Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...
How do you approach management of a patient with intermediate risk prostate cancer treated upfront with HIFU and intermittent ADT who is later found to have rising PSA and biopsy-proven prostate-confined recurrence?
These are frustrating situations, and ones I am now seeing frequently as focal therapies have gained traction in the United States. The approach, needless to say, is highly individualized. Often, these glands are quite abnormal in MRI appearance, and there is a concern for fibrosis. My approach is h...
Is there an absolute PSA level above which you would not recommend a radical prostatectomy for newly diagnosed prostate cancer despite the absence of metastatic disease with advanced imaging?
There is no absolute PSA level that would preclude radical prostatectomy in the absence of metastasis on staging imaging. However, I would explain to the patient that the chance of occult metastatic disease and the need for additional treatment after prostatectomy increases as the PSA increases. I w...
How often do you check serum glucose and lipid levels after starting a thiazide diuretic for patients with recurrent calcium based nephrolithiasis?
I think checking serum glucose, electrolytes, and lipids about one month after starting a thiazide is reasonable. If levels are normal, I would revert to annual monitoring. Stephen B. Erickson, MD.
When (if ever) would you offer adjuvant sunitinib to a patient with chromophobe renal cell carcinoma?
To date, evidence is lacking to recommend adjuvant TKIs in chromophobe and other non-clear cell RCCs. The subgroup analysis in ASSURE trial (Lancet Oncology 2016, EA E2805) did not show any benefit of adjuvant sunitinib or sorafenib in nonclear cell RCCs (including 111 patients with chromophobe RCCs...
How do you advise patients with recurrent nephrolithiasis and polyuria who require more than one 24 hour collection jug and need to adequately mix the specimens prior to aliquoting for mail-off lab analysis?
My understanding of methods for dealing with large volume collections (more than 1 container) is that each container is sampled and tested separately, and the results are combined by the processing laboratory to provide the actual 24-hour totals. While one could envision methods for mixing the conte...
What is your approach to managing patients with recurrent nephrolithiasis and hypercalciuria who develop sun photosensitivity following thiazide diuretic initiation?
Sun avoidance and/or protection are my first thoughts. Failing that, I would recommend more intense dietary modification and look for other metabolic abnormalities amenable to pharmaceutical treatment. Treatment follow-up is critically important, preferably with CT scanning, looking to see if there ...
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
Do you prefer starting potassium chloride or amiloride for those with recurrent calcium based nephrolithiasis and hypercalciuria who do not have hypocitraturia but develop hypokalemia following thiazide diuretic initiation?
I prefer going with Potassium citrate.
Would you start potassium citrate for a patient with recurrent calcium oxalate nephrolithiasis who has normal urinary citrate levels but persistent acidic urine?
An excellent, fundamental question!Before starting medical treatment, I want to know if the patient’s stone burden is increasing in volume. That requires, in my opinion, serial CT scans, typically annually.If the stone burden is increasing in volume, it’s time for metabolic (non-surgical) treatment....