The Impact of Smoking on Urologic Outcomes

Purpose: Cigarette smoking is the leading preventable cause of morbidity and mortality in the US and worldwide. The surgical literature demonstrates that active tobacco smoking is a major risk factor for perioperative morbidity and complications, and that preoperative smoking cessation is effective in reducing these associated risks. However, few studies have examined the dual effects of smoking on the etiology and treatment of urologic conditions, and perioperative complications following urologic procedures. The goal of this review is to highlight the scientific data regarding the impact of smoking on urologic conditions and outcomes, and to suggest ways that urologists can promote smoking cessation with their patients, and lead efforts to emphasize preoperative smoking cessation. Materials and Methods: The words “smoking and urology” or “tobacco and urology” were used as search terms in PubMed (for the years 1950–2014) to identify all articles that included at least one of these terms or phrases. All of the articles were evaluated, and the 67 key references included in this review. Results: There is strong evidence that smoking is associated with higher incidence rates of malignant and benign urological conditions, an increased risk of perioperative complications, and inferior long term outcomes. The increased risks of developing bladder and kidney cancer are well recognized in smokers, and an adverse impact on postoperative outcomes in the treatment of testicular and prostate cancer have been described. Smoking also is implicated in the pathogenesis of benign conditions such as nephrolithiasis, lower urinary tract symptoms and erectile dysfunction, and adversely impacts renal transplant outcomes. Smoking portends worse outcomes after medical and surgical management of different urological conditions, and evidence suggests that urologists can increase preoperative smoking cessation rates through a combination of counseling and pharmacologic therapy. Conclusions: Further research is needed to reduce the impact of smoking on perioperative urologic complications, and to characterize the related costs to the healthcare system. Urologists should encourage preoperative smoking cessation as part of their clinical practice to reduce perioperative morbidity and worsened outcomes associated with active smoking.