Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you offer varicocele repair to a man with elevated DNA fragmentation but otherwise normal semen parameters?
I would offer a varicocele repair to this patient, but would also carefully assess other risk factors for elevated DNA fragmentation, including lifestyle/occupational exposures like tobacco/vaping, obesity, alcohol/drug use, including cannabis, et cetera. If there are additional exposures, I would c...
How do you approach residual penile curvature during inflatable prosthesis placement in a patient with Peyronie's disease?
I think that if residual curvature is less than 30 degrees, modelling is a reasonable option for management. Anything more than that is usually best managed with additional straightening maneuvers with either plication or incision and grafting. I usually wait until after dilation to make the decisio...
What is your approach to management of patients with recurrent nephrolithiasis and osteoporosis who are receiving teriparatide?
Bones and calcium containing kidney stones can interact. I find it interesting that patients who have primary hyperparathyroidism are prone to predominantly calcium phosphate kidney stones, since the action of parathyroid hormone on renal tubes is to reabsorb urine calcium. That’s why people with hy...
What is your process of discontinuing testosterone you prescribe to a patient?
First of all, it’s really rare that I discontinue. Proper counseling is critical, as starting TRT will result in loss of the natural ability to produce testosterone—when many men hear this, they will decide either not to start or to consider SERM therapy with clomiphene/enclomiphene. And that’s also...
Would you take back an asymptomatic patient for stent exchange or adjustment if imaging revealed that the stent was intraparenchymal?
I would start with a question back - if the patient was asymptomatic, why was a CT scan obtained? Reimaging after stent placement rather than proceeding with definitive management implies that there is some issue with the patient that is outside of the norm. Secondly, reviewing the images carefully ...
How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?
The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of reas...
What are your top takeaways from ASCO GU 2026?
KEYNOTE-B15: Practice-changing study in mUC overturning prior SOC of several decades and establishing EVP as the new standard of care for patients with MIBC.RC48G001: Robust data for DV, a HER2-targeting ADC in treatment-refractory patients with mUC, supporting its use for a biomarker-defined patien...
Do you favor MRI-guided adaptive SBRT over conventional SBRT when baseline urinary symptoms raise concern for toxicity in a patient with localized prostate cancer?
Most trials of SBRT for prostate cancer had exclusion criteria based on baseline urinary symptoms. These vary somewhat from trial to trial, but if your patient is outside of the moderate range on the IPSS score, you may want to consider an alternative to SBRT. Also, the only randomized trial of whic...
For post-prostatectomy radiation, are there any special considerations if there is a bladder sling or artificial urinary sphincter?
Radiation after a bladder sling or a urinary sphincter can be done, and in my experience is mostly done without major complications. I have done it several times, and I am not aware of any significant problems. There are no prospective studies or randomized studies of which I am aware that can help ...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...