Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?
Para-aortic nodal disease <5 cm is well treated with radiotherapy to PA+pelvis with boost tot eh nodes with high cure rates and minimal toxicity. >5cm best treated with BEP or EP chemotherapy. No role for RPLND in seminoma.
When following active surveillance paradigm, what PSA increase will trigger prostate biopsy?
When using PSA to aid in the decision to re-biopsy a patient on active surveillance, I think you have to consider that the non-malignant prostate tissue also contributes to the rise in the PSA and that there are limits to the accuracy of the test. In patients not known to have prostate cancer, a PSA...
Do you routinely do restaging imaging before surgery for a patient who completed neoadjuvant treatment for MIBC?
Clinical staging of MIBC is suboptimal despite the advent of multiparametric (mp)-MRI. However, routine radiographic restaging following neoadjuvant chemotherapy and before radical cystectomy is prudent in patients with baseline cT2-T4aN0 MIBC and is generally required in clinical trials. It is know...
Would you treat a patient with prostate biopsy (and or MRI) suspicious for extraprostatic extension as high risk if they otherwise have IR disease factors?
Men in the intermediate risk category are a heterogeneous group, and clinical factors can be a useful way to further stratify risk in this group. In our practice, because of an institutional outcomes study, we primarily use % positive cores > 50% as a means to select men for the more aggressive ther...
Do you recommend a patient with recurrent nephrolithiasis who is performing a 24 hour urine collection add a urine preservative or keep the specimen refrigerated?
We always add a preservative that will not interfere with any of the analytes to be measured. Additionally, we recommend refrigeration of the specimen. Stephen B Erickson, MD
What would you recommend for pTa, stage 0a papillary urothelial carcinoma of the distal ureter?
I think a lot would rest on the grade (and presumably upper tract imaging was otherwise negative) – if low grade could do endoscopic resection and monitor, if high grade could consider neoadjuvant therapy with ureterectomy vs nephroureterectomy. …also depending on age, comorbities, etc.
In asymptomatic patients with unfavorable intermediate risk prostate cancer and a PSA <10, how helpful/reliable and clinically useful is bone imaging?
Bone scans amazingly are still something we discuss, and I imagine when we look back in 5 years at this question (at least I hope), people would think it is unthinkable to order a bone scan for intermediate risk with PSA <10 (let alone in localized PCa) instead of MRI and/or PSMA PET/CT.10 years ago...
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...