Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you offer neoadjuvant chemotherapy prior to trimodality therapy in a fit patient who refuses surgery for muscle-invasive bladder cancer?
Unfortunately, this is a question without a clear answer at this time. Trimodality therapy, consisting of maximal TURBT, chemotherapy, and radiation, appears to have equivalent outcomes and has NCCN Category 1 recommendations for patients with MIBC. We do not routinely do neoadjuvant chemotherapy fo...
How do you manage a prostate cancer patient with pelvic lymphadenopathy and a single enlarged PSMA PET+ gastrohepatic node?
I would treat it as oligometastatic, starting with ADT/ARPI and use metastasis-directed therapy and pelvic radiation.
How do you counsel/advise patients when asked to compare ultrahypofractionated radiotherapy with the TULSA procedure?
I start by noting that the three NCCN-guideline recommended management plans for favorable-risk prostate cancer are radiotherapy (including SBRT), surgery, and active surveillance, and the latter two often require additional local therapy to render a patient cured within the next 5-10 years. In gene...
Which patients with muscle invasive bladder cancer will you treat with adjuvant nivolumab?
I treat patients who fulfill the eligibility criteria of CheckMate 274. Thus, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization, with or without neoadjuvant cisplatin-based chemotherapy. Patients must have had pathological evidence of ur...
Would you start allopurinol for a patient with uric acid kidney stones who does not have hyperuricemia or hyperuricosuria?
Definitely not! The main risk factor for uric acid kidney stones is neither hyperuricemia nor hyperuricosuria; it is hyperaciduria. Typically uric acid stone formers have a urine pH below 5.8. Raising urine pH into the mid 6s will not only stop new stone formation and existing stone growth; it will ...
How do you approach a patient who has incidentally found liver and renal cysts?
If has many cysts in both organs, then consider polycystic syndromes and should see a nephrologist and hepatologist. For liver cysts - determine if simple or complicated (irregular borders, thick septations) - if the latter then likely need sampling. regardless hepatic simple cysts not causing sympt...
Do the results of IMvigor011 influence you to utilize ctDNA to guide all adjuvant IO in MIBC?
Based on ESMO '25 data, I am using ctDNA in ICI-naive patients s/p radical cystectomy (with or without neoadjuvant chemotherapy) to inform the decision & timing of potential adjuvant nivolumab (FDA-approved) (following IMvigor011 design). I acknowledge the logistical burden of every-6-week ctDNA tes...
Would you refer a patient for kidney only or kidney and liver transplantation if they develop advanced chronic kidney disease secondary to primary hyperoxaluria type 2?
Now that the data suggesting a benefit for nedosiran for PH2 is very disappointing, I think we have to say simultaneous liver and kidney. I have this one experience. My PH2 patient had kidney only because I was thinking that nedosiran would be effective. Ultimately, the kidney failed after about 5 y...
Is a larger prostate size or volume associated with a higher absolute PSA bounce after radiation?
I have not seen anything in the literature to indicate that the magnitude of the PSA bounce is related to prostate size, but it's certainly possible. The highest bounces I have seen after treatment were in patients treated with LDR brachytherapy (my personal record is 8 ng/mL, and it eventually beca...
Would the presence of only mature teratoma on orchiectomy specimen lead you to consider upfront RPLND followed by adjuvant chemotherapy as opposed to upfront chemotherapy in a patient with bulky para-aortic nodal disease (cN3) and AFP/beta-HCG elevation?
If there is an elevated AFP or hCG, then by definition, he has metastatic germ cell cancer and needs chemo initially, followed almost certainly by post-chemo RPLND done by a skilled and experienced urologist.