Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Do you periodically check a urine culture for patients without dysuria but who have a history of struvite kidney stones and urinary tract infections with urease producing organisms?
Struvite nephrolithiasis is caused by a high urine pH (usually>7.0). Typically, a urine this alkaline requires urinary infection with a bacterium that produces urease, (Proteus, Providencia, Klebsiella) which in turn splits naturally occurring urea into ammonium, driving the pH to supraphysiologic l...
For a very high risk prostate cancer with relatively no elevation in PSA but no distant or nodal metastasis would you consider “neoadjuvant” ADT and chemotherapy prior to EBRT?
This is a very challenging scenario in dealing with men who have M0 N0 but very high risk disease with a Gleason 10 (grade group 5) locally advanced tumor. Recent data supports a very poor outcome for these low PSA high grade patients when treated with IMRT and ADT alone (Mahal BA et al Eur Urol 201...
Do you routinely perform in-office urine microscopy for your patients with recurrent nephrolithiasis?
Yes and no. We have a dedicated laboratory at Mayo Clinic that specializes in urinalysis and is expert in recognizing crystals. I do not do office microscopy myself. I think it is important for my stone patients to have a urinalysis when I see them. I am looking for hematuria suggesting surgical sto...
What are some considerations to make when managing patients with recurrent nephrolithiasis who are found to have nephrocalcinosis on imaging?
Nephrocalcinosis is generally defined as calcification of the renal parenchyma, especially the medulla and papillary tips, as opposed to nephrolithiasis which refers to calcification in the urinary space. The two often coexist. Nephrocalcinosis, and its accompanying nephrolithiasis, are typically pr...
What is your preferred therapy to raise urinary citrate in a patient with recurrent calcium based stone disease and hypocitraturia?
I prefer potassium citrate tablets. For those who have trouble swallowing tablets, it also comes in liquid form. There used to be a powder packet that you could tear open and mix in liquid, but it is my understanding that is no longer available. These products require a prescription. For those on a ...
Would you continue pembrolizumab in a patient with BCG-refractory NMIBC with CIS who has a negative surveillance cystoscopy (including random biopsies) but positive urine cytology?
More important priority at this point is to evaluate the positive cytology. If the random biopsies were done with white light cystoscopy only, I would consider blue light and repeat biopsies and would also evaluate the upper tracts and prostatic urethra.
Do you routinely prescribe acetazolamide for patients with cystinuria who do not have significant urinary alkalinization or are intolerant to citrate therapy?
I have not used acetazolamide in this situation, although it makes good physiological sense, as urinary alkalinization increases urine cystine solubility. Sodium bicarbonate would be a bad idea because natriuresis increases cystinuria. I have used potassium citrate historically, and it is generally ...
What type of surveillance plan should one use to follow a young person after orchiectomy for a >3cm pure mature teratoma of the testicle?
I presume hCG and AFP were normal as well as appropriate imaging studies, thus a clinical stage I pure teratoma. These patients have a 25% probability for relapse and should be on regular surveillance. We have published on this topic previously. We prefer studies ( serum hCG, AFP, abdominal CT scan ...
What is your approach to patients with muscle-invasive bladder cancer who are ineligible for neoadjuvant cisplatin-based chemotherapy?
The data supporting the use of neoadjuvant chemotherapy for bladder cancer is derived from 2 randomized trials and a meta-analysis. The randomized trials demonstrating benefit used MVAC and CMV, respectively, both cisplatin-based combinations. The meta-analysis results support the use of neoadjuvant...
Should patients with muscle invasive node negative bladder cancer wishing to have bladder preservation receive chemoRT alone or neoadjuvant chemotherapy followed by chemoRT?
The best evidence that we have does not support neoadjuvant chemotherapy before chemo-RT for bladder cancer. One RTOG trial, admittedly underpowered, and the MRC meta-analysis suggest that, while that benefit may exist for cystectomy, it either doesn't exist or is simply too small to detect for chem...