Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you manage persistent pain at the split-thickness skin graft donor site during the first postoperative week?
I have found that lidocaine patches adjacent to the area can be helpful. I also switched to a large Xeroform dressing over the donor site. I have found that this results in less oozing and discomfort, as well as fewer dressing changes.
What is your preferred treatment for patients with painful gynecomastia on anti-androgen therapy for prostate cancer?
Gynecomastia can be a significant morbidity affecting the quality of life in patients on androgen deprivation therapy, especially in patients who receive bicalutamide as monotherapy or at higher doses such as 150 mg a day. In patients who are younger and/or who may spend time in public without their...
How do you differentiate between asymptomatic bacteruria and a true urinary tract infection in pediatric patients with urinary diversions who have a positive urine culture?
This is a very good question without a perfect answer. Much research is ongoing to better understand this exact question. Currently, the best answer I can give is to rely on symptoms and the degree of pyuria. Pyuria suggests inflammation, so in the absence of pyuria, a positive culture is more likel...
How do you proceed if you cannot get a bellows reflex during stage 1 sacral neuromodulation procedure?
It depends on whether you can get great toe plantar flexion, or if the patient is awake, and if you get good sensation. If there is good "toe" and/or sensation, then it's reasonable to test that side; however, if you don't get either and based on fluoroscopy you are sure you are in S3 and depth good...
If a patient has abdominal tubing erosion within a few months of AUS placement and does not appear infected, do you need to replace the whole device?
Fortunately, this is a rare clinical scenario. The key question is whether the device is infected, which would necessitate complete explantation. If the wound and all other device components appear uninfected, then, in carefully selected cases, with appropriate informed consent, it is reasonable to ...
Do you use a larger or smaller diameter ureteral stent in a patient with hydronephrosis due to malignant obstruction?
Malignant ureteral obstruction is the most difficult to manage. Two approaches: balloon-dilate the area of the stricture to 15 Fr with a 5 mm appropriately long ureteral dilating balloon, and then either put up two 6 Fr indwelling stents OR consider placing a Resonance stent (Cook Urology).
Do you prefer a running or interrupted anastomosis for the ureteroneocystostomy during renal transplant?
I prefer a running anastomosis using 4-0 absorbable suture. I universally stent for my cases and leave the stent for 3-4 weeks.
How does a negative PSMA PET change your management when completing salvage radiation for prostate cancer?
It's important to remember that if patients are being referred early for salvage RT, most of them will have negative PSMA PET/CTs (< 50% are positive if the PSA is < 0.5). So, in these cases, you are relying on the usual factors to decide on treatment fields, dosing, and the use of ADT, including ot...
Would you repeat a midurethral sling in a patient with recent failure of a mesh, midurethral sling placed 10 years ago?
It is very unusual for mesh to "fail" over time. Rather, the patient has urinary incontinence, which should be investigated before any surgical decisions are made. If she indeed has incontinence due to sphincteric insufficiency (the pathophysiologic explanation for stress urinary incontinence), then...
Do you place patients on anti-platelet or anti-coagulant medications after a distal shunt for priapism?
I have not routinely done so in my practice. However, it should be noted that these are very infrequent cases and there is no universal/standardized recommendation. Antithrombotic therapy is not routinely recommended in the AUA – SMSNA guidelines as an adjunctive maneuver when performing distal shun...