Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How long would you treat an upper urinary tract infection in a patient with acute obstructive pyelonephritis due to a kidney stone status-post urinary stenting without yet removal of the stone?
After treatment of an ascending urinary tract infection for 7 days, the infection will be treated. However, if the stone is large enough it may be colonized and cause recurrent infection. I would make my best efforts to get the stone removed as soon as possible and I would likely give the patient a ...
How would you treat intermittent hematuria post prostate radiation?
The citation below, good article, and excerpt below, a summary that may answer your question. Our urology colleagues would appreciate it if we initiated a workup like this, but I would always ask the patient to see a urologist as well. HBOT should be considered. “For grade 1 and grade 2 types, sympt...
What rectal spacer do you recommend for prostate cancer patients?
I’ve only ever worked with SpaceOARs. I’d be interested to hear from providers who have gotten to work with both. There are similarities between both. A similar amount of total volume is injected with either procedure. Both products begin natural resorption around 3 months after placement. SpaceOAR ...
For a patient who is cisplatin-eligible with localized, high-grade upper tract urothelial carcinoma, but no muscularis propria seen on biopsy, what is your approach?
The risk of clinical under-staging is notorious in UTUC; therefore, we aim to maximize control of disease and address the meaningful risk of micro-metastasis. In that context and outside clinical trial option, we favor the use of neoadjuvant cisplatin-based chemotherapy using either dose dense MVAC ...
Which salt substitutes do you recommend for your patients with recurrent nephrolithiasis who have hypercalciuria from excess sodium chloride intake?
In practice, as opposed to theory, I never use salt substitutes. I want patients to reduce use of sodium chloride as a life habit and work toward that end. I have no experience with salt substitutes, therefore.
What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conduc...
Are there instances when you obtain an abdominal X-ray over an ultrasound or CT scan for kidney stone surveillance in a patient with recurrent calcium based nephrolithiasis?
Currently, no. My goal with renal imaging is to determine the number, size and position of stones. Before the advent of ultrasound and CT scanning, I used KUB with tomograms. Those have been replaced by CT and ultrasound for more accuracy and less radiation. My urologic colleagues may use an abdomin...
Do you recommend plasmapheresis prior to kidney transplantation for patients with elevated panel-reactive antibody percentages?
No, preemptive PLEX is not necessary with a high PRA in the absence of DSA. At our center, we do monitor for emergence of DSA in our patients with the highest PRAs >98%.
When would you consider long-term suppressive antibiotic therapy in patients with chronic or recurrent bacterial prostatitis who continue to experience symptoms despite multiple courses of antibiotics?
I think this would depend on the organism to be honest. First, I would make sure the patient is seen by urology and evaluated for possible structural reasons for recurrent or chronic prostatitis. If there are no structural issues that can be rectified, I would consider a prolonged course of therapy ...
Would you favor oral bisphosphonates over intravenous formulations for patients with hormone sensitive prostate cancer and androgen deprivation therapy (ADT) related osteopenia?
If kidney function is normal, either would do. Therapy depends on the risk level. (See Cosman et al., PMID 39073912.)