Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
When would you repeat a kidney ultrasound with post void residual measurement for a patient with chronic kidney disease from bladder outlet obstruction who is started on tamsulosin?
This is more of a urology question but I would think you have to wait at least six months to see a difference. In either case, I am not sure if an ultrasound is necessary. I usually just go by symptoms.
How would you work up a patient with prostate cancer with bone scan suspicious for metastatic disease and a negative PSMA PET/CT?
While some bone metastases are 99mTc-positive and PSMA-negative, this circumstance is quite rare (< 2%). Based on this alone, in cases like this, I typically conclude that the patient is clinically M0. However, I do consider 3 other factors: the prevalence of bone metastases within the patient’s par...
Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?
According to one our smart fellows "SGLT2i turns the urine into a sugary orange juice", so it should not be given at the time of UTI or in persons with high likelihood of UTI or prior recurrent UTIs. Additionally, under the real world scenario when eGFR<25 ml/min, dialysis initiation can likely be d...
Would you continue or switch therapy for someone who progressed through AR directed therapy and has a rapid rise in PSA while receiving Ra-223 for bone-dominant castrate resistant prostate cancer?
Certainly, it is reasonable to stop an AR inhibitor that is no longer clinically benefiting a patient irrespective of the use of concurrent radium-223, particularly a second AR inhibitor if there is no evidence of a response. Cross resistance between AR inhibitors is common and a rapid PSA rise sugg...
Do you avoid potassium citrate due to concerns with increasing the urine pH in patients with recurrent struvite nephrolithiasis who also have hypocitraturia?
Thanks for asking! My answer is: In general, "No", but it depends... Struvite stones can only form at un-physiologically high urine pHs. This situation occurs when urease-producing bacteria cause urinary infection. Urease splits normally occurring urinary urea to ammonium, raising the urine pH >7.0 ...
Would you consider treating a patient with prostate cancer and biopsy-proven involved inguinal nodes with radiation to the prostate/pelvis/groin?
Would favor starting with ADT plus ASRI and base subsequent treatment in 3 to 6 months based on responses ranging from prostate-only RT (like STAMPEDE for nonregional node) or definitive RT to primary and node.
How do you deal with a discordant MRI prostate after a systematic biopsy?
This is a good question and something that we are coming across more often.A few assumptions that I am making with reference to your question: When you state “discordant” MRI prostate after biopsy, I am assuming that you mean that the biopsy demonstrated something like Gleason 3+3 or maybe nothing a...
Would you start potassium citrate in a patient with recurrent nephrolithiasis of unknown stone composition who has hypocitraturia and alkaline urine pH?
I would be slow to start potassium citrate for a patient with alkaline urine and stones of unknown composition. Alkaline urine predisposes to calcium phosphate kidney stones, and potassium citrate would likely make the urine more alkaline and worsen the formation of calcium phosphate stones. First, ...
Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?
Tumor thrombus is an intraluminal extension of tumor mass, rather than a true thrombus. There is no evidence that anticoagulation improves outcomes in tumor thrombus (Marcoux et al., Blood 2019). Primary management is surgical resection, typically as part of radical nephrectomy for localized RCC or ...
What is your approach to a patient with muscle invasive bladder cancer getting neoadjuvant gemcitabine/cisplatin who develops significant ototoxicity due to cisplatin after two cycles?
My approach would be to proceed to surgery and based on pathological response, determine if the patient is a candidate for nivolumab.For patients who cannot tolerate cisplatin, there is no recommendation for an alternate regimen in the neoadjuvant setting.If treatment-naive and cisplatin-ineligible ...