Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
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 ...
What tips and tricks are there for catheterizing a patient with a history of metoidioplasty?
History is the key first step. I would ask what exact operation the patient had, whether urethral lengthening was performed, where they void from, whether they have had strictures or fistulas, and what catheter size has worked before. I would also ask exactly why a catheter is needed. For example, i...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
Do you incorporate the results of 24 hour urine chemistries that were obtained several years prior when evaluating new patients for kidney stone prevention?
I do but the issue is complex. Interpreted in context - life events, surgeries, meds etc - they tell me the range of behaviors for a patient in chemistry terms. But it takes a lot of time, and is not a good idea unless you are prepared to take that time.
Until what age do you monitor asymptomatic boys with a history of posterior urethral valve ablation?
Most patients with a history of posterior urethral valves (PUV) should be routinely followed by urology into mid to late adolescence, though it all depends on renal function, bladder function, and the degree of residual hydronephrosis. These factors determine the frequency of clinic visits. For very...
Has the TRAVERSE trial, which showed testosterone therapy was noninferior to placebo for MACE but raised signals for pulmonary embolism and atrial fibrillation, changed how you counsel middle-aged men who specifically cite cardiovascular safety when requesting TRT?
Results from the TRAVERSE trial have made my discussions a bit more streamlined, but I have always used a handout discussing known risks of TRT, such as infertility, testis atrophy, and erythrocytosis, and associated risks based on poor literature dating back to 2011. This trial confirmed what most ...
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
I would reverse the question order. For node-positive disease, I start ADT once staging imaging is complete. If logistically practical (as with high-risk localized), I often perform the simulation and start ADT at the same time, then start RT without a neoadjuvant period. Evidence for neoadjuvant AD...