Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
In the setting of prior salvage radiation therapy for rising PSA post prostatectomy, can there be any role of additional radiation therapy for isolated local recurrence in the bladder neck/prostate bed?
I have not run into this scenario. If it is visible on imaging (ultrasound +/- CT or MRI) I would explore the possibility of HDR, 13.5 Gy x 2. Careful consideration would need to be given to the location of the recurrence and anatomy. Technically it may be challenging due to scar tissue and the limi...
Do you recommend a metabolic evaluation in a kidney transplant patient with no prior history of nephrolithiasis who is found to have donor derived kidney stones?
Thanks for an interesting question. It would help if we knew the relevant donor medical history, such as dietary indiscretions or enteric hyperoxalutia, which would not be issues in the recipient. Since this information is typically not available, I would collect two 24-hour urinary supersaturation ...
How would you treat a young man with a history of stage IA testicular pure seminoma s/p radical orchiectomy who has a solitary left inguinal lymph node recurrence and normal tumor markers?
Relapse in an inguinal node is somewhat unusual in testicular cancer unless there has been prior scrotal violation or surgery for maldescent. Trans-scrotal biopsy of the testis is usually an incorrect approach, as it can cause a different pattern of spread (to the inguinal nodes). Thus, I would not ...
What factors prompt you to treat enterococcus when isolated in polymicrobial culture from patients with urinary tract infection?
Enterococcus is an organism that I would treat when isolated in a clinically significant positive urine culture, even when polymicrobial. Since Enterococcus produces a biofilm, it can essentially trap other organisms in and be seen in the setting of a polymicrobial infection. In this setting, I woul...
When do you recommend postoperative radiation therapy for a ureter carcinoma?
The role of postoperative radiotherapy for ureteral cancers (and, by extension/association renal pelvis cancers) is controversial. Patients who might stand the most to benefit from adjuvant radiotherapy are those with locally advanced disease; unfortunately, these patients have a high risk of distan...
Would you consider a treatment break for a patient with metastatic urothelial carcinoma who achieved a near-complete response to enfortumab?
The answer to this question is highly dependent on the specific clinical context. However, for a patient who has a deep and durable response to enfortumab vedotin monotherapy and has been on treatment for a prolonged period of time (again context-dependent, but at least a few months), I think it is ...
What would be the next step if a patient’s serum testosterone remains above 40 several weeks after the initial dose of a GnRH agent in the treatment of prostate cancer?
Real-world data show that approximately 3-7% of patients experience breakthroughs above 40 ng/dL per patient course, while 6.6% experience breakthroughs above 32 ng/mL (1.1 nmol/L). When using the lower threshold of 20 ng/dL (0.7 nmol/L), breakthrough rates increase to approximately 41%. One large r...
How do you evaluate and manage incidental urinary retention in hospitalized patients?
Another great question. First, we need to confirm the presence of urinary retention (>300 ml on postvoid residual [PVR] bladder scan is considered clinically significant to continue evaluating for common reversible causes, such as medications, structural abnormalities, presence of constipation, feca...
Do you recommend 24 hour urine stone risk studies for patients with no history of nephrolithiasis who are undergoing evaluation as potential kidney donors?
We ask all donors if they have had a history of kidney stones. All donors also get a CT angiogram of the abdomen. Patients with a stone history will need a 24-hour urine stone risk profile. If a donor has an incidental single stone, we may still allow donation, but we would ask for a 24 stone profil...
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...