Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Do you consider tertiary grade pattern, LVI or PNI on prostatectomy specimens as adverse features to recommend EBRT and ADT for patients with unfavorable intermediate prostate CA after prostatectomy with undetectable PSA?
No, I don’t think there is any current available evidence to define a benefit for ADT in the post-operative setting for patients with an undetectable PSA. The two major trials which define a benefit for ADT in this setting, RTOG 9601 and GETUG AFU-16 had a lower limit of a PSA of 0.2 at treatment in...
Are there any special considerations when treating patients with recurrent nephrolithiasis who also have medullary sponge kidney?
Sponge kidney patients present a very challenging therapeutic situation. Anatomically speaking, a sponge kidney is often a congenital, although occasionally acquired, dilation of the renal collecting ducts, which in turn causes the inability to acidify urine. Urine pH is typically unusually alkaline...
How do you weigh the risk of urinary catheter or fecal management system placement with that of soiling sacral wounds?
This question is an important question that arises for many of our bed-bound and poorly mobile patients, as sacral wounds commonly develop due to pressure injury. They become very challenging to treat due to fecal and urinary contamination, which can lead to further infection. Fecal and urinary dive...
When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?
I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both. I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...
Do you have your patients with recurrent calcium phosphate nephrolithiasis and hypocitraturia avoid high citrate containing foods if they have alkaline urine?
A good question, and I don’t think we have hard evidence to answer it. Most kidney stones are a mixture of calcium oxalate and calcium phosphate, the oxalate content usually predominating. Pure oxalate stones should prompt a search for one of the hyperoxalurias. Pure phosphate stones (apatite/brushi...
What is your approach to managing patients with recurrent nephrolithiasis who consistently fail to adhere to recommended dietary changes including animal protein and sodium restriction and remain at elevated stone risk due to hypercalciuria despite thiazide diuretic use?
This question is why I selected stone prevention as a clinical interest. Adherence is critical and perhaps more complex for me than all of the numerical issues with stone pathogenesis. When diet fails as described above, I have failed, and I do what I can to improve. No one answer because diet and l...
Does the presence of perineural invasion on a prostate biopsy change your management decision?
I would consider perineural invasion as one of the "soft" criteria that may help impact treatment decisions. Previously this would have also included such things as Gleason 3+4 vs. 4+3, Gleason 8 vs. 9-10, or the percentage of positive cores. However, as these factors have now been included in the A...
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...
When incidental microscopic hematuria is found on routine urinalysis, how do you decide on further workup versus repeat testing?
How do you counsel patients on pelvic floor physical therapy who are initially very hesitant to try it?
I typically will inform patients that I can understand the hesitation of pursuing pelvic floor physical therapy, as it involves exercising muscles in a sensitive area of the body. However, patients who have completed pelvic floor PT have a significant improvement in their symptoms, with some studies...