On callEmergency
Testicular torsion
A young man, sudden scrotal pain, and a clock that started before he reached you. Why the OR is the investigation and Doppler is the tiebreaker, never the verdict.
6 minOpen
Teaching topics · 18 and growing
Reasoning first, the maneuver second
Walk-throughs of urology built the way I wish someone had built them for me — anatomy and reasoning up front, and the part everyone gets wrong said out loud. Drawn from the same notes I study from.
StageFoundationsthe model before the maneuverCorebread-and-butter clinic & OROn callthe 3 a.m. emergencies
On call & emergencies
5On callEmergency
Ischemic priapism
A rigid, painful erection past four hours is a compartment syndrome of the penis. One needle is both the diagnosis and the start of treatment — and the corpora are dying while the patient sits in the waiting room, often too embarrassed to say why.
6 minOpen
On callStones / Emergency
The infected obstructed kidney
Flank pain, a fever, and a stone the urine can't get past. This is one of the few things on a urology service that can quietly kill a ward patient overnight — and antibiotics alone are not the treatment.
6 minOpen
On callInfection / Emergency
Fournier's gangrene
Necrotizing fasciitis of the perineum, where the skin lies about how sick the patient is. Pain out of proportion, septic physiology without an obvious source — and a mortality that climbs with every hour you wait for a scan.
5 minOpen
On callTrauma / Emergency
Blood where it shouldn't be: GU trauma
A trauma bay, a pelvic fracture, and blood at the tip of the penis — and the single most important thing you can do is not pass the catheter you're about to reach for. Most kidneys are saved without an operation; the urethra is saved by leaving it alone until you've imaged it.
7 minOpen
Stones
2CoreStones
The stone in the ER
The patient who can't find a position that helps, a CT that takes four minutes, and a decision tree that hinges on two numbers: how big and how high. Most stones pass on their own — your job is to know which ones won't, and which 'stone' is an aneurysm in disguise.
7 minOpen
FoundationsStones
Why this stone patient will be back
Half of stone formers recur within ten years, and the single most under-ordered test in urology is the one that stops it. The 24-hour urine turns a vague 'drink more water' into a directed prescription — a specific number, a specific drug, a specific target.
8 minOpen
Benign prostate & LUTS
1Bladder & continence
1Urologic cancer
6FoundationsUrologic cancer
Reading the PSA, finding the cancer
PSA is organ-specific, not cancer-specific — it rises with cancer, BPH, infection, and a recent ride on a bicycle. The modern pathway threads an MRI between the blood test and the biopsy so we stop finding cancers that were never going to matter.
7 minOpen
CoreUrologic cancer
Localized prostate cancer: to treat or to watch
The hardest part isn't treating prostate cancer — it's deciding which ones to leave alone. Active surveillance for the indolent, surgery or radiation for the rest, and a long conversation about continence and erections that matters as much as the cancer math.
8 minOpen
CoreUrologic cancer
The mass on the kidney
Most are found by accident on a scan ordered for something else. The Bosniak score tells you how worried to be about a cyst; the size tells you whether to watch, ablate, or operate — and 'spare the nephron' is the quiet rule behind all of it.
7 minOpen
CoreUrologic cancer
Blood in the urine, and the cancer behind it
Painless gross hematuria is bladder cancer until proven otherwise. The whole disease pivots on one pathology word — whether the tumor has invaded muscle — and that single distinction separates a bladder you can keep from one that has to go.
8 minOpen
CoreUrologic cancer
The testicular mass: the cancer that you cure
A young man, a painless lump, and one of oncology's great success stories — even widely metastatic disease is often curable. But the cures depend on getting the first moves exactly right: the markers before the knife, the inguinal approach always, and the sperm bank before the chemo.
7 minOpen
CoreUrologic cancer
When prostate cancer comes back, or spreads
A rising PSA after treatment, or metastatic disease at diagnosis — the part of prostate cancer that has changed the most in a decade. The old answer was 'start hormones'; the new answer is to intensify up front, profile the genome, and sequence a growing menu of drugs.
8 minOpen
Andrology & men's health
2CoreAndrology
Erectile dysfunction, and the warning it carries
The complaint is about sex, but the message is often about the heart. ED is an early marker of vascular disease, and the workup is as much about cardiovascular risk and a missed testosterone as it is about getting an erection back. The treatment is a ladder, and one drug combination can kill.
6 minOpen
FoundationsAndrology
Low testosterone: the diagnosis people rush
It has become a fashionable diagnosis and a frequently wrong one. Real testosterone deficiency needs symptoms and two morning measurements — and the single decision that changes the whole plan is whether the man still wants to father children.
6 minOpen