title: E-cigarettes and Urologic Health: A Collaborative Review of Toxicology, Epidemiology, and Potential Risks.
abstract: Use of electronic cigarettes (ECs) is on the rise in most high-income countries. Smoking conventional cigarettes is a known risk factor for urologic malignancy incidence, progression, and mortality, as well as for other urologic health indicators. The potential impact of EC use on urologic health is therefore of clinical interest to the urology community.
  
  
  
  To review the available data on current EC use, including potential benefits in urologic patients, potential issues linked to toxicology of EC constituents, and how this might translate into urologic health risks.
  
  
  
  A Medline search was carried out in August 2016 for studies reporting urologic health outcomes and EC use. Snowballing techniques were also used to identify relevant studies from recent systematic reviews. A narrative synthesis of data around EC health outcomes, toxicology, and potential use in smoking cessation and health policy was carried out.
  
  
  
  We found no studies to date that have been specifically designed to prospectively assess urologic health risks, even in an observational setting. Generating such data would be an important contribution to the debate on the role of ECs in public health and clinical practice. There is evidence from a recent Cochrane review of RCTs that ECs can support smoking cessation. There are emerging data indicating that potentially harmful components of ECs such as tobacco-specific nitrosamines, polyaromatic hydrocarbons, and heavy metals could be linked to possible urologic health risks.
  
  
  
  ECs might be a useful tool to encourage cessation of conventional cigarette smoking. However, data collection around the specific impact of ECs on urologic health is needed to clarify the possible patient benefits, outcomes, and adverse events.
  
  
  
  While electronic cigarettes might help some people to stop smoking, their overall impact on urologic health is not clear.
authors.affiliation: Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK. Electronic address: l.bourke@shu.ac.uk.
authors.forename: Liam
authors.initials: L
authors.lastname: Bourke
authors.affiliation: Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bullen
authors.affiliation: Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Cumberbatch
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.affiliation: Wolfson Institute of Preventative Medicine and UK Centre for Tobacco and Alcohol Studies, Queen Mary University of London, London, UK.
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.affiliation: Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
authors.affiliation: Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
authors.forename: James W F
authors.initials: JWF
authors.lastname: Catto
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D003257:Consumer Product Safety; D066300:Electronic Nicotine Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D014570:Urologic Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000072137:Vaping / Q000009:adverse effects / Q000295:instrumentation*; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine
keywords: Electronic cigarettes; Smoking cessation; Toxicology; Urologic health