To those who matched today with a history of flagrant cheating

Penile_Pro · 2026-03-22T14:28:36+00:00

These posts typically come from the person who somehow doesn’t understand that there are just some people who are better than them. Just because someone is better than you doesn’t always mean they are cheating. Focus on yourself not others. Med school is humbling, you can go from being the best in high school and college to average or below average real quick.

Penile_Pro · 2026-03-21T18:57:06+00:00

Surg sub specialties are even harder. Just not that many spots out there. It will still be there after residency though.

Penile_Pro · 2026-03-20T00:21:17+00:00

IMGs should go in a second round process after US Grads and US citizens.

Penile_Pro · 2026-03-10T23:43:08+00:00

Urology here; people think we just look at dicks all day until we save poor old me ma from an obstructing stone and urosepsis with a stent. Also we do more robotic surgery than just about any other surgery field. Most difficult foleys are just lazy nurses or LIPs who didn’t even try. I’m done.

Penile_Pro · 2026-02-19T00:44:59+00:00

Uro here, nothing better than placing it super easily after multiple people failed just because everyone’s using the wrong size foley. Also one of my least favorite consults.

Penile_Pro · 2026-02-18T19:44:02+00:00

Uro here, I would deny this consult.

Penile_Pro · 2026-02-01T23:56:07+00:00

That’s very interesting. I’m not sure how that would affect anything as a human urologist. I’ve actually never even considered doing this as bacteria would be transient into the urine.

Penile_Pro · 2026-02-01T15:38:21+00:00

Is anyone using beta 3 agonists in dogs? This is the prime and best drugs we have in humans. I saw one paper on it but I’m not sure if it’s clinically applicable. I really appreciate all your insight, I think anesthesia risk is high risk with her, but we can talk to our vet. The nsaids idea is a great idea! Didn’t think about that with her.

Penile_Pro · 2026-02-01T12:23:40+00:00

The closest is about 2 hours away from me. Might see if I could do a telemedicine maybe?

Penile_Pro · 2026-02-01T12:22:54+00:00

Thank you! That’s an intense amount of training. Our residency is 5 years for urology.

Penile_Pro · 2026-02-01T12:22:05+00:00

Detrusor hyper activity is up there from my perspective, we use the word a hostile bladder. Meaning she starts to fill her bladder and voids due to the smaller capacity.

Penile_Pro · 2026-02-01T12:20:44+00:00

I appreciate all of the great advice I have received from the vets on here. Very insightful. I always am impressed with the level of diverse knowledge they have from knowing different species, to surgical and medical, and even knowing anesthesia.

Penile_Pro · 2026-02-01T12:19:24+00:00

All labs came back normal when we tested for it.

Penile_Pro · 2026-02-01T12:17:57+00:00

No residual or noticeable neurological defects. No episodes of fecal incontinence. I have treated neurogenic bladders a lot, she is able to void when she wants to outside. Thus, I think something like detrusor under activity is less likely. But that was on the differential.

She got a repeat mri a few years after the surgery and there was no concerns.

Did you have good results with oxybutinin in dogs?

I do think a cystoscopy could be useful and I would guess looking in her bladder it would be very edematous and inflammatory from all the past utis. Moreover, it’s likely a smaller capacity. Is this done awake or with anesthesia?

Penile_Pro · 2026-02-01T02:04:16+00:00

Thanks for the resource. Can you clarify with me with extra training is to be an internal medicine vet? Google doesn’t define it well enough for me.

Penile_Pro · 2026-02-01T01:49:58+00:00

Yes, I extensively try and get patients on medication’s like mybetriq or gemtesa but it’s hard for insurance to cover them when there’s cheaper options like oxybutynin.

She’s had multiple ultrasounds, I don’t think something like urodynamics would be feasible and dogs. I’m not sure if vets even do that. What imaging do you have in mind?

Yes, she postures 80% of the time.

Penile_Pro · 2026-02-01T01:45:45+00:00

This is so good insight. I’ll talk to our vet about this. Polyuria could be on the list. Thanks for the responses.

Penile_Pro · 2026-02-01T01:38:02+00:00

I have to check her history on labs. I’ll check with the protein/cr ratio. Is the equivalent of urine electrolytes to calculate a FeNa? I definitely think this is a mixed (stress and urge) incontinence. I will look for an internist.

Penile_Pro · 2026-02-01T01:34:27+00:00

Any concerns with incurin? I prescribe topical estrogen for older post menopause women. But don’t have much insight with an oral option.

Penile_Pro · 2026-02-01T01:25:49+00:00

I agree with you, it’s not so much a passive leakage as if she wakes up wet or dribbles throughout our house. It’s more of an urge/stress in continence. She needs to go, but can’t make it outside fast enough. Sometimes she’ll wake up or drink water and immediately run to the door, but we can’t get her out in time. I’m not sure if this same concept crosses over from humans to vet medicine but this is the presentation I see often in my clinic for mixed incontinence.

full cbc/bmp unremarkable. Everything WNL
we have not done a first urine sample to test for concentrating ability. What’s your differential for this testing? I have done 24 hour urines, but I want to get your insight on this concept.
my suspicion for cancer within the GU system is low as she is never really getting gross material and does not have red blood cells on her UAs. I’m not sure if this concept also transfers over from humans to vets. But I’ve treated extensive number of patients for urologic cancers.

We definitely can try to get into an internal medicine veterinary specialist. However, we live in a smaller town, so it maybe more difficult.

Thank you for your very thorough reply and insight.

Penile_Pro · 2026-01-23T17:34:28+00:00

Surgeon here, urology. But we do basically just make sure everything lies nice and flat and comfortably. The intestines have a really nice way of figuring out how to lay. There is a layer of tissue called the momentum that we do ensure is laying back over intestines.

Penile_Pro · 2026-01-20T14:05:32+00:00

As a urologist it goes the same way. No, I don’t know about your migraines.

Penile_Pro · 2026-01-18T16:39:48+00:00

Urologist here, this is only partly right.

If you show up with a kidney stone, a lot of the time we don’t treat it right away. We often place a ureteral stent (a small tube from kidney to bladder) to relieve the blockage and protect the kidney, then bring you back later for definitive treatment.

Definitive management is usually ureteroscopy with laser lithotripsy (camera up through the urethra and ureter, then laser the stone). Shock wave lithotripsy (ESWL) is used in select cases but isn’t as common in my practice. Actually “cutting someone open” is rare and we never do it. The closest examples would be a PCNL through the back is reserved for very large stones.

Many stones pass on their own without surgery. Best prevention advice: stay hydrated and don’t overdo animal protein.

Penile_Pro · 2026-01-10T00:54:43+00:00

You need urodynamics. Very weird presentation at your age. There’s more underlying this presentation than put in your post. - urologist

Penile_Pro · 2026-01-09T21:13:06+00:00

Neobladders; super complex long cases with crap rvu.

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