Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
What alternative therapies do you recommend for botox non-responders?
For non-responders, I recommend waiting longer between injection sessions, trying different brands especially those with less protein associated with them such as Xeomin which has the least amount of protein, and therefore, less likely to trigger the development of neutralizing antibodies. In some c...
Is there a maximum dose of potassium citrate you would use for patients with recurrent calcium oxalate nephrolithiasis and hypocitraturia?
I don’t think there is a maximum dose of potassium citrate. Hyperkalemia can occur, especially if GFR is impaired, and monitoring for that is important. In my experience, diarrhea is the most common dose limiting effect. Taste fatigue is common; fortunately there are multiple preparations available ...
What is your approach to managing patients with recurrent calcium oxalate nephrolithiasis since childhood who are found to be gene carriers for mutations in genes associated with primary hyperoxaluria?
Thank you for this question. In general, there is no good evidence that patients with a carrier of 1 of the 3 primary hyperoxaluria genes (AGXT, GR/HPR or HOGA1) has any phenotype consistent with primary hyperoxaluria, or that these genes are enriched in the general stone forming population. That be...
What is the best management for a patient with advanced renal medullary carcinoma?
Very interesting regarding case reports of long term responses with proteasome inhibitors. Thanks for sharing.
When will you consider doing a biopsy of a potential metastatic site (lymph node, lung/visceral) for testicular cancer after orchiectomy?
I will biopsy a potential metastatic deposit seen on the scan after the orchiectomy if tumor markers are negative, have reduced to normal with appropriate half-lives, or are equivocal. A raised LDH, in isolation, is not enough to support the diagnosis of metastasis, and I will usually biopsy if that...
How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?
Bacillus Calmette–Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumor immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. As rheumatologists, we occasio...
Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?
Hyperparathyroidism does increase the risk of developing kidney stones. A study in New England Journal of Medicine, Broadus et al., PMID 7351950, reported that patients with elevated concentrations of 1,25-dihydroxyvitamin D are at increased risk for kidney stones. The reason is that 1,25-dihydroxyv...
How do you treat muscle invasive bladder cancer with neuroendocrine differentiation?
Is there a role for neoadjuvant chemotherapy in upper-tract urothelial carcinoma?
Very common scenario with significant variability in clinical practice. There is no standard high-level evidence as compared to muscle-invasive bladder urothelial cancer, in which neoadjuvant cisplatin-based chemotherapy is the standard of care for cisplatin-eligible patients. The literature lacks d...
Is there any indication for monitoring for renal medullary carcinoma in patients with sickle cell trait?
Hematuria occurs episodically in approximately 5% of people with sickle cell trait. Although often recurrent and sometimes producing anemia, the causes of hematuria are usually benign and it is self-limited. Medullary carcinoma of the kidney is a rare highly aggressive tumor that occurs almost exclu...