Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
When is it safe for a rectal biopsy in a patient with prior prostate radiation?
A biopsy of rectal tissue that has been radiated will have a higher risk of developing non-healing wounds and ulcers. Part of the reason that biopsies are discouraged as well as radiation proctitis is a clinical diagnosis and that biopsies of proctitis are certainly not needed to confirm this. Recta...
Would you recommend prescribing testosterone replacement therapy to reduce osteoporosis fracture rates in men with hypogonadism?
100% yes. Especially if improved quality of life may be realized. Practitioners need to understand that TRT supersedes physiologic testosterone when it comes to quality-of-life benefits, especially INJ testosterone. That's assuming even normal testosterone to begin with. Clinical real-world benefits...
How often do you monitor labs such as complete blood count, liver function panel, and urine protein in a patient with cystinuria receiving tiopronin?
I check patients newly started on tiopronin or after an increase in dosage about one month later. Assuming the lab results are normal, I do not continue to check them. I think late adverse reactions must be very rare. Stephen B Erickson, MD
Would you recommend neoadjuvant chemotherapy for a 3.5 cm low-grade UTUC in a cisplatin-eligible patient?
Neoadjuvant chemotherapy (NAC) conceptually makes sense in UTUC. A number of retrospective studies showed improved surgical and oncologic outcomes with NAC in UTUC. A recent phase 2 clinical trial (Coleman et al., PMID 36603175) confirmed this (63% pathologic response, improved PFS and OS) using spl...
How would you manage radiation cystitis in a vulvar cancer patient still receiving EBRT with known history of cystocele and who is otherwise hemodynamically stable?
For me, this is a very confusing question. First, I am not sure what is meant by "radiation cystitis." The question seems to imply that the patient is having hematuria as a component of the radiation cystitis diagnosis. In my long career, I have never seen a patient have noticeable hematuria during ...
How long do you continue a thiazide diuretic in a patient with nephrolithiasis and hypercalciuria who achieves normalization of urinary calcium excretion following therapy initiation?
This question needs to be viewed from many angles in considering the answer. At the first level, an effective therapy choice for stone formation should be continued as long as the patient remains a stone former, which is probably for the rest of their life. We should always remember that the desired...
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...
Would you consider maintenance immunotherapy after cisplatin-gemcitabine chemotherapy and chemoRT for stage 3 bladder cancer in a patient declining cystectomy or who is a poor surgical candidate?
Great question and relevant clinical scenario. We need a clinical trial in this setting, the INSPIRE (EA8185, PI: Dr. @Dr. First Last) is an ideal trial to enroll. In the meantime, would not add "consolidation/maintenance" ICI in the absence of data in this particular setting.
How would you manage a patient with recurrent calcium phosphate nephrolithiasis who has hypercalciuria, hypocitraturia, and a urine pH greater than 6.3?
Good question! Calcium phosphate stone formers are the second most common type after calcium oxalate stone formers. The underlying problem is an elevated urine pH. Your differential diagnosis will include primary hyperparathyroidism, renal tubular acidosis, medullary sponge kidneys and the use of al...
Do you recommend ADT for a patient with hypogonadism with unfavorable or high risk prostate cancer whose PSA dropped to <1 after cessation of supplementation?
When I encounter this situation, I will measure the testosterone level off supplementation. If the testosterone is castrate level (<50 ng/dL), then I would not add ADT, as the target testosterone level has already been achieved. If the patient's testosterone level remains above the castrate threshol...