Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Which genomic test do you choose for a patient with favorable intermediate prostate cancer trying to decide between active surveillance and treatment?
Decipher.
What is your fluid intake target for patients with nephrocalcinosis and no history of kidney stones?
Nephrocalcinosis represents calcification of the renal parenchyma as opposed to nephrolithiasis that represents classification in the urinary space. The two conditions occasionally coexist, such as a medullary sponge kidney, distal renal, tubular, acidosis or primary hyperparathyroidism. For patient...
What is your approach to patients with chronic kidney disease who are found to have pelviectasis without hydronephrosis on renal ultrasound imaging?
Good question. I would involve urology early on. I would get more history as to other signs/symptoms of urinary obstruction (nocturia, BPH symptoms, history of retroperitoneal fibrosis). Then, consider a Lasix urogram.
Does a negative staging PSMA PET in a patient with biopsy-proven recurrent prostatic adenocarcinoma change your management?
The bottom line is that you have to believe the biopsy. PSMA PET will not show microscopic disease, which is why it cannot "rule out" disease in lymph nodes or elsewhere. It is comforting when it is negative, but it is not absolute truth. A few questions; What was the PSA at the time of the PSMA PET...
Do you recommend patients consume dairy products over taking calcium carbonate with meals if they have recurrent calcium based nephrolithiasis and persistent hyperoxaluria?
I generally consider the decision between dairy and calcium tablets in the context of other medical conditions. For instance, if the patient has surgical or medical short gut syndrome as a cause of hyperoxaluria, I favor using calcium tablets to help compensate for the enteric loss of bicarbonate in...
Do you recommend checking 1,25-hydroxy vitamin D levels in patients with recurrent nephrolithiasis who have hypercalciuria of unknown etiology?
No, unless they are hypercalcemic or I suspect renal sarcoidosis. Stephen B Erickson, MD
Are there any factors which would lead you away from recommending active surveillance in low risk prostate cancer?
A healthy male with a BrCa mutation Or Any male with at least 50% + bxs Or The presence of Perineural invasion Or PSA density more then 0.30 may be a new indication after the AUA this year Would prompt a mpMRI and then fusion bx of any PiRADS 3,4 or 5 areas to rule out grade 4 pc
Would you consider a patient with spina bifida and end stage kidney disease secondary to reflux nephritis with an ileal conduit for a kidney transplant?
In general, patients with ileal conduit and those with neobladder can be considered for kidney transplantation.
What is your approach for patients with recurrent nephrolithiasis who you have a strong suspicion for primary hyperoxaluria though genetic testing returns without any abnormalities?
As an adult nephrologist, most of my patients with oxalosis have enteric hyperoxaluria. I suggest you take a careful history, looking for inflammatory bowel disease, removal of small bowel or surgical rerouting of the intestines. If your patient is a child, I would explore the possibility of insuran...
How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?
Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimod...