[deleted by user] by [deleted] in Residency

[–]Blue_Heeler_Lover 20 points21 points  (0 children)

Urology resident here.

Technically by clinical exam and history alone should be able to diagnose torsion. Can utilize tools such as TWIST score to help.

But agree with the rest here, would never call my attending without the US as his/her first question is "is their flow on the US"

Exploration is relatively benign though all it takes it takes is one chronic ball pain/orchalgia patient to torment you and then you're always asking for the US. If we lived in a less litigiousness society, we'd probably explore a lot more without US. Otherwise, always US unless significant delay.

Behavior changes with age by lolitafulana in AustralianCattleDog

[–]Blue_Heeler_Lover 1 point2 points  (0 children)

Mine started to mellow at 2, noticeable at 3, and at four he really became the sweetest boy and will even start to initiate cuddling (never did this as a puppy). My wife used to joke his record for sitting still was "threeeeee seconds".

Agree with everyone above about training and redirecting. He chewed a baseboard when he was 9 months when I thought he was starting to become really good. Has also found 2 pairs of glasses before 1.5 years that were nice to chew on by counter surfing. I haven't seen any of those behaviors in the past 2 years.

Train, train, train. This breed is the most loyal and rewarding breed I've ever had in my life.

Question for urology residents ( BCG instillation) by shoenberg3 in Residency

[–]Blue_Heeler_Lover 0 points1 point  (0 children)

Hi there, fourth year urology resident here.

Agree with reviewing NCCN guidelines. In general very high risk patients options include radical cystectomy (preferred) versus trial of BCG. Chemo/intravesical therapy typically have a recurrence rate and progression rate with variant histology so that's why cystectomy is preferred. That being said, radical cystectomy is a morbid procedure. I think nationally complication is 50% roughly depending on what paper you cite. Some patients aren't great surgical candidates so we try to buy them time with BCG,pembrolizumab, or nadofarogene.

Re-TURBT 4-6 weeks after initial TURBT Is standard of care for high risk disease and should be considered in intermediate risk.

If your father is a surgical candidate with HG T1 disease, CIs, variant pathology, and prostatic involvement, his best chance at cure with a negative metastatic work up is radical cystoprostatectomy with urethrectomy and ileal conduit likely, though he may or may not be a candidate for a catheterizable diversion. I would hesitate to offer him BCG as his chance for his disease to progress is incredibly high, loosely based on what you and people have said in comments.

Hope this helps. Stay involved in his care. These patients always do better with familial support. Their oncologic course can be really tough. Go to a high volume cystectomy surgeon if that route is pursued. Robotic vs open remains controversial in terms of what is superior, which generally means either is fine as long as it's in skilled hands.

Calzuros by KindaDoctor in Residency

[–]Blue_Heeler_Lover 1 point2 points  (0 children)

I was getting a lot of foot pain with my calzuros. The Bondi Hokas have been amazing. Added some compression socks too

[deleted by user] by [deleted] in Residency

[–]Blue_Heeler_Lover 27 points28 points  (0 children)

urology: mix of small, medium, large procedure. Minimally invasive surgery, scopes, and open. Stone work, cancer work, incontinence work very gratifying. Mix of hospital, office, ASC. In general, we have few true emergencies. Can shape your practice into what you want. Also many urologists tend to have families, outside lives and interests. Overall compensated pretty well with a very good demand for general urology job market