Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Would you add amiloride for patients with recurrent calcium nephrolithiasis who have hypercalciuria despite adherence to maximum dose thiazide, low sodium dietary intake, and low animal protein dietary intake?
Amiloride does not lower urine calcium on a chronic basis. In one set of experiments, acute loading lowered urine calcium, but the effect was very brief. I use amiloride to prevent potassium wasting from thiazides and on and off in primary hyperaldosteronism, but it will not lower urine calcium in t...
How do you advise your patients with recurrent nephrolithiasis to avoid consuming more than usual fluid volume on the day of a scheduled 24 hour urine stone risk study?
I tell them to collect on a day that represents their life as lived - how things are in general. I tell them not to show off. I tell them that if the day does not reflect their usual life, I will be misled and may make mistakes in how I treat them for stone prevention.
What chemotherapy regimen do you use for de novo metastatic squamous cell carcinoma of penile urethra?
Challenging cancer and prognosis; therapy with palliative intent (Nutrition and Palliative Care consults can help regardless of which therapy to use); in pure SCC of penile urethra, would likely consider platinum/gemcitabine or platinum/taxane as 1L therapy as a conventional chemo regimen with perio...
How do you approach patients with biochemical relapse of high-risk prostate cancer, with PSA doubling time less than 6 months?
This is a very thoughtful question. The assumption is that the patient has no evidence on conventional imaging by (CT/Bone scan) and BCR with rapidly doubling PSA after both prostatectomy and adjuvant XRT. The biology of these patients remains concerning and although STAMPEDE would include these typ...
Would you recommend enfortumab vedotin plus pembrolizumab for localized advanced non-invasive urothelial carcinoma of the renal pelvis?
Urothelial carcinoma of the renal pelvis is always challenging to stage and is often understaged. However, it would be difficult to justify systemic therapy with EV + P for non-invasive disease on the path. This patient will likely need upfront RNU followed by adjuvant therapy based on pathological ...
What is your approach to managing patients with recurrent ammonium urate kidney stones?
Pure ammonium urate stones are very unusual, and, to my knowledge, there are no studies to guide us in their treatment. Much more common are magnesium ammonium urate stones, commonly known as "struvite". These are caused by urease-producing bacteria, usually Proteus or Klebsiella. I would first chec...
How do you approach management of a patient with a retroperitoneal soft tissue mass and elevated IgG4 level when tissue biopsy is not feasible?
The question of whether to biopsy in presumed retroperitoneal fibrosis is asked in almost every case. The reason for the biopsy is to primarily rule out other causes of retroperitoneal masses, such as lymphoma, infection, and other rare variants. The mildly elevated IgG4 is not very helpful due to t...
How do you approach extensive recurrent genital warts that have failed liquid nitrogen, imiquimod, 5 fluorouracil and electrodessication?
I have used 0.2 ml of Candida IL with success for recalcitrant scrotal warts (injected in 2-3 lesions). I used this study below as a reference. My patient cleared in 3 sessions (4-6 weeks apart), the study below states max 5 sessions.Nofal et al., PMID 31923442
For patients with high-volume hormone-sensitive prostate cancer, would you consider shortening the docetaxel course to 4 cycles to facilitate better tolerance?
My default here is always evidence-based medicine, in which 6 cycles of docetaxel were given as part of either concurrent triplet therapy (ARASENS or PEACE-1) or sequential triplet therapy (ARCHES, TITAN), without prednisone. For those who develop intolerance, a dose reduction or growth factor suppo...
Would you offer adjuvant chemotherapy/immunotherapy for resected pure squamous cell carcinoma (T2-T4 or N+/-) of the renal pelvis?
Primary or pure squamous cell carcinoma of renal pelvis is very rare and the role of adjuvant therapy after surgery is unknown. Squamous cell carcinomas in head-neck, anal and other sites, tend to recur locally. Based on that behavior, I would offer radiation with a sensitizer, preferably weekly cis...