Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
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...
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
Is there evidence that prostatectomy improves overall survival in local recurrence of prostate cancer post-definitive radiation?
I am not aware of any prospective clinical trial data to suggest that salvage prostatectomy for locally recurrent prostate cancer improves overall survival as compared to any other comparator. Such evidence would be very difficult to generate given that historically, most prospective studies have fo...
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 a credit card-sized Tegaderm cut to penis length on all my hypospadias repairs. On rare occasions, with a very proximal hypospadias with increased concern for hematoma, I will place a Coban wrap. All dressings stay on for 48 hours, and the family removes them in the bath.
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 ...
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.
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.