Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What are your top takeaways in GU Cancers from ASCO 2025?
Here are the top 3 prostate cancer studies: AMPLITUDE. LBA5006: Attard and colleagues show that the PARP inhibitor niraparib plus abiraterone/prednisone delayed rPFS in men with mHSPC (HR 0.63, p = 0.0001), meaning this is the first ARPI/PARPI successful combination in this hormone-sensitive HRRm se...
Would you recommend initiation of cinacalcet in a patient with hypercalcemia and recurrent nephrolithiasis attributed to an atypical presentation of familial hypocalciuric hypercalcemia?
I would really like to know the level of the patient’s parathyroid hormone. If it is low, cinacalcet would probably not be helpful. Stephen B Erickson, MD
Do you recommend restricting alcohol use in patients with recurrent nephrolithiasis?
No. Clearly excess alcohol use is to be avoided. I much prefer water or citrate containing beverages for stone prevention. Beer has some oxalate content and is better avoided. Stephen B. Erickson, MD
Is switching to carboplatin/gemcitabine reasonable for a patient with muscle invasive bladder CA who proceeded to cystectomy first and had AKI with cisplatin/gemcitabine prohibiting further cisplatin?
There is not a role for gemcitabine and carboplatin in the adjuvant setting in patients with muscle invasive bladder cancer. Based on CheckMate 274 (Bajorin et al., PMID 34077643), in patients with MIBC with a high risk of recurrence (pT3, pT4a, or pN+ and not eligible for or declined adjuvant cispl...
How do you manage or monitor hypogonadal men on clomiphene citrate?
I typically monitor men being treated for hypogonadism on clomiphene citrate the same as other hypogonadal men. There is less concern for timing of ordering testosterone levels to assess response in regard to treatment administration. There is also theoretically less concern for abnormal hematocrit ...
As PARTIQoL was a negative study, what is the current role for proton therapy in the management of prostate cancer patients?
Thank you for the comprehensive answer Dr. @Dr. First Last! It is interesting you talk about integral dose - that almost rarely comes up from the patient in my experience. They have read and have been told that it IS less toxic (not that it may be). They are told that protons are better and the auth...
How would you manage incidentally-found prostate cancer on TURP?
The patient's risk group along with genomic classification with Decipher would inform the treatment recommendation regardless of the source of the tissue. The pathologist should be able to estimate how much of the tissue had cancer and provide the Gleason Group. The location and volume of tissue are...
Would you recommend definitive XRT for prostate cancer in patients with prior Holmium Laser Enucleation of the Prostate (HoLEP)?
There are multiple options for outlet procedures in patients who present with baseline obstructive symptoms but prefer to avoid a radical prostatectomy. HoLEP is an effective procedure preferred by some urologists due to low re-treatment rates. HoLEP can often be quite aggressive leading to marked r...
In a young male patient with hypogonadotropic hypogonadism and fertility goals, would starting testosterone replacement therapy affect fertility chances?
Men with hypogonadotropic hypogonadism due to congenital hypogonadotropic hypogonadism or acquired hypogonadotropic hypogonadism due to structural disease (e.g., a pituitary macroadenoma) typically require gonadotropin therapy to optimize spermatogenesis and fertility. For men who have hypogonadotro...
For patients with T1 bladder cancer who have severe obstructive uropathy/hydronephrosis, do you treat as high risk stage I disease with RC, or clinically upstage and manage as a more locally advanced disease (NAC+RC)?
Clinical staging of bladder cancers with cystoscopy and imaging is associated with significant upstaging at immediate surgery nearly 25% of the time. Hydronephrosis is typically viewed as a T3 disease barring some other clear-cut cause high in the ureter such as a stone. Therefore, I prefer to have ...