Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
In a frail older adult with moderate-to-severe lower urinary tract symptoms, when do you start a beta-3 agonist like vibegron over an anticholinergic?
In a frail older adult with OAB-predominant moderate-to-severe LUTS, I generally start a β3 agonist (vibegron or mirabegron) as the first-line pharmacologic option once behavioral interventions are insufficient. Behavioral therapies may include fluid management, bladder retraining, pelvic floor exer...
What interventions do you recommend for patients with a chronic catheter who have recurrent blockage due to sediment?
The first thing to do is to perform a cystoscopy to ensure that there are no stones and or significant debris that is obstructing the catheter. Particularly in the face of infection, stones may form very quickly. At the time of the cystoscopy, make sure that there are no stones and irrigate all debr...
Given results of the RADICALS trials, is LT-ADT standard of care for salvage prostate RT?
I do not think long-term ADT is established as standard of care for salvage prostate radiation, as this would require a demonstration of improved overall survival in at least specific subgroups of patients. RADICALS-HD demonstrates improvement in freedom from metastasis as well as freedom from non-p...
How would you treat node positive (pN+) prostate cancer with undetectable post-op PSA after radical prostatectomy and pelvic LND?
The short answer is, YES I would, in general, recommend treatment. I also respectfully disagree that ADT monotherapy is the standard of care. It is an option of course, but rarely performed given it is non-curative and the data to support its use is of minimal relevance today.Some key points of reas...
Is there any data on the use of PARP inhibitors in patients with metastatic urothelial carcinoma with deleterious DDR mutations?
Urothelial cancers harbor high rate of deleterious DDR alterations. Based on clinical data from other tumor types, especially TOPARP-A in metastatic castration-resistant prostate cancer where responses to olaparib monotherapy were observed especially among men with defective DDR genes, the use of PA...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
What is your management for intermittent bleeding and pain at the buccal mucosa graft donor site within the first postoperative week?
Gauze packing as needed. I would not intervene with surgical closure. Sponges soaked in lidocaine with epinephrine can also help in this situation. We do use a swish and spit viscous lidocaine to help with oral pain in the first few weeks after surgery. The patient should avoid foods that are hard a...
Is there a PVR cutoff over which you worry about urinary retention when giving bladder botox to spontaneously voiding patients with suprapontine lesions?
I am not worried about numbers, but symptoms. If the patient is improved and happy, then I am not concerned about PVR unless infections become an issue.
How are you using ArteraAI in 2026 for intermediate risk patients?
I use both ArteraAI and Decipher to help with these decisions. As Dr. @Dr. First Last says, it's post-hoc based on large datasets. Artera claims to be predictive, while Decipher is just prognostic. Without going through all the data, I find it helpful for intermediate risk, where it is on the cusp o...
What is your approach to managing neobladder acidosis?
Alkali supplementation is the mainstay of treatment of neobladder acidosis. Since prolonged urinary contact with the intestinal epithelium used for urinary reconstruction leads to increased ammonium reabsorption and chloride absorption in exchange for bicarbonate secretion, regular catheterization o...