Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
In patients with muscle-invasive bladder cancer, in what clinical scenarios would you consider neoadjuvant cisplatin-based therapy in light of emerging data on enfortumab vedotin plus pembrolizumab?
Of course, we are still awaiting FDA approval of EV + Pembro in the cisplatin-eligible population, but the data from KEYNOTE-B15 presented at ASCO GU 26 are overwhelmingly positive. KEYNOTE‑B15 (EV‑304) was a randomized phase III trial in 808 cisplatin‑eligible patients with muscle‑invasive bladder ...
What interventions do you recommend for patients with a chronic catheter who have recurrent blockage due to sediment?
The first thing to do is to perform a cystoscopy to ensure that there are no stones and or significant debris that is obstructing the catheter. Particularly in the face of infection, stones may form very quickly. At the time of the cystoscopy, make sure that there are no stones and irrigate all debr...
Given results of the RADICALS trials, is LT-ADT standard of care for salvage prostate RT?
I do not think long-term ADT is established as standard of care for salvage prostate radiation, as this would require a demonstration of improved overall survival in at least specific subgroups of patients. RADICALS-HD demonstrates improvement in freedom from metastasis as well as freedom from non-p...
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 is your management for intermittent bleeding and pain at the buccal mucosa graft donor site within the first postoperative week?
Gauze packing as needed. I would not intervene with surgical closure. Sponges soaked in lidocaine with epinephrine can also help in this situation. We do use a swish and spit viscous lidocaine to help with oral pain in the first few weeks after surgery. The patient should avoid foods that are hard a...
Is there a PVR cutoff over which you worry about urinary retention when giving bladder botox to spontaneously voiding patients with suprapontine lesions?
I am not worried about numbers, but symptoms. If the patient is improved and happy, then I am not concerned about PVR unless infections become an issue.
How do you evaluate exercise induced hematuria that persists after one week of cessation of exercise?
Exercise-induced hematuria typically resolves within a week. If the hematuria persists after one week of cessation of exercise, further work-up of the hematuria is warranted. First, hematuria should be confirmed by excluding myoglobinuria and march hemoglobinuria. If hematuria is confirmed, then one...
How would you treat a monopolar injury to the bowel if there is no obvious defect in the intestinal wall?
Depending on extent of injury, intervention would be different. However, if it’s an incidental thermal “kiss” (<3-4mm), I would put a few imbricating stitches in the seromuscular layer to oversew the injury.
Would you consider offering salvage radiation to a patient with castrate resistant prostate cancer who has never had local therapy and has no evidence of lymph node or distant metastasis?
It's hard to give a great answer without knowing more information, such as the PSA, Gleason score, and T-stage at presentation, why he was treated with androgen deprivation alone up front, what AD he was treated with, how long he was under treatment before he became castrate resistant, and what is t...
How would you manage a patient with a history of prostate radiation who is presenting with LUTS and elevated PVR?
This can be a very difficult problem, because the risk of stressing continence following prostatic resection in the radiated patient is much higher than in the non-radiated patient. Following brachytherapy, stress incontinence can occur more than half the time, and following external beam radiation ...