Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
How do you evaluate for clinically significant ureteral obstruction in a pregnant patient with AKI, since physiological hydronephrosis on kidney ultrasound is common?
For AKI, it would have to be bilateral, and then I would consult urology.
Is a history of provoked DVT a contraindication to starting testosterone replacement therapy in a middle aged man with symptomatic hypogonadism who is on anti-coagulation?
The data on testosterone replacement and thromboembolic disease is not so clear but there is likely a link and should be noted in patients at high risk (e.g smoking, prior event, erythrocytosis). It’s important to discuss the risk benefits with the patient but as long as they are on anticoagulation,...
Do you administer prophylactic antibiotics for GU procedures?
The common GU procedures performed in radiation oncology are transperineal brachytherapy and transperineal retroprostatic hydrogel insertion. Rarely transrectal biopsy or transrectal intraprostatic injections may be performed by radiation oncologists. I don't believe any randomized studies looking a...
Is there a PSA value below which you would not offer salvage radiation post-prostatectomy?
I am commonly asked the inverse question: if I use a "PSA cutoff" whereby a rise beyond this value will strongly favor treatment with post-op radiation. I think it is difficult to have a set value that applies for all patients, as the decision to treat should be individualized to patient and disease...
Under what circumstances would you treat prostate cancer without a biopsy?
I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...
How would you treat a patient with cN1 MIBC, treated with neoadjuvant cisplatin-based chemotherapy with outstanding clinical response, who is no longer a cystectomy candidate?
This is certainly a not uncommon clinical scenario in practice with, unfortunately, limited prospective data. The ECOG ACRIN INSPIRE trial (EA8185) is aiming to generate key prospective data in this setting. For patients with node positive patients and great response to initial systemic neoadjuvant ...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?
I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in s...
Which method provides a more accurate assessment of hypercalciuria: 24-hour urinary calcium excretion or the spot urine calcium-to-creatinine ratio?
24-hour urine should be more accurate. F. Singer
What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?
To be succinct, the correct answer is BEP x 3 if he wants the therapy that would achieve optimal cure rate. If disease is limited to retroperitoneal nodes, especially if < 3 cm is the largest node and normal postorchiectomy, serum hCG and AFP, RPLND would then be the preferred option.