Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?
Hyperparathyroidism does increase the risk of developing kidney stones. A study in New England Journal of Medicine, Broadus et al., PMID 7351950, reported that patients with elevated concentrations of 1,25-dihydroxyvitamin D are at increased risk for kidney stones. The reason is that 1,25-dihydroxyv...
How would use of adjuvant pembrolizumab after nephrectomy for ccRCC impact your treatment choice for metastatic recurrence?
I think treatment selection after recurrence/metastases will depend on the timing after adjuvant pembrolizumab has been completed. If it's about 9 months or more, I think re-challenge with pure IO/IO combination is fair, especially if a patient tolerated pembrolizumab well. If it's within 3-6 months...
How do you manage prostate cancer with adenocarcinoma histology at the primary site but neuroendocrine differentiation in visceral metastases?
I would recommend whole genome sequencing of the tumor and referral to an expert prostate cancer medical oncology for personalized - if possible -systemic therapy.
How would you treat an isolated urothelial cancer local recurrence abutting the duodenum?
My first question would be "why not surgery?" This would be my preferred approach unless there is some contradiction to surgery that I am unaware of. If surgery is contraindicated, I would use a conventionally fractionated approach and try to get to a dose of 5,940 cGy, but this would be following a...
Would you offer Break Wave Lithotripsy as a first-line option in a patient with a symptomatic ureteral or renal stone who is a candidate for ureteroscopy, given S.O.U.N.D. trial data showing noninferiority to ESWL without anesthesia?
This is a great question. I am not sure yet. I agree that the data regarding Break Wave Lithotripsy is very promising and exciting. However, I think more data is needed once Break Wave Lithotripsy is widely available for clinical use to better understand its potential role in symptomatic stone treat...
Do you plan to extrapolate from the NIAGARA trial regarding peri-operative durvalumab/cis/gem to treat upper tract urothelial carcinoma?
UTUC has different biology from MIBC and is considered more aggressive. Patients with UTUC were excluded from the NIAGARA, and therefore, we cannot make assumptions and extrapolations. Having said that, in patients with UTUC, it is important to check if they have microsatellite instability or Lynch ...
How will the results of NRG GU006 and the use of the PAM50 genomic classifier impact treatment for recurrent prostate cancer?
Top line results: The prostate cancer-adapted PAM50 gene expression biomarker was validated in the NRG GU006 randomized trial to predict the differential benefit of hormone therapy, specifically apalutamide monotherapy, for patients with recurrent prostate cancer after radical prostatectomy being tr...
Do you need to perform an emergent orchiopexy on a patient who presents with acute onset testicular pain and scrotal ultrasound shows whirlpool sign but there is arterial flow to the testicle?
I would at least council the family/offer an urgent orchidopexy in this situation. In the practice at my hospital, we have sent someone home in this situation who came back with a non viable testis.
Is PSA reliable in a patient who has a foley catheter or has undergone recent DRE?
PSA is usually not reliable in a patient who has a Foley catheter and is transiently unreliable for 24-48 hours in a patient who has undergone a recent DRE. The reason is inflammation or infection from a Foley catheter, the underlying condition requiring a Foley catheter, or the physical trauma from...
In an obese male with low testosterone, would you initiate testosterone replacement therapy at the initial visit, or start tirzepatide first and monitor for improvement in testosterone levels and erectile function?
Dr. @Dr. First Last has given a thoughtful answer. Assuming no evidence of a structural hypothalamic-pituitary-testicular (HPT) disease (normal prolactin, LH, and FSH in the low-normal to normal range, normal free T4), the best approach is weight loss for these men. Whether to try lifestyle changes ...