Jonathan Pavlinec, MD

@SPuro88 @AshleyGWinter Esp when it’s 25 miles from the hospital I’m rounding at….

@AshleyGWinter Incidental small renal mass inpatient consult? Yea, send the robot.

My first job after fellowship I was on call for 3 hospitals which covered 2 states and I would work the entire weekend. Some consults needed hands on interaction. Others I was going to place a ureteral stent and needed to just discuss the procedure. This would have been helpful, imo.

@SPuro88 I think probably creates a black hole that no stone or urologist can escape from haha One of our local docs did it recently. I use both, but haven’t used them together

Waiting for the paper for someone putting a Calyxo into a FANS. Who’s going to be the first to do it and see what happens?

@DrIngold @SPuro88 😂😂

@jpavs17 @SPuro88 My man no doubt gets a cut off every script, which would likely come to a whopping $0.04 for a 90-day supply 😂

Same. Recommended by my great PCP @DrIngold who I literally found on Twitter.

The Pitt is not complete until they have a difficult foley and the urologist they call grills them on which catheters they tried, who tried and say they’re not coming in until the doctor themselves try. And then they come in and place it in 3 seconds.

MRI before prostatectomy isn’t just staging… it’s prognostic. New meta-analysis in JAMA Oncology shows MRI predicts outcomes independently. 🧵 📌 Study: Pretreatment MRI as prognostic factor after radical prostatectomy 📊 40 studies | 24,941 patients 👨‍⚕️ Population Men undergoing radical prostatectomy with pre-treatment MRI ⚔️ Key MRI features → Strong outcome predictors 🔴 Extraprostatic extension (mrT3a) •BCR: HR 2.16 •Metastasis: HR 3.18 •Cancer-specific mortality: HR 10.9 (!!) 🔴 Seminal vesicle invasion (mrT3b) •BCR: HR 2.74 •Metastasis: HR 5.58 📊 Quantitative MRI also matters •PI-RADS 4–5 → HR ~2.1 •Tumor ≥20 mm → HR ~2.35 •Low ADC → HR ~2.4 💡 Key insight MRI adds independent prognostic value beyond PSA, Gleason, and pathology 👉 Not just imaging 👉 A biologic risk signal before surgery ⚠️ Practice-changing angle MRI T-staging may be stronger than DRE-based clinical staging → Enables better pre-op risk stratification → Potential for treatment intensification / de-escalation 🎯 Takeaway If you’re still using MRI only for staging… You’re underusing it MRI = prognosis + decision-making tool 🔖 Save this for clinic discussions 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #ProstateCancer #UroOncology @OncoAlert @myesmo @esmo_open @asco

If a patient with low testosterone on testosterone replacement has an elevated PSA and you begin your workup, say, with an MRI, why tell the patient to stop the T replacement? Think about this: If a patient with normal testosterone has an elevated PSA, we don't castrate them while we proceed with a workup. Let people have a quality of life.

This is something we can each do: ask our pathologist colleagues to include cribriform to their structured templates for #ProstateCancer histopathology reports

Cisplatin ruled muscle-invasive bladder cancer for decades... EVP just ended that era regardless of cispaltin eligibility. EV + pembrolizumab vs gem/cis in MIBC: Event-free survival HR: 0.40, overall survival was HR: 0.50 This isn't just improvement. It's replacement... @NEJM @ASCO @BladderCancerUS @OncoAlert

I thoroughly enjoyed this morning thread! Pointing out so many great practical points! Thank you @TylerSbrt7

7️⃣ 🚨This is BIG 👇🏼 ‼️No cribriform = No metastasis. Zero.‼️ @APCCC_Lugano @Uroweb @OncoAlert @PCF_Science @urotoday @montypal @DrRanaMcKay @JoshLangMD @ProfHadaschik

@SPuro88 @CjWarren_MayoAZ 💯

@CjWarren_MayoAZ If 87 minutes was the average Aqua time for these surgeons, I will wholeheartedly tell you these are inexperienced, low volume Aqua surgeons.

Interesting that holep operative time was faster, would not expect that.

