Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
As PARTIQoL was a negative study, what is the current role for proton therapy in the management of prostate cancer patients?
Thank you for the comprehensive answer Dr. @Dr. First Last! It is interesting you talk about integral dose - that almost rarely comes up from the patient in my experience. They have read and have been told that it IS less toxic (not that it may be). They are told that protons are better and the auth...
How would you manage incidentally-found prostate cancer on TURP?
The patient's risk group along with genomic classification with Decipher would inform the treatment recommendation regardless of the source of the tissue. The pathologist should be able to estimate how much of the tissue had cancer and provide the Gleason Group. The location and volume of tissue are...
Would you recommend definitive XRT for prostate cancer in patients with prior Holmium Laser Enucleation of the Prostate (HoLEP)?
There are multiple options for outlet procedures in patients who present with baseline obstructive symptoms but prefer to avoid a radical prostatectomy. HoLEP is an effective procedure preferred by some urologists due to low re-treatment rates. HoLEP can often be quite aggressive leading to marked r...
In a young male patient with hypogonadotropic hypogonadism and fertility goals, would starting testosterone replacement therapy affect fertility chances?
Men with hypogonadotropic hypogonadism due to congenital hypogonadotropic hypogonadism or acquired hypogonadotropic hypogonadism due to structural disease (e.g., a pituitary macroadenoma) typically require gonadotropin therapy to optimize spermatogenesis and fertility. For men who have hypogonadotro...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
How do you evaluate for clinically significant ureteral obstruction in a pregnant patient with AKI, since physiological hydronephrosis on kidney ultrasound is common?
For AKI, it would have to be bilateral, and then I would consult urology.
Is a history of provoked DVT a contraindication to starting testosterone replacement therapy in a middle aged man with symptomatic hypogonadism who is on anti-coagulation?
The data on testosterone replacement and thromboembolic disease is not so clear but there is likely a link and should be noted in patients at high risk (e.g smoking, prior event, erythrocytosis). It’s important to discuss the risk benefits with the patient but as long as they are on anticoagulation,...
Do you administer prophylactic antibiotics for GU procedures?
The common GU procedures performed in radiation oncology are transperineal brachytherapy and transperineal retroprostatic hydrogel insertion. Rarely transrectal biopsy or transrectal intraprostatic injections may be performed by radiation oncologists. I don't believe any randomized studies looking a...
Is there a PSA value below which you would not offer salvage radiation post-prostatectomy?
I am commonly asked the inverse question: if I use a "PSA cutoff" whereby a rise beyond this value will strongly favor treatment with post-op radiation. I think it is difficult to have a set value that applies for all patients, as the decision to treat should be individualized to patient and disease...
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...