Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How often do you check renal function panels for patients with recurrent nephrolithiasis?
Interestingly, most patients with recurrent kidney stones have normal or near normal GFR. I check them annually when I do imaging and 24-hour urine supersaturations looking for metabolically active stone disease. For those patients with decreased GFR, I recheck them at the same frequency, I would c...
Is there a role for cefpodoxime for treatment of acute cystitis caused by an Enterobacterales isolate with resistance to cefazolin, but susceptibility to ceftriaxone?
Yes – “sort of”. This is a much more complex question than it initially seems. First some background. CLSI has established a surrogate cefazolin breakpoint to predict susceptibility of urine isolates of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis causing uncomplicated infection to...
What is the risk of local recurrence in a high grade muscle invasive bladder cancer (MIBC) s/p incomplete TURBT treated with concurrent chemoradiation compared to a complete TURBT?
One source I’m aware of that could shed light on this specific question is a 2017 publication from MGH (Giacalone et al., PMID 28081860), reporting the outcomes of 475 patients with T2-4a N0 M0 bladder cancer treated with various protocols from 1986-2013. Not all patients had high-grade tumors, but ...
Do you recommend chanca piedra supplements for patients with recurrent calcium oxalate nephrolithiasis?
NO. No data support its use. The idea of ''breaking' a crystal matrix mass of CaOx crystals does not seem thermodynamically likely.Given it is implausible and unproven I shun the stuff.
How do you treat metastatic squamous cell carcinoma of the bladder?
No good data, we tend to use either gemcitabine/cisplatin or 5FU or taxane based therapy. Ideally clinical trials. Recent data that we published showed underlying biology and retrospective experience amenable to checkpoint inhibitor, which can be tried, esp. after PD on chemoTx.
How do you treat muscle-invasive and metastatic sarcomatoid bladder cancer?
This is a very challenging disease with poor prognosis and low response rate to therapy. If it's predominant or pure sarcomatoid, we are opening a neoadjuvant clinical trial with dose dense MVAC plus pembrolizumab before surgery. If there is no trial, I would do upfront radical cystectomy and PLND f...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
Do you hold anticoagulation prior to LDR or HDR prostate brachytherapy?
Yes, we have an algorithm for holding prior to brachytherapy/spaceoar/fiducial placement and the patient generally resumes 2-3 days later when they do not notice any blood from urine/bowel. We have a recommendation for each agent. Here are some general examples. Indocin and voltaren: 1 day prior t...
How long would you treat an upper urinary tract infection in a patient with acute obstructive pyelonephritis due to a kidney stone status-post urinary stenting without yet removal of the stone?
After treatment of an ascending urinary tract infection for 7 days, the infection will be treated. However, if the stone is large enough it may be colonized and cause recurrent infection. I would make my best efforts to get the stone removed as soon as possible and I would likely give the patient a ...
How would you treat intermittent hematuria post prostate radiation?
The citation below, good article, and excerpt below, a summary that may answer your question. Our urology colleagues would appreciate it if we initiated a workup like this, but I would always ask the patient to see a urologist as well. HBOT should be considered. “For grade 1 and grade 2 types, sympt...