#SESAUA26 State of the Art Lecture @sanojpunnen PCa Screening Guidelines: ♦️Start: 45-50 yrs ♦️Screen q2-4 yrs if PSA < 1 ♦️Screen q1-2 yrs if PSA >1 ♦️Intervene: PSA 3-4 ♦️Stop: 70-75 yrs or life expectancy < 10 yrs @urotoday

@CanesDavid @DrSpratticus @dr_coops @Uroweb @BogdanaSchmidt @ChapinMD @wandering_gu @qdtrinh @jeshoag @SFreedlandMD @EUplatinum @UrologyUS Have done some SP, but mainly MP. I usually use MP w/ an aggressive hood/PATENTS-type approach starting posterior. Since I moved to preserving as much surrounding tissue as possible w/various techniques described, it’s amazing how well they do with functional outcomes.

I can tell you my take based on my experience as a multi-port surgeon, which apparently differs from all the other comments here. I also helped to work on some of the earliest laparoscopic single-port surgeries in the early 2000s. Better outcomes in prostate removal come from experience and preservation of as much surrounding anatomy as possible. From my point of view, that comes from making good DECISIONS with your surgical plane choices, and anatomical preservation. I can't for the life of me logically understand why it would be in any way based on single port versus multi-port. A single port surgeon can make poor decisions, as can a multi-port surgeon, and vice versa.

Urology community Help teach us non-surgeons the benefit of single port and continence outcomes. Is this something that improves outcomes? @dr_coops @Uroweb @BogdanaSchmidt @ChapinMD @wandering_gu @qdtrinh @jeshoag @SFreedlandMD @EUplatinum @UrologyUS

💧 Kidney stone prevention… reality check 👇 👏Large RCT (n=1,658) testing hydration adherence strategies in @TheLancet ✔️Smart bottles + incentives + coaching = ↑ urine volume 📉But increase was modest and not sustained over time ❌ No reduction in stone recurrence (HR ~0.96) 🚨 What this really shows: 1⃣Adherence is HARD 2⃣Even well-designed behavioral interventions struggle long-term 3⃣Changing behavior ≠ changing outcomes 🤔 Takeaway: Hydration still matters… But “just drink more water” isn’t a scalable solution for most patients @AmerUrological 🔗shorturl.at/tnTda

Management of post-micturition dribble in men. @AhmedAlbakr @CleClinicUro joins Alan Wein, MD, PhD(hon), FACS @dsui_miami_uro to discuss this systematic review, summarizing 4 trials showing that tadalafil and udenafil significantly improve Hallym PMD scores and leakage volumes, while pelvic floor exercises provide durable benefit and urethral milking offers quicker, less sustained relief—highlighting that PMD is measurable and treatable with both behavioral and pharmacologic strategies. #WatchNow on UroToday > bit.ly/40iAzy9 @icsoffice

That's not what the trial shows. The difference in volume between the control and intervention was around 1/10 of a liter... The intervention group was 40% below the guidelines... What this study showed was not that hydration doesn't work, but that compliance is challenging.

Travelers are ruining medicine. #IYKYK

@_ShankarSiva @GiulioFrancoli1 @sophia_kamran If anything, I want to see this excellent data bc I’d much rather refer for RT instead of doing high risk nephrectomy for many of these patients in this cohort. Nephrectomy has substantial risk for many of these patients. It is fantastic to see a better path forward for many here

@jpavs17 @GiulioFrancoli1 @sophia_kamran These were rigorously conductive prospective clinical trials; complications by definition were not underreported during the 5 year median F/U, which can be different in retrospective research.

🚀 Largest prospective SABR cohort in inoperable RCC. Pooled FASTRACK trials show 98% local control at 5 years, excellent CSS, low ≥G3 toxicity and no late safety signals. A durable, non‑invasive, kidney‑sparing option—now poised for randomized comparison vs surgery. #EAU26

@_ShankarSiva @GiulioFrancoli1 @sophia_kamran I’m sure they were. I’m not saying anything about the trials. If anything, it’s commendable to show such great work. All I’m saying is a post SABR colo-renal fistula case from the mass into the colon months later was the closest I’ve ever been to on-table intraop mortality