Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you select patients for prostatic artery embolization over standard surgical options for BPH?
Assuming that the patient is proceeding with PAE after failed medical management, choosing PAE depends on a few factors: Patient's prostate characteristics: size, shape, and whether there is bleeding related to the patient's prostate Patient comorbidities: PAE is less invasive and usually doesn't ...
Is the PROTEUS data enough to change your practice in the treatment of patients with high-risk localized or locally advanced prostate cancer?
The question asks if the results of PROTEUS would/should impact practice patterns...let us take a look: ADT is not recommended to be used with radical prostatectomy in prostate cancer by any guideline. Apalutamide or any ARPI are not recommended to be used with RP in prostate cancer in any guideline...
In a child with grade III-IV VUR who has a second febrile UTI while on antibiotic prophylaxis, do you move to surgical correction or continue medical management?
A second febrile UTI on ppx does not mandate surgical correction. Many factors go into whether surgery is ultimately recommended. In the example patient, I would ask about bowel and bladder habits (if male, circumcision status or phimosis). If anything can be optimized medically, I would first work ...
How long do you continue surveillance ultrasounds for antenatal hydronephrosis that's improving and does that differ if it's unilateral versus bilateral?
Until resolved, or until stably mild and the child is toilet trained.
Do you offer treatment of prostate/oligomets upfront with systemic therapy for oligometastatic de novo prostate cancer?
There's no right or wrong answer here, and I've done both options (treat everything up front and treat sequentially) based on disease sites and volume, and patient symptoms and priorities. I can share how I think through the decision-making: Do they qualify for prostate RT based on STAMPEDE and life...
In light of recent updates on neoadjuvant enfortumab vedotin plus pembrolizumab for muscle-invasive bladder cancer showing benefit, how should a trimodality bladder-preservation strategy be contextualized?
The treatment of muscle-invasive bladder cancer. has evolved quickly. Neoadjuvant EVP is absolutely the standard of care in all patients who can receive it. The clinical trials (EV-303/304) used cystectomy as the bladder-directed therapy, and this is the standard of care. Having said that, many pati...
How do you counsel a man with nonobstructive azoospermia and a normal FSH on his odds of successful sperm retrieval?
There is no easy answer. It depends upon testis size, his history, and his genetics testing. The success rate can range from 0->95%, depending on the situation.
How do you approach a child with a single febrile UTI and no prenatal history of hydronephrosis when deciding whether to obtain a VCUG?
Get a postnatal US. If normal consider deferring VCUG unless high risk features like sepsis on presentation, family history, or unusual organism.
What do you tell patients that opt for HIFU for favorable intermediate risk prostate cancer over AS, RP, EBRT, or brachy?
There are currently no published trials that specifically address this question, which is a very good one.My general discussion is that ablation therapies (not specifically HIFU) will have less negative impact on quality of life factors such as preserving erectile function, avoiding urinary incontin...
What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?
Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...