Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How would you treat a monopolar injury to the bowel if there is no obvious defect in the intestinal wall?
Depending on extent of injury, intervention would be different. However, if it’s an incidental thermal “kiss” (<3-4mm), I would put a few imbricating stitches in the seromuscular layer to oversew the injury.
What tips and tricks are there for catheterizing a patient with a history of metoidioplasty?
History is the key first step. I would ask what exact operation the patient had, whether urethral lengthening was performed, where they void from, whether they have had strictures or fistulas, and what catheter size has worked before. I would also ask exactly why a catheter is needed. For example, i...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
Until what age do you monitor asymptomatic boys with a history of posterior urethral valve ablation?
Most patients with a history of posterior urethral valves (PUV) should be routinely followed by urology into mid to late adolescence, though it all depends on renal function, bladder function, and the degree of residual hydronephrosis. These factors determine the frequency of clinic visits. For very...
Has the TRAVERSE trial, which showed testosterone therapy was noninferior to placebo for MACE but raised signals for pulmonary embolism and atrial fibrillation, changed how you counsel middle-aged men who specifically cite cardiovascular safety when requesting TRT?
Results from the TRAVERSE trial have made my discussions a bit more streamlined, but I have always used a handout discussing known risks of TRT, such as infertility, testis atrophy, and erythrocytosis, and associated risks based on poor literature dating back to 2011. This trial confirmed what most ...
How has your approach to managing asymptomatic bacteriuria in kidney transplant patients changed in light of a recent meta-analysis showing no significant differences in pyelonephritis, symptomatic UTI, or graft loss between patients treated with antibiotics and those who were not treated?
The referenced meta-analysis has not dramatically impacted my approach to asymptomatic bacteriuria (ASB) in kidney transplant recipients (KTRs). The included trials clearly show no benefit (and possible harm) in treating ASB at time periods >2 months post-transplant. So we do not screen and we do no...
How would you eliminate chronic/recurrent fungal stent colonization in a patient with chronic hydronephrosis who is not eligible for reconstructive surgery due to medical comorbidity?
Need a CT scan to rule out a possible renal pelvis fungal ball. If the kidney is clear, then would remove the old stent and consider replacement with either a Resonance stent or a Boston Scientific Percuflex stent - would soak both in fluconazole prior to placement and also irrigate the kidney and b...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
How do you evaluate for an ascending UTI in a patient with a urostomy?
Evaluating for ascending UTI in a patient with a urostomy UA Generally low value; chronic pyuria/mucus makes results unreliable. Urine culture Essential; must be collected from a clean stoma catheterization or a fresh pouch, and not from the urostomy bag. Imaging (CT abdomen and pelvis wit...
How do you manage bladder spasms during pelvic radiotherapy?
My approach would depend on the disease under treatment, specific symptoms, concurrent therapies, and whether or not the patient has a prostate. The first thing I would do, if you have not already done it, is obtain a urine sample to rule out infection. Let's assume that was done and there is no inf...