Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your approach to managing neobladder acidosis?
Alkali supplementation is the mainstay of treatment of neobladder acidosis. Since prolonged urinary contact with the intestinal epithelium used for urinary reconstruction leads to increased ammonium reabsorption and chloride absorption in exchange for bicarbonate secretion, regular catheterization o...
Is the PROTEUS data enough to change your practice in the treatment of patients with high-risk localized or locally advanced prostate cancer?
The question asks if the results of PROTEUS would/should impact practice patterns...let us take a look: ADT is not recommended to be used with radical prostatectomy in prostate cancer by any guideline. Apalutamide or any ARPI are not recommended to be used with RP in prostate cancer in any guideline...
What is the role for robotic pyelolithotomy in the modern era of lasers, PCNLs, and flexible and navigable suction ureteral access sheathes?
Laparoscopic or open pyelolithotomy still plays a role in regions where access to technology may be limited. For surgeons who have access to the technology mentioned (including robotics), the need for robotic pyelolithotomy would be limited to those patients undergoing robotic pyeloplasty. There may...
How do you manage a seminal vesicle recurrence after prostate brachytherapy?
Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
Are there any online or publicly available pelvic floor physical therapy resources you regularly use or offer to patients?
PFPT is a great adjunct to many treatment regimens for pelvic conditions, such as urge or stress incontinence, dyspareunia, and pelvic pain. While supervised PFPT is outstanding, many women cannot maintain regular follow-up sessions, especially if they have to travel. I direct my patients to YouTube...
What options do you have when a patient has urinary obstruction during radiation treatment?
Here is my general practice on urinary symptom management for a man with prostate cancer undergoing RT.Urinary symptom management RT can decrease urinary symptoms in men with irritable urinary symptoms (Malik et al., PMID 20643513) - not sure of the mechanism, but it takes time to see the IPSS drop ...
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
How do you work up and manage patients with persistent cloudy and mucus-like urine, but no obvious cause on imaging or urinalysis?
Challenging, but it greatly depends on whether the patient is symptomatic or not. Few possible etiologies: Phosphaturia Vaginal discharge, bacterial vaginosis Sterile pyuria Sexually transmitted disease (STD) Genitourinary tuberculosis (TB) If it is coming from the urine, the urinalysis (UA) shoul...
In a frail older adult with moderate-to-severe lower urinary tract symptoms, when do you start a beta-3 agonist like vibegron over an anticholinergic?
In a frail older adult with OAB-predominant moderate-to-severe LUTS, I generally start a β3 agonist (vibegron or mirabegron) as the first-line pharmacologic option once behavioral interventions are insufficient. Behavioral therapies may include fluid management, bladder retraining, pelvic floor exer...