Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you risk stratify patients with MRI guided prostate biopsies?
If the patient has had standard template biopsies and targeted biopsies, I only consider that standard biopsies in the quantification of the proportion of cores involved since the data used to derive the prognostic significance of this feature was based on standard template biopsies not targeted cor...
Does acute radiation cystitis cause microscopic hematuria and pyuria?
Radiation cystitis is the diagnosis.
How do you approach a urethral carcinoma s/p non-oncologic resection?
I have treated a few of them. It usually tends to be clear cell histology. For a non oncologic resection, I treat with chemo RT and have had mixed results.
What is your approach to the diagnosis and management of lupus cystitis?
Lupus cystitis is a rare complication of lupus but there does appear to be an association. I depend on the urologist to confirm the diagnosis of interstitial cystitis. If mild to moderate in activity, will use standard treatments for cystitis with bladder infusions, bladder relaxants in collaboratio...
How do you approach a prostate cancer patient with oligomet disease on PSMA PET?
I think there is a spectrum of 'PSMA-PET Avid lesion suspicious for metastasis'. In some locations, such as ribs, I worry more about false positives. For lesions with PET avidity without CT correlate, I worry about false positives and may advocate for a biopsy if it will change the treatment plan. S...
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...
Is prior TURP a contraindication to SpaceOAR placement?
It's worth a try. Most of the time, I haven't had an issue. Occasionally, a TURP or other procedure can lead to more fibrosis in the rectoprostatic space that can make it hard to hydrodissect. But typically, it is not an issue.
Do you change your monitoring strategy for a high risk prostate cancer after XRT if the initial PSAs have never been very high?
In general, a patient whose volume of cancer is out of proportion to their PSA makes me nervous. So, I'm much more worried about the patient with a PSA of 5 and multiple cores positive for high volumes of Grade Group 4-5 cancer than I am about the patient with a PSA of 5 and a single positive core s...
How would you manage stable/slightly enlarged pulmonary metastasis from non-seminoma testicular cancer after receiving 3 cycles of BEP, which resulted in a mixed responses on chest CT but normalized AFP?
This is a patient with nonseminomatous germ cell tumor, with presumably pulmonary metastases at start of BEP X 3. I am also assuming that his abdominal CT scan was either normal baseline or it reverted to normal post BEP. The issue now is a mixed response in the lungs, implying some lesions are smal...
Do you recommend surveillance for secondary malignancies of the rectum and bladder after prostate XRT?
I think it's important to be sure that patients are up to date with screening for colorectal cancer before beginning a course of prostate XRT. I have had an occasional patient who was found to have a colorectal cancer on colonoscopy performed pre-treatment because they were out of compliance with sc...