Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you consider adding abiraterone to ADT and salvage RT in a prostate cancer patient with pN1 disease at radical prostatectomy?
This is a question that is being addressed in the salvage setting by NRG GU008. Currently, we have high level evidence that adding abiraterone to ADT is superior to ADT alone for subsets of patients with metastatic disease and the combination with RT is superior to ADT alone plus RT for both clinica...
When do you find ultrasound guidance to be most helpful for botulinum toxin injection?
I occasionally use ultrasound to survey the target muscle and neighboring structures such as blood vessels. I find this most helpful in the groin area or abdomen. The main difficulties with ultrasound relate to maintaining aseptic technique and needing an extra hand to control the probe in some situ...
Would you use fezolinetant for hot flashes for men on ADT?
I might consider it after trying the usual agents that will at least partially relieve symptoms in the majority of patients, such as low-dose megestrol or venlafaxine (there are others, but these are the ones with which I have had the most experience and success). Fezolinetant is expensive and requi...
What are your top takeaways in GU Cancers from ASCO 2024?
PSMAfore presented previously showed (177Lu-PSMA-617) prolonged radiographic progression-free survival vs change of androgen receptor pathway inhibitor (ARPI) in taxane-naïve patients with metastatic castration-resistant prostate cancer. At ASCO, data presented showed 177Lu-PSMA-617 delayed time to ...
How would you treat a patient with muscle invasive urothelial carcinoma with squamous differentiation?
In general, pure and predominant urothelial carcinoma (majority or >50% of tumor consisting of urothelial carcinoma) have been treated similarly at least in trials. Patients with predominant or pure non-urothelial histology have typically not been enrolled in trials of urothelial carcinoma. There ar...
Is there a serum potassium level for when you would recommend discontinuing potassium citrate in a patient with recurrent nephrolithiasis, hypocitraturia, and hyperkalemia?
I take hyperkalemia seriously, as cardiac effects do not correlate closely with serum levels. If evaluation does not reveal a correctable cause, I would decrease potassium citrate dosage to keep serum potassium below 5.0. Stephen B. Erickson, MD
Is it ever acceptable for high risk prostate cancer patients to be treated with upfront radical prostatectomy?
This is an excellent and timely question. There is definitely an increasing trend of patients with high-risk prostate cancer (PCa) receiving upfront radical prostatectomy (RP). Some of this is spurred by a recent, high-profile meta-analysis (https://www.ncbi.nlm.nih.gov/pubmed/26700655), which poole...
How do you decide between RPLND vs. chemotherapy in patients with Stage IIA mixed germ cell tumor as primary treatment?
I agree but would add a few comments: If there is a rising hCG or AFP above normal values, we prefer BEP X 3 rather than RPLND. If the patient > age 50, EP X 4. Also, we consider any AFP < 25 to be “ normal” despite many labs listing 0-8 as their normal range. Our group recently published data in J...
What is your approach to treating antibody-mediated rejection in a pregnant patient with a kidney transplant?
This is a very difficult situation. Presumably, this is late AMR, and to begin with, we would have very few treatment options. I would first optimize immunosuppression and consider IVIG and solumedrol, and defer further treatment until after delivery. We have not used rituximab in pregnancy. Rituxim...
When would you recommend uric acid-lowering therapy for a patient with asymptomatic hyperuricemia without comorbidities but with family history of gout?
I would not recommend treating asymptomatic hyperuricemia unless the patient has clinical gout or concern for proven urate nephropathy (such as with uric acid kidney stones). The family history component is important to acknowledge that the patient may be at greater risk in the future, however, it d...