Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?
There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). ...
How do you counsel a patient with NCCN favorable intermediate prostate cancer but a high risk Decipher score?
Active surveillance has become the preferred management strategy for most men with low-risk prostate cancer and is increasingly used in carefully selected patients with favorable intermediate-risk disease. However, men with IR PC have approximately a three-fold greater risk of tumor upgrading or pro...
Given that the PUSH trial found that interventions to increase fluid intake didn't actually reduce symptomatic stone recurrence, will this change the way you counsel patients on fluid intake for stone prevention?
Although the PUSH trial did not demonstrate the benefit of increasing fluids to prevent recurrent stone formation, a number of randomized, prospective trials plus my own clinical experience have validated the importance of increased fluid intake to reduce recurrent nephrolithiasis. All of the patien...
How do you decide between a single-stage and staged approach for a pan-urethral or long-segment anterior urethral stricture repair?
In practice, the decision between a single-stage and staged repair depends less on the length of the stricture than on the quality of the urethral plate and surrounding tissues.A single-stage oral mucosal graft urethroplasty is generally preferred when the stricture is nonobliterative, the urethral ...
How do you decide between sacrocolpopexy and vaginal native tissue repair for apical prolapse in a patient with no prior mesh complications?
Sacrocolpopexy provides better average anatomic durability. In the 2024 ASPIRe randomized trial of posthysterectomy vault prolapse, adjusted 36-month composite failure was 28% after sacrocolpopexy versus 43% after native-tissue repair. Nevertheless, symptom improvement, satisfaction, and decision re...
Would you give treatment to a male patient with subjective dysuria but no objective pyuria with Ureaplasma urealyticum detected by PCR from urine?
No treatment is indicated. First, dysuria alone in males is not an STD symptom; published research is clear that discharge is required to suspect urethritis. The absence of urine WBCs (i.e. no pyuria) is a pretty good substitute for examining for discharge - not perfect but makes urethritis unlikely...
Under what circumstances would you treat prostate cancer without a biopsy?
I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...
What is the role of liquid biopsy in patients with metastatic castration resistant prostate cancer to asses BRCA1/2 or other mutations and consider PARP inhibitors?
There are no FDA cleared tests that have been shown to accurately predict response or benefit from PARP inhibitors in men with prostate cancer. The risk of both false positives and false negatives remains high with these assays due and no studies in prostate cancer have shown concordance with a high...
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...
How do you approach a patient with stoma bag adhesive allergic contact dermatitis?
To keep the area dry, I have patients use Cavilon spray and Skins, an antimicrobial spray.