Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What is your approach for patients with a history of nephrolithiasis who are being evaluated for living kidney donation?
We have a protocol that guides us on the work-up in this situation. If they have a remote history of stones, then we do a Litholink and if they have a urinary milieu that is risky for stone disease they are counseled on fluid intake and dietary changes. If they have symptomatic stones, they are rule...
For an older patient with hormone-sensitive high-volume, high-risk prostate cancer with metastases to bone who developed toxicity with enzalutamide, what other oral AR blocker would you offer?
There are two other options that this patient might tolerate. One option is darolutamide, which has similar AR-blocking activity but does not cross the blood brain barrier. In large trials, the symptom profile was less severe than those of enzalutamide or apalutamide though some patients will have s...
Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?
Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).My...
What is your approach to management of patients with recurrent nephrolithiasis and osteoporosis who are receiving teriparatide?
Bones and calcium containing kidney stones can interact. I find it interesting that patients who have primary hyperparathyroidism are prone to predominantly calcium phosphate kidney stones, since the action of parathyroid hormone on renal tubes is to reabsorb urine calcium. That’s why people with hy...
Do you have recommendations after prostate RT for patients who want to conceive?
This conversation has two directions based on whether or not the patient currently can produce semen. Assuming he currently canNOT produce semen obtained via ejaculation, I would refer him to a urological specialist for surgical extraction of sperm. From that point, the sperm could be inspected by a...
How do you manage surveillance imaging for patients with metastatic castration-resistant prostate cancer?
Outside of trials - for SOC patients, I'll usually get imaging around treatment PSA nadir (understanding some of the changes in bone may lag PSA responses). Then, will re-image based on consistent/significant PSA rise or new symptoms. I try to adhere to working group radiographic criteria for SOC pa...
What are your top takeaways in GU Cancers from ESMO 2024?
1. Tivozanib–nivolumab vs tivozanib monotherapy in patients with renal cell carcinoma (RCC) following 1 or 2 prior therapies including an immune checkpoint inhibitor (ICI): Results of the phase III TiNivo-2 study. This trial confirmed (along with CONTACT-03: cabozantinib +/- atezolizumab) that cont...
What advice do you offer to patients with recurrent nephrolithiasis who are on a tube feeding diet and seeking stone prevention guidance?
As always, it is important to know their stone composition, so that you tailor the invention appropriately. Regardless, I have seen many such patients with calcium oxalate stones. It is important to get detailed information about their tube feeding formula and dosing, because tube feedings can vary ...
How does prior prostate artery embolization impact your treatment recommendations for prostate cancer?
PAE is a "newer" modality that is being used to treat LUTS in men with BPH and BPH symptoms at baseline. Case series report relatively impressive results, with the average AUA score dropping from around 20 to 8 in populations receiving this therapy. PAE is sold as a procedure that is unlikely to hav...
What are your management strategies for patients with recurrent uric acid nephrolithiasis and chronic kidney disease who have persistent hypocitraturia and acidic urine pH?
This is a good question. The primary goal is to correct the urine pH to at least 6 and preferably 6.5, regardless of renal function. Hypocitraturia is not a critical issue in uric acid stones disease, though it will likely respond to therapies listed below. Concurrent chronic kidney disease does not...