Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your treatment algorithm for management of retroperitoneal fibrosis that does not respond to high-dose glucocorticoids?
There are a number of caveats to this. Is the retroperitoneal fibrosis biopsy-proven and/or IgG4 disease ruled out? If a case is refractory, I first question whether the diagnosis is correct and will often biopsy in this situation with more than an FNA biopsy. The second question is how long have t...
For mCRPC patients who are eligible for both, how do you decide between Enzalutamide+Rad223 (EORTC 1333/PEACE-3) or Enzalutamide+Lu-PSMA-617 (ENZA-p)?
While both these studies addressed interesting questions, both enrolled patients who were ARPI-naive. We are in an era where ADT intensification is the standard of care, and hopefully, we will see an even smaller number of folks with mCRPC who would look like the patients enrolled in both these stud...
In a patient with biochemical recurrence after radical prostatectomy for pT2 disease and a high-risk Decipher genomic classifier, with a PSA of 0.7 ng/mL, is there a rationale for administering salvage radiation therapy to the prostate fossa?
Yes, salvage RT to the prostate fossa (+ ADT/ pelvic lymph nodes) would be considered the preferred option in this circumstance, in my opinion (see NCCN 2026.3). Despite the PSA being higher than is typical in 2026 and some risk factors for not responding to RT (e.g., margin-negative resection), it ...
Assuming approval, in which patients would you choose Belzutifan + Lenvatinib (LITESPARK-011) for advanced RCC, with progression after IO therapy?
LITESPARK-011 is an interesting study as it relates to current standard practice. Presently, lenvatinib/everolimus is a well-established and potent treatment option. Each clearly contributes towards the clinical benefit observed in most patients. For instance, in the study NCT01136733 (Motzer et al....
How do you approach management for recurrent stone formers who sleep over 8 hours per day and fail to reach 2.5 liters of daily urine output on 24 hour urine stone risk studies?
I suggest the patient plan a schedule by which they drink 2.5 L per day. To get started, I suggest they set their phone to alert them when it is time to drink the requisite amount of fluid, preferably water. After a while, this becomes an automatic habit. Stephen B. Erickson, MD
How would you approach adding ADT to salvage radiation therapy for a biochemically recurrent prostate cancer patient with very high Decipher but non-luminal B on PAM50?
Yes, especially if PSA is more than 0.5 ng/mL.
How long do you treat retroperitoneal fibrosis with immunosuppression?
I normally treat for 9 months to a year depending on response. I have found PET CT useful in determining if there is active ongoing inflammation.
Do you rely on urinalysis testing for microscopic hematuria as a means to assess for a ureteral stone for patients with recurrent nephrolithiasis who report mild potential stone-related pain?
No. I think hematuria is nonspecific as regards ureteral stones. I use imaging, preferably CT, although ultrasound, looking for hydroureter or even KUB, if positive, would suffice.
What are your recommendations in managing pudendal neuralgia/red scrotum syndrome?
Red scrotum syndrome is very challenging to treat. The list of reported treatments is long, but I have not found one to be consistently effective. Treatment selection depends significantly on patient characteristics and preferences. In my opinion, every patient with red scrotum syndrome should under...
Do you consider estrogen patches in treatment of prostate cancer?
Oral estrogenic formulation (such as DES) was historically used for androgen suppression in prostate cancer patients. This was based on the principle that estrogen decreased serum testosterone levels by suppressing luteinizing hormone production through a negative feedback loop on the hypothalamus a...