Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
How do you evaluate exercise induced hematuria that persists after one week of cessation of exercise?
Exercise-induced hematuria typically resolves within a week. If the hematuria persists after one week of cessation of exercise, further work-up of the hematuria is warranted. First, hematuria should be confirmed by excluding myoglobinuria and march hemoglobinuria. If hematuria is confirmed, then one...
How do you manage a seminal vesicle recurrence after prostate brachytherapy?
Finding more of these in the PSMA era. Have managed a few patients with SBRT +/- ADT adjusting dose based on overlapping OAR if needed.
How would you treat a monopolar injury to the bowel if there is no obvious defect in the intestinal wall?
Depending on extent of injury, intervention would be different. However, if it’s an incidental thermal “kiss” (<3-4mm), I would put a few imbricating stitches in the seromuscular layer to oversew the injury.
Would you consider offering salvage radiation to a patient with castrate resistant prostate cancer who has never had local therapy and has no evidence of lymph node or distant metastasis?
It's hard to give a great answer without knowing more information, such as the PSA, Gleason score, and T-stage at presentation, why he was treated with androgen deprivation alone up front, what AD he was treated with, how long he was under treatment before he became castrate resistant, and what is t...
What are treatment options for elderly patients with a remote history of cystoprostatectomy with neobladder who are no longer able to empty their neobladder fully, are unable to CIC, and are beginning to have complications such as infection and rising creatinine?
The recommended management of elderly patients with this history is dependent on several factors. The fact that they are unable to drain spontaneously and unable to perform CIC limits the options for drainage. With their creatinine rising, this also suggests that limiting the contact time of excrete...
How would you manage a patient with a history of prostate radiation who is presenting with LUTS and elevated PVR?
This can be a very difficult problem, because the risk of stressing continence following prostatic resection in the radiated patient is much higher than in the non-radiated patient. Following brachytherapy, stress incontinence can occur more than half the time, and following external beam radiation ...
What tips and tricks are there for catheterizing a patient with a history of metoidioplasty?
History is the key first step. I would ask what exact operation the patient had, whether urethral lengthening was performed, where they void from, whether they have had strictures or fistulas, and what catheter size has worked before. I would also ask exactly why a catheter is needed. For example, i...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
Do you incorporate the results of 24 hour urine chemistries that were obtained several years prior when evaluating new patients for kidney stone prevention?
I do but the issue is complex. Interpreted in context - life events, surgeries, meds etc - they tell me the range of behaviors for a patient in chemistry terms. But it takes a lot of time, and is not a good idea unless you are prepared to take that time.
How do you treat decreased libido from SSRIs?
Serotonin-1 agonism will revert it in about 60% of cases. You have a choice of adding buspirone at about 30 mg bid or going to vilazodone which has already an SR1 agonism. Some bupropion, not clearly understood at about 300 mg can also do it. Or if possible, use vilazodone, bupropion, or mirtazapine...