Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Do you use potassium phosphate for patients with recurrent nephrolithiasis to acidify the urine and prevent certain types of stones?
Short answer: No. That study was done about 40 years ago, I think by the Kaiser group, and was negative. That said, they used a suboptimal dose of 250 mg bid and measured success by stone passages rather than stone growth. However, studies using neutral phosphates (K Phos Neutral) were done by my me...
What is the preferred chemotherapy regimen for a patient with bladder adenocarcinoma with signet ring features?
Signet ring cell variants are considered an aggressive phenotype of urinary bladder adenocarcinoma with poor outcome. Because of the rarity, evidence based treatment approach is unknown. There are anecdotal experience in the literature.For example, a long term survival of 90 months was reported for ...
Would you add ADT to EBRT for favorable intermediate risk patients with T1c prostate cancer by DRE and bilateral prostatic lobe involvement by MRI?
Let's break down the question: If the patient has favorable intermediate risk disease, but cT1c by DRE, then he must have either: Grade group 2 (Gleason 3+4), PSA <10, and percent positive cores <50%; or Grade group 1 (Gleason 3+3), PSA 10-20, and percent positive cores <50% For scenario 1: Havi...
In high or very high risk prostate cancer, do you utilize combined androgen blockade in patients receiving definitive RT?
Since I had initially posted this, the STAMPEDE investigators have released a new publication reporting the utility of intensified androgen axis blockade (abiraterone ± enzalutamide) in high-risk non-metastatic patients which included high-risk N0 (≈ 60%) and N1 patients (≈ 40%). For this combined p...
Would you offer neoadjuvant chemotherapy to high grade T1 urothelial carcinoma in a bladder diverticulum?
Due to anatomical considerations (lack of muscularis propria in the diverticulum wall), clinical staging is very challenging in this setting. That is a great example of how a multi-disciplinary clinic of experts, including Urologists, Med Onc, Rad Onc, Radiologists, and Pathologists, can help get a ...
When do you consider lymphadenectomy vs pelvic lymph node RT in a lymph node recurrence after prior prostatectomy or prostate-only RT?
I typically recommend a modified GETUG P07 (OLIGOPELVIS) treatment paradigm in this setting because I believe it has a favorable toxicity and short term treatment efficacy as well as the best evidence basis at this time. This regimen consists of a fractionated, extended pelvic nodal field with conco...
What is your approach to patients with recurrent nephrolithiasis and hypercalciuria who are unable to tolerate thiazide diuretics due to hyperglycemia?
I think it is a risk-benefit analysis. The answer depends on the severity of the stone disease and the severity of the hyperglycemia. Obviously, controlling hyperglycemia would have multiple benefits, and I would certainly proceed along that route. But if the calcium-based kidney stone disease is se...
How do you manage unintended hypercalciuria that results from an increase in dietary calcium intake as recommended to patients with recurrent calcium oxalate nephrolithiasis attributed to enteric hyperoxaluria?
I find this to be a common concern. As you know, the idea of treating enteric hyperoxaluria with supplemental oral calcium is to bind dietary oxalate in the gut before it can be absorbed systematically. In addition to arranging an appointment with our stone clinic (not general) dietitian to discuss...
What are your top takeaways from ASCO GU 2024?
Prostate. BRCAAway. This small but important phase 2 randomized multicenter trial of HRRm mCRPC in the first line setting demonstrated the clear synergy in delaying progression or death and inducing better response between abiraterone and olaparib as compared to either abi or olaparib monotherapy o...
Do you recommend using methionine to acidify the urine in patients with alkaline urine and recurrent calcium phosphate nephrolithiasis?
I have not used it. Many of these patients have a partial renal tubular acidosis and will develop a metabolic acidemia if so treated. I suggest checking a urinary acidification test before prescribing it. Stephen B. Erickson, MD