Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
Would you perform varicocelectomy in a non-obstructive azoospermic patient with grade 3 varicocele or proceed straight to sperm retrieval?
Assuming no Y chromosomal microdeletions, no karyotypic anomalies, and no testosterone use, yes, I would. About 25% or so will achieve some level of spermatogenesis 4 months later for use with ICSI, and that would obviate the need for a TESE. If no sperm have returned to the ejaculate, at least you ...
How and with what urgency do you work up hematuria in a patient with ESRD who is pending renal transplant?
Depends! There isn't enough information to provide a reasonable response.
What medications do you offer patients prior to in-office vasectomies?
I offer an anxiolytic to take 30 minutes before the procedure, but only about 5% of patients request this. Most want to drive themselves, so they prefer not to be sedated. I use 0.25% Marcaine without epinephrine for local anesthesia. I do not prescribe anything post-procedure, just recommend ibupro...
How long do you leave a ureteral stent if placed at the time of transplant?
In general, studies suggest earlier removal is better from a potential urinary tract infection (UTI) and BK virus perspective. Most centers try to remove the stent at the 2 to 3 week mark. The risk of urine leak and transient stenosis should be gone by 2 to 3 weeks.
Is there a kidney stone size for which you refer your patients with recurrent nephrolithiasis to urology?
Predicting ureteral stone behavior is fraught with error. In general, stones less than or equal to 3 mm in maximum diameter will pass spontaneously if the patient can tolerate the pain. In fact, routine annual follow-up imaging occasionally shows the absence of small stones, but the patient has no m...
What is your technique for denuding vaginal epithelium during a colpocleisis?
Depends on the type of colpocleisis. For a Le Fort, I typically make two trapezoids. With the vagina everted, I pre-mark the edges of the dissection, starting with a horizontal border approximately 1 cm distal from the cervical reflection, then a second horizontal border ~1 cm proximal to the bladde...
How do you decide between an endoscopic and open approach for a patient with a 1.5 cm distal ureteral stricture 6 months postoperatively following renal transplant?
Based on the length of the stricture, I would start with endoscopic management and follow up with appropriate studies (Lasix renogram, voiding cystourethrogram [VCUG]). If endoscopic management failed and there were no comorbidities that preclude surgery, I would recommend a reconstructive procedure...
Can a PSA bounce be seen shortly after SBRT to prostate cancer oligometastases while on androgen deprivation therapy?
I would not consider it a "bounce" if it happens shortly after treatment because the timing of a post-treatment bounce is later. If the PSA is higher than pre-treatment baseline soon after metastasis-directed SBRT, then you are likely observing one of two scenarios. First, the pre-treatment baseline...
Do you add ADT to RT for a patient with intermediate-risk prostate cancer with discordant Decipher and ArteraAI results?
This will be a long response to try to provide transparency to these tests from what I know as a researcher and clinician. I also clinically see this situation frequently. We have made incredible progress in developing biomarkers in prostate cancer, but it is important to know that no single test is...