Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?
Our hospital's approach, which is consistent with CDC guidance, limits urinary catheters (UC) for I/O measurement to critically ill patients. We clarify that the information from the UC should be used at least q1-2 hours, otherwise it can be obtained in other ways (noninvasive collection, bladder sc...
How does the presence of indeterminate lymphadenopathy on PSMA PET scan alter your management of unfavorable intermediate-risk prostate cancer?
Summary: In practice, I usually review the imaging myself and attempt to evaluate for common pitfalls of interpretation or evidence that may convince me of a true positive. Often, I find a second review by a blinded radiologist helpful. Unless I am highly suspicious of a false positive, I often err ...
How do you manage hot flashes in men with prostate cancer on androgen deprivation therapy?
I prescribe Effexor extended release (XR) 37.5 mg increasing to 75 mg if needed. Serves double duty since many men would benefit from an antidepressant anyway. Works for women as well.
How would you treat a patient with Gleason 8 or 9 prostate cancer, pretreatment PSA 15-24, with retroperitoneal adenopathy?
I would offer a similar approach to that described nicely by @Dr. First Last and @Dr. First Last: definitive RT+ADT+abiraterone, with SIB to the grossly positive nodes. My caveats and additions are: I start with a frank discussion with the patient re: evidence for various scenarios and general prog...
Would you recommend HRT to treat hypogonadism in a male patient in his 80s?
If the patient is symptomatic, cautious use of a small dose can be considered with close monitoring.
Do you consider tertiary grade pattern, LVI or PNI on prostatectomy specimens as adverse features to recommend EBRT and ADT for patients with unfavorable intermediate prostate CA after prostatectomy with undetectable PSA?
No, I don’t think there is any current available evidence to define a benefit for ADT in the post-operative setting for patients with an undetectable PSA. The two major trials which define a benefit for ADT in this setting, RTOG 9601 and GETUG AFU-16 had a lower limit of a PSA of 0.2 at treatment in...
Are there any special considerations when treating patients with recurrent nephrolithiasis who also have medullary sponge kidney?
Sponge kidney patients present a very challenging therapeutic situation. Anatomically speaking, a sponge kidney is often a congenital, although occasionally acquired, dilation of the renal collecting ducts, which in turn causes the inability to acidify urine. Urine pH is typically unusually alkaline...
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
Do you have your patients with recurrent calcium phosphate nephrolithiasis and hypocitraturia avoid high citrate containing foods if they have alkaline urine?
A good question, and I don’t think we have hard evidence to answer it. Most kidney stones are a mixture of calcium oxalate and calcium phosphate, the oxalate content usually predominating. Pure oxalate stones should prompt a search for one of the hyperoxalurias. Pure phosphate stones (apatite/brushi...
What is your approach to managing patients with recurrent nephrolithiasis who consistently fail to adhere to recommended dietary changes including animal protein and sodium restriction and remain at elevated stone risk due to hypercalciuria despite thiazide diuretic use?
This question is why I selected stone prevention as a clinical interest. Adherence is critical and perhaps more complex for me than all of the numerical issues with stone pathogenesis. When diet fails as described above, I have failed, and I do what I can to improve. No one answer because diet and l...