Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What techniques do you use for patients with tight scrotums during in-office vasectomies?
If, on the initial counseling visit, I know that the patient has a very tight scrotum and is anxious about the vasectomy, I may just defer performing it in the operating room of the outpatient facility. If, however, it becomes apparent only during the procedure that his vas is difficult to access du...
Is PSA reliable in a patient who has a foley catheter or has undergone recent DRE?
PSA is usually not reliable in a patient who has a Foley catheter and is transiently unreliable for 24-48 hours in a patient who has undergone a recent DRE. The reason is inflammation or infection from a Foley catheter, the underlying condition requiring a Foley catheter, or the physical trauma from...
Do you need to perform an emergent orchiopexy on a patient who presents with acute onset testicular pain and scrotal ultrasound shows whirlpool sign but there is arterial flow to the testicle?
I would at least council the family/offer an urgent orchidopexy in this situation. In the practice at my hospital, we have sent someone home in this situation who came back with a non viable testis.
How do you counsel patients on the potential temporary and permanent side effects of finasteride?
Finasteride has been shown in some series to have effects on erections and libido. In some cases, these effects were permanent even after stopping the drug. There is also some data concerning the effects of finasteride on sperm quality and fertility.
Do you send urine cultures and treat positive results prior to bladder botox injections?
The consensus increasingly supports not treating ASB prior to intradetrusor botulinum toxin injection. The AUA/SUNA guidelines on ASB explicitly recommend against screening or treating ASB in most clinical contexts, and this extends logically to procedures like Botox, where the risk of ascending inf...
How do you differentiate between asymptomatic bacteriuria and a true urinary tract infection in a neuro-urology patient?
This can be a challenging distinction, especially in those patients that have no sensation of bladder filling. For those patients that void or perform clean intermittent catheterization (CIC), strong indicators that this is a true urinary tract infection (UTI) that would benefit from antibiotic ther...
How do you treat nocturia refractory to desmopressin?
If a patient has isolated nocturia, it's often not a urologic issue but can be a symptom of a sleep disorder or sleep apnea. If the patient has daytime OAB symptoms as well, then treat it may be time to try third line OAB treatment.
Is there a PVR cutoff or “percent empty” cutoff you use to determine if an asymptomatic patient needs a Foley catheter?
There is no universal, evidence-based cutoff that mandates Foley catheterization in an asymptomatic patient based on PVR alone. Clinical judgment integrating voiding function, upper tract status, renal function, UTI history, and patient preference guides the decision. The PVR is one data point, not ...
Would you recommend a bladder outlet procedure in a patient with a large obstructing prostate but little to no bladder function on urodynamics?
Given the large obstructing prostate, an outlet procedure may be reasonable despite little to no detrusor contractility. However, the expected benefit is less predictable than in patients with preserved detrusor function. The procedure may relieve obstruction, but it cannot restore bladder contracti...
Are there any online or publicly available pelvic floor physical therapy resources you regularly use or offer to patients?
I really like Nicole Cozean’s PFPT videos on YouTube.