AUA 2018: Environmental Impact on Urologic Health

Truckee, CA (UroToday.com) -- Panel discusses how geographic variation plays a role in urologic health - Two new studies examining environmental factors relating to bladder cancer and urinary stone disease will be presented at the 113th Annual Meeting of the American Urological Association (AUA). During a joint press conference at the Moscone Center in San Francisco, CA on Friday, May 18 at 11:00 a.m. PT, researchers will share data highlighting the association between environmental “hot spots” and bladder cancer, as well as a link between the California municipal water supply and the prevalence of urinary stone events.

Study Details
Publication #: MP06-05

Geo-mapping and Spatial Analysis of Environmental Exposures in Patients with Bladder Cancer in Upstate New York: An Exploratory Study: Bladder cancer is one of the most common cancers in the U.S., affecting nearly 81,200 adults each year. Known bladder cancer risk factors include smoking, exposure to industrial chemicals, genetics, family history and not drinking enough fluids, to name a few; however, environmental exposures and their association with bladder cancer prevalence have yet to be clarified.

In this study, researchers from Buffalo, NY performed a retrospective review of their institution’s database for patients with bladder cancer who visited their institution between 2006 and 2016. Once the information was gathered, Geographic Information Systems (GIS) software was used to map patient addresses in Erie and Niagara counties in Upstate New York. Analyses were also conducted at the census block level and hot spots were described in terms of water quality and industrial site presence.

Results showed:
  • Forty-nine percent of the institution’s bladder cancer patients lived in Erie and Niagara counties in Upstate New York. 
  • Spatial clustering of patients in four environmental hot spots were identified. Within these hot spots, water quality and environmental effects of industrial sites were of concern. 
  • Future research will determine the relationship between environmental exposures, patient characteristics, and prevalence of bladder cancer.

Study Details
Publication Number: MP13-02

Tapping into Geographic Variation in Urinary Stone Disease: What’s in the Water? The etiology of the urinary stone disease is multifactorial and includes environmental factors, fluid intake, and urine concentration. It is not known if characteristics of the municipal water supply are associated with urinary stone disease, which is why researchers from California sought to identify if measured characteristics of local California municipal drinking water were related to the prevalence of urinary stone events. Researchers identified approximately 64,000 patients who underwent stone procedures in the state of California between 2010 and 2012. They calculated the rate of operative stone disease for each California County based on the patient’s home zip code and compared it to municipal water analyses data. Water characteristics explored included hydroxide alkalinity, potassium, pH, total alkalinity, and water hardness (as CaCO3). Finally, researchers fit multivariable logistic regression models to explore what water or population factors were associated with operative stone burden.

Results showed:
  • The average water potassium level (1.2 versus 2.8 mg/L, p<0.001) and average water hardness (94.8 versus 178.1 mg/L, p<0.001) were inversely associated with the county-level operative urinary stone disease.
  • There was a trend toward significance for lower water pH in high stone burden counties (7.52 vs. 7.73, p=0.08). 
  • Increased water potassium level was predictive of significantly decreased odds of a county being in the top for stone burden.

Researchers concluded that in the state of California, potassium concentrations in the municipal drinking water are inversely associated with county-level operative urinary stone disease. This finding suggests further investigation into exposures, such as municipal water characteristics, might be used to enact effective stone prevention policies.
“Bladder cancer and Kidney stones can recur frequently,” said Dr. Borin. In some studies, more than 50 percent of patients will have a recurrence over the course of 10-20 years. Genetics certainly plays some role as do human behaviors such as smoking and diet. However, environmental exposures may represent a hidden cause of these diseases. In particular, research into variations in the quality and content of drinking water may have larger implications for disease prevention and public health policy.”

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