Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is there any role for adjusting how long to hold anticoagulation perioperatively based on DOAC dose?
The PAUSE trial evaluated perioperative management of DOACs. However, only 20% and 16% of patients were on prophylactic doses of apixaban and rivaroxaban, respectively. It was suggested to hold the drugs for two days, and one day before high-risk and low-risk procedures. A useful review of this appr...
Would you pursue more dedicated stone surveillance imaging testing for a patient with recurrent nephrolithiasis who has PET-CT scans twice yearly?
Unless the patient is symptomatic, I am not sure there is a reason to. Though PET CT is not the best imaging to look for stones.
Do you recommend ADT or other systemic therapy in patients with rising PSA after prostatectomy and salvage RT and PSMA scan negative for metastatic disease?
Generally, I do not recommend systemic therapy for such patients. If doing so, it would be intermittent ADT (alone) for 6-or 9-month cycles. The EMBARK study will hopefully address this important question.
At what PSA do you initiate ADT for a biochemical recurrence after prostate radiotherapy (adjuvant, salvage, or definitive)?
Great question, and one that highlights the variability in practice and philosophy that often emerges to fill the void when hard data and concrete guidelines are lacking. I find that the PSA doubling-time (DT) often tracks with patient and provider anxiety levels; a rapid DT (<8-10 mos or so) in an ...
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
Would you recommend pregnancy testing for a female patient with recurrent nephrolithiasis for whom you are considering a CT stone scan for routine stone surveillance?
I would go with an ultrasound first and not with CT for screening.
How would you approach management of retroperitoneal fibrosis causing ureteral compression that has already caused irreversible loss of kidney function?
I agree with my colleagues and will add some additional thoughts. While I agree that tissue diagnosis is helpful whenever it can be obtained (both to differentiate IgG4-related vs idiopathic RPF and to exclude other causes such as lymphoma, sarcoma, and Erdheim-Chester Disease), it is often the case...
What is the best way to assess exercise capacity in kidney transplantation candidates to predict post-transplant outcomes?
This is a great question and quite variable across centers. The most consistently used across centers is the 6 min walk, though we are not yet doing that. Our general guide is for them to try to exercise 30 minutes on non-dialysis days, with the ultimate goal of walking a mile in 30 minutes (though ...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Do you routinely recommend D-mannose or probiotics for patients with recurrent urinary tract infections?
I would like to add that estrogen is very helpful for postmenopausal women with recurrent UTIs-- and is underprescribed for this use. Data seems to be strongest for vaginal estrogen, but see for example, Tan-Kim et al., PMID 37178856 and Rosenblum, PMID 33927578.