Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
Are there any online or publicly available pelvic floor physical therapy resources you regularly use or offer to patients?
PFPT is a great adjunct to many treatment regimens for pelvic conditions, such as urge or stress incontinence, dyspareunia, and pelvic pain. While supervised PFPT is outstanding, many women cannot maintain regular follow-up sessions, especially if they have to travel. I direct my patients to YouTube...
How do you approach balancing the treatment of urinary incontinence with anticholinergic medications with the use of cholinesterase inhibitors in dementia?
This is a great question and speaks to the importance of shared decision-making and understanding the context of individual patients. Ultimately, it would be best to avoid anticholinergic medications in our patients living with dementia. Medications with anticholinergic properties increase the risk ...
How do you weigh the risk of urinary catheter or fecal management system placement with that of soiling sacral wounds?
This question is an important question that arises for many of our bed-bound and poorly mobile patients, as sacral wounds commonly develop due to pressure injury. They become very challenging to treat due to fecal and urinary contamination, which can lead to further infection. Fecal and urinary dive...
What approaches do you take to avoid further eGFR decline in patients undergoing unilateral nephrectomy for renal cell carcinoma?
The most important/effective intervention by far is good blood pressure control. Secondarily, if there is proteinuria, one should consider ACE/ARB, SGLT-2, etc. The optimal blood pressure target can be uncertain, but I would advocate for a systolic pressure of less than 130 mmHg.
Does poor glycemic control influence your management of diabetic patients seeking vasectomy?
There is no "hard evidence" linking poor glycemic control to inferior vasectomy outcomes. That being said, I generally adhere to the rule that elective surgical cases should ideally be done with Hgb A1c levels under 8. As such, I will ask the patient if they can work with their endocrinologist or in...
When do you consider platelet transfusion in thrombocytopenic patients who are undergoing HoLEP?
I would transfuse thrombocytopenic platelets to a goal platelet of 50 prior to a HoLEP.
How do you monitor and discuss the sexual side effects of SSRIs with adolescents?
Much of this depends on the individual adolescent. During my initial evaluation, I typically obtain a confidential sexual/relationship history with the adolescent. When completing an informed consent with a teen, I will refer back to this history and ask if anything has changed. I'll then frame the ...
Would you start potassium citrate for a patient with recurrent calcium oxalate nephrolithiasis who has normal urinary citrate levels but persistent acidic urine?
An excellent, fundamental question!Before starting medical treatment, I want to know if the patient’s stone burden is increasing in volume. That requires, in my opinion, serial CT scans, typically annually.If the stone burden is increasing in volume, it’s time for metabolic (non-surgical) treatment....
Would you recommend a diuretic renogram prior to planned unilateral nephrectomy for renal cell carcinoma in a patient with normal kidney sizes bilaterally?
This is more a urological question than a nephrological one. If renal function and kidney sizes are normal, then I am not sure I would, unless there is an option of doing a partial nephrectomy. Not sure how that would change management.