Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What rectal spacer do you recommend for prostate cancer patients?
I’ve only ever worked with SpaceOARs. I’d be interested to hear from providers who have gotten to work with both. There are similarities between both. A similar amount of total volume is injected with either procedure. Both products begin natural resorption around 3 months after placement. SpaceOAR ...
For a patient who is cisplatin-eligible with localized, high-grade upper tract urothelial carcinoma, but no muscularis propria seen on biopsy, what is your approach?
The risk of clinical under-staging is notorious in UTUC; therefore, we aim to maximize control of disease and address the meaningful risk of micro-metastasis. In that context and outside clinical trial option, we favor the use of neoadjuvant cisplatin-based chemotherapy using either dose dense MVAC ...
Do you plan to extrapolate from the NIAGARA trial regarding peri-operative durvalumab/cis/gem to treat upper tract urothelial carcinoma?
UTUC has different biology from MIBC and is considered more aggressive. Patients with UTUC were excluded from the NIAGARA, and therefore, we cannot make assumptions and extrapolations. Having said that, in patients with UTUC, it is important to check if they have microsatellite instability or Lynch ...
Which salt substitutes do you recommend for your patients with recurrent nephrolithiasis who have hypercalciuria from excess sodium chloride intake?
As the questioner correctly implies, dietary sodium will worsen hypercalciuria. For hypercalciuric calcium stone formers, I recommend a no-sodium-added diet. Non-sodium salt substitutes are permissible. I do not have a brand preference. If the patient has renal insufficiency, potassium-containing su...
What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conduc...
Are there instances when you obtain an abdominal X-ray over an ultrasound or CT scan for kidney stone surveillance in a patient with recurrent calcium based nephrolithiasis?
Currently, no. My goal with renal imaging is to determine the number, size and position of stones. Before the advent of ultrasound and CT scanning, I used KUB with tomograms. Those have been replaced by CT and ultrasound for more accuracy and less radiation. My urologic colleagues may use an abdomin...
Do you recommend plasmapheresis prior to kidney transplantation for patients with elevated panel-reactive antibody percentages?
No, preemptive PLEX is not necessary with a high PRA in the absence of DSA. At our center, we do monitor for emergence of DSA in our patients with the highest PRAs >98%.
When would you consider long-term suppressive antibiotic therapy in patients with chronic or recurrent bacterial prostatitis who continue to experience symptoms despite multiple courses of antibiotics?
I think this would depend on the organism to be honest. First, I would make sure the patient is seen by urology and evaluated for possible structural reasons for recurrent or chronic prostatitis. If there are no structural issues that can be rectified, I would consider a prolonged course of therapy ...
Would you favor oral bisphosphonates over intravenous formulations for patients with hormone sensitive prostate cancer and androgen deprivation therapy (ADT) related osteopenia?
If kidney function is normal, either would do. Therapy depends on the risk level. (See Cosman et al., PMID 39073912.)
Would you give treatment to a male patient with subjective dysuria but no objective pyuria with Ureaplasma urealyticum detected by PCR from urine?
No treatment is indicated. First, dysuria alone in males is not an STD symptom; published research is clear that discharge is required to suspect urethritis. The absence of urine WBCs (i.e. no pyuria) is a pretty good substitute for examining for discharge - not perfect but makes urethritis unlikely...