Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you start allopurinol for a patient with uric acid kidney stones who does not have hyperuricemia or hyperuricosuria?
Definitely not! The main risk factor for uric acid kidney stones is neither hyperuricemia nor hyperuricosuria; it is hyperaciduria. Typically uric acid stone formers have a urine pH below 5.8. Raising urine pH into the mid 6s will not only stop new stone formation and existing stone growth; it will ...
How do you approach a patient who has incidentally found liver and renal cysts?
If has many cysts in both organs, then consider polycystic syndromes and should see a nephrologist and hepatologist. For liver cysts - determine if simple or complicated (irregular borders, thick septations) - if the latter then likely need sampling. regardless hepatic simple cysts not causing sympt...
Do the results of IMvigor011 influence you to utilize ctDNA to guide all adjuvant IO in MIBC?
Based on ESMO '25 data, I am using ctDNA in ICI-naive patients s/p radical cystectomy (with or without neoadjuvant chemotherapy) to inform the decision & timing of potential adjuvant nivolumab (FDA-approved) (following IMvigor011 design). I acknowledge the logistical burden of every-6-week ctDNA tes...
Would you refer a patient for kidney only or kidney and liver transplantation if they develop advanced chronic kidney disease secondary to primary hyperoxaluria type 2?
Now that the data suggesting a benefit for nedosiran for PH2 is very disappointing, I think we have to say simultaneous liver and kidney. I have this one experience. My PH2 patient had kidney only because I was thinking that nedosiran would be effective. Ultimately, the kidney failed after about 5 y...
Is a larger prostate size or volume associated with a higher absolute PSA bounce after radiation?
I have not seen anything in the literature to indicate that the magnitude of the PSA bounce is related to prostate size, but it's certainly possible. The highest bounces I have seen after treatment were in patients treated with LDR brachytherapy (my personal record is 8 ng/mL, and it eventually beca...
Would the presence of only mature teratoma on orchiectomy specimen lead you to consider upfront RPLND followed by adjuvant chemotherapy as opposed to upfront chemotherapy in a patient with bulky para-aortic nodal disease (cN3) and AFP/beta-HCG elevation?
If there is an elevated AFP or hCG, then by definition, he has metastatic germ cell cancer and needs chemo initially, followed almost certainly by post-chemo RPLND done by a skilled and experienced urologist.
How much proteinuria would warrant consideration of native kidney nephrectomies at the time of a kidney transplant?
We don't typically consider native nephrectomies unless the proteinuria is > 5-6 grams. We rarely end up doing native nephrectomies, though. The main problem, besides the complications associated with heavy proteinuria, is the inability to assess for recurrent disease post-transplant. This can be pa...
What is the minimum duration to be on bicalutamide prior to starting GnRH agonist in de novo metastatic prostate cancer with significant bone disease?
The onset of action for bicalutamide is rapid--typically slightly more than a day to reach maximum/peak concentration. In contrast, the pharmacological effect of leuprolide is related to the time to testosterone suppression which occurs approximately 2-4 weeks after starting. So the time to testoste...
Would you recommend avoiding intravesical (bladder) tobramycin administration in a patient with advanced chronic kidney disease?
Guess fear is absorption, build up, and toxicity. A single loading dose of an aminoglycoside is not to toxic level. Maintaining the level of risks ototoxicity, build up also nephrotoxicity. Would depend on absorption and residual GFR. Try a single loading dose, check levels after 12 or 24 hours to g...
Would you recommend adjuvant cisplatin/gemcitabine or nivolumab in a patient with muscle invasive bladder CA who proceeded to radical cystectomy first?
This is an excellent question and one we are seeing more and more in clinics these days now that the FDA has approved nivolumab for adjuvant therapy for patients with locally advanced urothelial carcinoma at high risk of recurrence after radical resection. This is based on data from CheckMate 274 wh...