Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you follow/manage patients with metastatic prostate cancer with undetectable PSA and castration-sensitive but active disease on PSMA PET?
Summary: This is a challenging clinical scenario, and one in which I think there is currently a lot of practice variability. In such cases, I would not jump to action immediately, and I would first try to obtain some additional information. This would include repeat PSA for confirmation as well as f...
What are your top takeaways in GU Cancers from ASCO 2026?
1. A-DREAM (Alliance A032101): Can We Give Patients a Break from ADT?For men with APMS prostate cancer who achieve exceptional biochemical responses to testosterone suppression (TS) plus an ARPI, can treatment be safely interrupted to allow testosterone recovery and improved quality of life?Single-a...
What is your approach to delayed or inhibited ejaculation related to SSRI sexual dysfunction?
There are several theoretical possibilities that have been suggested over time. Periactin 4mg 30 minutes prior to sex is noted as a possible intervention. I've never seen any benefit from this. Another possibility is to add Wellbutrin at regular dose which allows for additional sympathetic nervous s...
Do you recommend CT or ultrasound imaging testing when monitoring a patient with nephrocalcinosis?
I recommend CT. It is much more sensitive for detecting small changes in calcification than US. Yes, it is more expensive and requires a small amount of radiation, but if monitoring is indicated, I think sensitivity is most important. Stephen B. Erickson, MD
Do you routinely offer prophylactic mid-urethral sling in patients undergoing repair of significant prolapse without preop stress incontinence?
No— this was shown not to be beneficial and might cause more harm in the OPUS trial. (Wei et al., PMID 22716974)
Do you typically recommend placement of a rectal spacer prior to definitive radiotherapy, regardless of dose/fractionation?
In my opinion, the potential and role of rectal spacing in minimizing toxicity is not debated. The concern about spacing relates to risks of the procedure and its associated additional cost to treatment may be greater than the potential improvement in toxicity for the patient. As we continue to show...
Do you prescribe tamsulosin after ureteroscopy in a patient with residual stone fragments on postoperative imaging to assist with stone passage?
I use alpha blockers after ureteroscopy for stent pain or if there is no stent to help with transient colic or dust passing. I don’t obtain routine imaging after URS - I am selective for those with impacted stones, complicated URS, or symptoms. (Adiyat et al., PMID 19100606)If this imaging showed ur...
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
When a patient presents with an infected IPP, do you go straight to explant/salvage reimplantation or explant and wait for completion of antibiotics before delayed replacement?
The answer to this question is nuanced, meaning it depends. If there is the possibility that the infection is superficial, in the wound, a trial of oral antibiotics is reasonable. I would get baseline CBC and CRP; the latter we have found can guide whether deeper infection is going on. If CRP is low...
What is your approach to foley catheter placement and duration in a patient with a prostatic abscess that is being managed with either aspiration, unroofing, or antibiotics alone?
My approach is to treat the Foley as bladder drainage, not as treatment for the abscess. Catheter use should be driven by degree of retention, bladder emptying, bleeding, and the extent of transurethral manipulation. There are no standardized catheter duration guidelines for prostatic abscess, so pr...