Urology
Expert guidance on urologic oncology, stone disease, BPH management, incontinence, and minimally invasive surgical approaches.
Recent Discussions
Do you have patients with recurrent calcium oxalate kidney stones stop taking supplements containing vitamin C if their 24 hour urine oxalate excretion is normal?
No. I am not aware of data that suggests Vitamin C would aggravate kidney stone formation in this situation. Stephen B. Erickson, MD
How would you approach a fit older (>70 years) with grade I-II, bulky, follicular lymphoma causing ureteral obstruction and renal failure?
You could also consider focal radiotherapy as we know follicular lymphoma is often very radiosensitive (and can respond quickly to RT). Depending on the trajectory of the AKI and dysfunction, I would discuss with my urology colleagues to see if there is any role for ureteral stenting to see if kidne...
What is your approach to differentiating primary from secondary hyperparathyroidism in recurrent kidney stone formers who also have chronic kidney disease, an elevated PTH, and hypercalcemia?
You have asked a complicated question. It is certainly possible for both conditions to coexist simultaneously. It would be unusual for primary hyperparathyroidism to cause secondary hyperparathyroidism, although recurrent obstructive uropathy from stones would be a possible etiology. Similarly, seco...
What are your management strategies for patients with nephrolithiasis and hypercalciuria who have a severe sulfa drug allergy and are unable to tolerate thiazide diuretics?
This is a difficult situation. Assuming the nephrolithiasis is calcium-based, I think the patient has to lean more heavily on dietary control. Dietary sodium restriction will decrease hypercalciuria. A further increase in fluid consumption will dilute the urinary calcium concentration. We are fortun...
Has the recent presentation of RADICALS-HD changed your ADT duration recommendations for patients receiving post operative radiation therapy for prostate cancer after radical prostatectomy?
The way I interpret RADICALS is that for adverse pathology meaning GS 8 and above, T3 disease or node positive who benefit from ADT would favor 24 over 6 months and probably these are patients who benefit from nodal RT also. For a favorable type prostate fossa only RT with unclear if any additional ...
What percentage of your patients receive hydrogel SpaceOAR?
T3+ or poor KPS, we don't use SpaceOAR.
Would you treat a patient with evidence of prostate cancer who refuses biopsy?
No. I cannot think of a situation where I would treat localized prostate cancer with radiotherapy without biopsy confirmation.In the scenario provided above (PSA>15, PI-RADS 5), we cannot be positive the patient even has cancer. A meta-analysis (Barkovich et al., PMID 30807218) found PI-RADS 5 repre...
How would you treat a newly diagnosed hormone sensitive high risk prostate cancer with one small lung metastasis and no other evidence of metastatic disease per PSMA PET?
I think there is no solid answer to this. De-novo visceral metastases are very rare in mHSPC, and lung-only oligometastases on PSMA-PET are even more rare. Since lung metastases is expected to be visible on CT, this is undeniably a high-volume disease based on the CHAARTED criteria. Patients with vi...
How do you approach management of locally-advanced, unresectable, but non-metastatic bladder cancer?
"Locally advanced" has a broad meaning. I will focus on muscle invasive urothelial carcinoma which is non-metastatic, node negative, and does not invade the pelvic or abdominal wall, and is a maximum of T4a, N0, M0 disease, and in those patients who either have unresectable disease or who are not su...
What is your approach to patients with recurrent nephrolithiasis and hypercalciuria who take daily calcium supplements?
Calcium-based stone disease and osteopenia/porosis commonly occur together in postmenopausal women. Calcium supplements are the basic treatment for osteopenia/porosis but may aggravate stone disease in hypercalciuric patients. My approach is first to ask our Stone Clinic dietitian to estimate the pa...