Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How long do you leave a ureteral stent if placed at the time of transplant?
In general, studies suggest earlier removal is better from a potential urinary tract infection (UTI) and BK virus perspective. Most centers try to remove the stent at the 2 to 3 week mark. The risk of urine leak and transient stenosis should be gone by 2 to 3 weeks.
Is there a kidney stone size for which you refer your patients with recurrent nephrolithiasis to urology?
Predicting ureteral stone behavior is fraught with error. In general, stones less than or equal to 3 mm in maximum diameter will pass spontaneously if the patient can tolerate the pain. In fact, routine annual follow-up imaging occasionally shows the absence of small stones, but the patient has no m...
What is your technique for denuding vaginal epithelium during a colpocleisis?
Depends on the type of colpocleisis. For a Le Fort, I typically make two trapezoids. With the vagina everted, I pre-mark the edges of the dissection, starting with a horizontal border approximately 1 cm distal from the cervical reflection, then a second horizontal border ~1 cm proximal to the bladde...
How do you decide between an endoscopic and open approach for a patient with a 1.5 cm distal ureteral stricture 6 months postoperatively following renal transplant?
Based on the length of the stricture, I would start with endoscopic management and follow up with appropriate studies (Lasix renogram, voiding cystourethrogram [VCUG]). If endoscopic management failed and there were no comorbidities that preclude surgery, I would recommend a reconstructive procedure...
Can a PSA bounce be seen shortly after SBRT to prostate cancer oligometastases while on androgen deprivation therapy?
I would not consider it a "bounce" if it happens shortly after treatment because the timing of a post-treatment bounce is later. If the PSA is higher than pre-treatment baseline soon after metastasis-directed SBRT, then you are likely observing one of two scenarios. First, the pre-treatment baseline...
Do you add ADT to RT for a patient with intermediate-risk prostate cancer with discordant Decipher and ArteraAI results?
This will be a long response to try to provide transparency to these tests from what I know as a researcher and clinician. I also clinically see this situation frequently. We have made incredible progress in developing biomarkers in prostate cancer, but it is important to know that no single test is...
If a patient has hydronephrosis in the immediate postoperative period following renal transplant, would you place a stent or nephrostomy tube?
The answer depends on the degree of hydronephrosis and whether there is obstruction. Is creatinine increasing? Immediately after transplant, recovery of ureteral peristalsis is delayed, and the collecting system may dilate somewhat. There may also be edema at the uretero-vesical junction that needs ...
Would you pursue cystoscopy and CT urogram in a young patient with one episode of gross hematuria and no other risk factors for bladder or kidney cancer?
Gross hematuria is treated very differently from microscopic hematuria. The correct board answer would be to offer a workup including upper tract imaging and cystoscopy. We would treat them like a high-risk microscopic hematuria patient. We have patients who develop bladder and kidney cancer who hav...
How do you approach rising PSA following radical prostatectomy and early salvage radiation therapy?
There are several factors that I will take into consideration, including the patient's overall health, the interval from treatment to relapse, the PSA doubling time (rather than a PSA threshold), whether or not they're castrate resistant and whether or not they now have overt metastatic disease. Pat...
What treatment do you offer for patients with florid incontinence due to a patulous urethra secondary to chronic catheterization?
If you have adequate urethral length (which is usually not the case in this scenario), you could consider an obstructing fascial sling. Otherwise, the options are: SP tube, which often does not work due to the urethra being so incompetent, so UI continues Bladder neck closure + SP tube Ileal condui...