Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is the longest acceptable interval between radical orchiectomy and adjuvant BEP for Stage IIB/III pure seminoma in the age of COVID-19?
Drs. @Dr. First Last and @Dr. First Last have worked with GCT experts to create practical recommendations during this pandemic. You can read these here. Briefly, these patients should be still be treated with timely curative intent. Treatment decisions will need to be individualized for each patient...
How do you bandage the penis after hypospadias repair, and how long do you leave the dressing in place?
I place Telfa lined with Vaseline, wrapped in 1-inch Kerlix, sandwiched with credit card-sized Tegaderms. The dressing comes off in 48 hours in the bath, but if it is difficult for the families to remove, I also tell them that our team can help remove them when they come back for the catheter remova...
What is your approach for managing patients with recurrent nephrolithiasis who have elevated urinary cystine levels but calcium oxalate stone composition?
This is usually heterozygous cystinuria, and the urine cystine is in the range of 50 mg. Supersaturation with cystine is absent, and the cystine can be ignored. Rarely, urine cystine is high enough to produce stones, and I treat both stone risk factors. In all cases where urine cystine is above 100 ...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will contin...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...
How do you distinguish between andropause versus pathological hypogonadism in older male patients?
The American Urological Association (AUA) guidelines state: "Men with sustained elevated prolactin levels, very low total testosterone (T) levels (<150 ng/dL) and unexplained failure to produce luteinizing hormone (LH)/follicle-stimulating hormone (FSH) warrant a pituitary magnetic resonance imaging...
Would you consider focal therapy for a patient with NCCN unfavorable intermediate risk prostate cancer, but only 1/16 cores positive, and it's from a targeted lesion biopsy?
A targeted biopsy confirms the MRI lesion is cancer so treatment should be based on imaging and not core #, core length, etc. We routinely treat MRI visible and MRI invisible GG3 with both HIFU and Cryo, depending on the location.
What technique or tool do you use to remove mucinous, infection stones?
In the past, we have performed percutaneous nephrolithotomy to remove mucinous, infection stones. Using the Trilogy device through the nephoscope, to fragment and aspirate stones/mucus was quite successful. Although this is significantly more invasive than standard ureteroscopy, we had a much better...
How do you perform the renorrhaphy during a partial nephrectomy?
A renorrhaphy can be performed using one or two layers. I use running 3/0 Monocryl for the deep layer and 2/0 Stratafix continuous suturing with the sliding clip technique for the cortical layer. I do not use bolsters or tissue sealants in most cases.
What is your approach for managing patients with recurrent nephrolithiasis and hypercalciuria who experience significant urinary frequency symptoms after starting a thiazide diuretic?
To some degree, an increase in urine volume and frequency is expected and even desirable after starting a diuretic. Diluting urinary mineral concentration is a major goal in inactivating metabolic stone disease. If frequent voiding is problematic, urological consultation might be in order, looking f...