Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Is TURP a contraindication for prostate cancer SBRT?
I have not done it, but Georgetown experience recently published here: Pepin et al., PMID 32432033A recent informal Twitter poll shows many are comfortable with SBRT after TURBT: https://twitter.com/TylerSbrt/status/1323315130990432256?s=20I'm interested if any have further insight.
What are your top takeaways in GU Cancers from ASTRO 2024?
The Presidential Symposium was outstanding. Dr. Brandon Mahal’s presentation hit on a top priority for the field, in my view: how do we improve/accelerate the implementation of advances like focal microboost for prostate cancer? RCT evidence of benefit to dose escalation is rare in rad onc. The FLA...
Is there a role for 24 hour urine stone risk profiles in your patients with known recurrent struvite kidney stones?
It depends. Pure struvite stones are not a metabolic abnormality; they are the consequence of a urease-producing urinary infection that splits urea to ammonium, raising the urine pH into the high 7-8 range, which in turn precipitates magnesium ammonium phosphate, otherwise known as struvite. Pure st...
How would you treat a patient with synchronous node positive prostate cancer (T3bN1M0) and oligometastatic rectosigmoid cancer (T4aN1M1) with a solitary liver metastasis?
I reached out to my colleague, Dr. @Dr. First Last, a radiation oncologist and co-director of the Prostate Cancer Center at Dana Farber, who has expertise in both genitourinary and gastrointestinal cancers for his thoughts on this question. Here is his answer: Recognizing that the rectal cancer is l...
Do you recommend any specific testing for patients with recurrent nephrolithiasis and suspected absorptive hypercalciuria?
I would consider genetic testing in this situation, although it would not alter my recommendations for diet and thiazide diuretic treatment. I would also look for primary hyperparathyroidism. Counterintuitively, parathyroid hormone increases absorption of urinary calcium; that’s why HPT patients are...
Are there instances when you recommend using sevelamer for patients with recurrent calcium phosphate nephrolithiasis?
Basically no. The main drivers of calcium phosphate stones are mildly alkaline urine and hypercalciuria. Primarily, I am looking for the causes of these conditions. Urine volume is always important. If urine phosphate is elevated, my first intervention in that regard is dietary. Stephen B. Erickson...
Do you routinely check Pulmonary function testing prior to each cycle of BEP for young patients with testicular cancer with no pulmonary risk factors?
A few comments: I do not check DLCO or PFTs in general in patients under age 50 getting just 3 courses of BEP. We tend to avoid bleo if over age 50. If a patient is getting 12 weeks of bleo, I check DLCO just prior to the start of the 4th course, and if DLCO < 60%, I give VIP for the 4th course. Ad...
Would you avoid SGLT2 inhibitors in patients with nephrostomy tubes?
I probably would unless a compelling reason to use. I worry about risk of infection and would imagine that depending on the reason for the nephrostomy tubes might limit the potential upside of using these agents. Maybe in future years as we gain more experience in non-study populations my answer wil...
When do you recommend the use of oral testosterone replacement over injectable testosterone?
Oral testosterone was approved by the FDA for men who have low testosterone levels due to specific medical conditions, such as genetic disorders like Klinefelter syndrome or pituitary conditions causing damage to the pituitary gland.
Do you recommend repeat kidney stone composition testing for a patient with recurrent nephrolithiasis who passed an additional stone but previously already had stone composition testing performed?
Good question. Certainly, if there has been a gap in stone events prior to new development of stones, it is reasonable to confirm both the stone composition and the 24-hour urine chemistry, to see if conditions have changed in a meaningful way. It would be less important, if the patient had regular ...