Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
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...
Would you perform varicocelectomy in a non-obstructive azoospermic patient with grade 3 varicocele or proceed straight to sperm retrieval?
Assuming no Y chromosomal microdeletions, no karyotypic anomalies, and no testosterone use, yes, I would. About 25% or so will achieve some level of spermatogenesis 4 months later for use with ICSI, and that would obviate the need for a TESE. If no sperm have returned to the ejaculate, at least you ...
How and with what urgency do you work up hematuria in a patient with ESRD who is pending renal transplant?
Depends! There isn't enough information to provide a reasonable response.
What medications do you offer patients prior to in-office vasectomies?
I typically offer 10 mg of diazepam to take prior to the procedure. I would say about 40% take it. I find that it takes the edge off of coming in. Once they’re here, they don’t really need it.In terms of aftercare, I just tell them ice, acetaminophen, and ibuprofen. We haven’t offered a narcotic for...