via Hospital Frailty Risk Score (HFRS).
- Outcomes included length of stay, complications, emergency department visits, and readmissions; subgroup analysis for TRT effects.
Main Results:
- No significant difference in length of stay or 90-day complications between hypogonadal and eugonadal men.
- Intermediate- and high-risk frailty associated with increased 90-day emergency department visits and readmissions.
- Among high-risk hypogonadal men, TRT correlated with reduced 90-day emergency department visits (p=0.04).
Conclusions:
- Frailty is a key predictor of postoperative outcomes after PN.
- Hypogonadism is linked to increased frailty in this population.
- TRT may mitigate postoperative risks in frail, hypogonadal men, supporting frailty assessment and testosterone screening.
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