Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Have any studies shown that testosterone replacement therapy lowers the incidence of prostate cancer in hypogonadal men, or is the evidence still largely neutral?
This is a broad question to which I will give a broad answer.For men with hypogonadism (symptoms and signs of androgen deficiency, reproducibly low serum testosterone with an accurate, reliable assay) and no reversible cause, the epidemiological data overall do not show evidence of increased risk of...
Do you recommend checking a serum phosphorus level in patients with recurrent nephrolithiasis?
For patients with pure calcium phosphate or mixed calcium phosphate/oxalate nephrolithiasis, l routinely check serum phosphorus as part of a panel that also contains serum calcium, PTH, creatinine, and 25-vitamin D, looking for primary hyperparathyroidism, a surgically curable cause of these stones....
For patients who have completed up-front docetaxel for metastatic castration-sensitive prostate cancer, should they proceed to abiraterone before the development of castration resistance?
There is data for upfront triplet therapy currently in high-volume HSPC. The triplet therapy consists of ADT + docetaxel x 6 cycles + either darolutamide or abiraterone. Given that this patient has already completed a course of docetaxel, holding off on adding ARSI therapy until the first signs of P...
What is your next step in management for patients who develop sexual side effects on an SSRI (anorgasmia, low libido, etc.) but are responding well to therapy?
Managing side effects from SSRI medications is a key component of treating patients in the outpatient setting who are suffering from depression and/or anxiety. This is doubly true given the fact that primary care is often the most accessible, and often most trusted, source for patients to make their...
Do you recommend a waiting period to conceive after prostate radiation?
Yes, I typically advise that men and their partner use contraception for at least 3-4 months after the last fraction of radiotherapy based on the fact that the maturation cycle of sperm is estimated at approximately 2- 2.5 months. I typically counsel men prior to treatment that there is a chance (bu...
Do you recommend using anastrazole in men developing gynecomastia while on testosterone replacement treatment for hypogonadism depending on pre-treatment estradiol level?
There is no role for aromatase inhibitors (e.g., anastrozole) for the prevention of gynecomastia. A randomized trial of anastrozole for the treatment of gynecomastia demonstrated no benefit compared to placebo.There is no reason to administer prophylactic therapy prior to the initiation of testoster...
Do you advise patients with a personal or family history of germ cell tumors to avoid endocrine disruptors such as marijuana/CBD, lavender oils, or tea tree oils?
No, I do not advise against MJH or other putative endocrine disruptors, other than cautioning against the general health effects of MJH. I assume the question was triggered by the concern regarding older reports of an association of MJH and the development of germ cell tumors. Several things: Our un...
How do you approach balancing the treatment of urinary incontinence with anticholinergic medications with the use of cholinesterase inhibitors in dementia?
This is a great question and speaks to the importance of shared decision-making and understanding the context of individual patients. Ultimately, it would be best to avoid anticholinergic medications in our patients living with dementia. Medications with anticholinergic properties increase the risk ...
When considering cytoreductive nephrectomy in metastatic kidney cancer, in which situations would you consider nephron-sparing approaches such as partial nephrectomy or SBRT?
Nephron-sparing strategies (partial nephrectomy or stereotactic radiation therapy are reserved for patients with limited disease, favorable anatomy, or contraindications to surgery, where the goal is to maximize oncologic control while preserving renal function and minimizing morbidity. Careful mult...
How do you monitor and discuss the sexual side effects of SSRIs with adolescents?
Much of this depends on the individual adolescent. During my initial evaluation, I typically obtain a confidential sexual/relationship history with the adolescent. When completing an informed consent with a teen, I will refer back to this history and ask if anything has changed. I'll then frame the ...