Care with Roscoe Nelson, MD, board-certified urologist.
What I kept, and what I gave up
I do not practice general urology anymore, and treating prostate cancer is not part of my current work. The education on those subjects stays on PeeDoc because it is still useful. Three urologic problems are still an active part of my practice, alongside recurrent UTI, vasectomy and second opinions, which have their own pages.
Kidney stones: the workup almost nobody gets
Treating a stone is the easy half. Preventing the next one is where the value is, and most people who form stones never get a proper evaluation. The full one has three parts: a 24-hour urine collection that shows which chemistry is driving your stones, blood work covering calcium, uric acid, kidney function and the hormones that regulate them, and analysis of the stone itself.
The result is specific to you. Water first, enough that your urine runs pale. Then whatever your collection shows: citrate if yours is low, less salt if sodium is pushing calcium into the urine, oxalate moderation for some. And the counterintuitive part: dietary calcium usually should stay, because it binds oxalate in the gut. A plan built from your numbers beats every generic list, this one included. Fever with a stone means the emergency room tonight, because an infected blocked kidney is a true emergency.
Enlarged prostate: between the pill and the operation
Medication helps many men, but relief is often partial, it fades, and the sexual side effects lead plenty of men to quietly stop. Traditional surgery works and carries a real chance of retrograde ejaculation. For years there was almost nothing in between. The minimally invasive options fill that gap, and they are an active part of what I do.
Those options hold the channel open with small implants, shrink tissue with water vapor, cut off the gland's blood supply so it shrinks, or open the channel with a drug-coated balloon. The right one depends on the size and shape of your prostate, on anatomy that only shows when someone looks, and on what you most want to protect, particularly sexual function. The unhappy men are usually the ones who picked a procedure before anyone measured the prostate. Anatomy first, then the menu.
Complex voiding problems
Urgency, frequency, waking at night, leakage and incomplete emptying get lumped under one word and are often several conditions. Leaking with a cough or a lift is a support problem at the urethra. A sudden urge followed by a leak is a bladder signaling problem. Many women have both, and the two are treated differently. After menopause, thinned tissue from estrogen loss is part of the picture more often than anyone expects, and vaginal estrogen changes what happens next.
Pelvic floor physical therapy with a trained therapist is one of the most effective and least used treatments there is. For stress leakage there are two main routes, a sling and a mesh-free hydrogel injection at the urethra, and starting with the gentler one does not close off the other. Pads manage the problem rather than fix it, and a great many people use them for years without ever being evaluated for something treatable.
Peri opens Late 2026 in Draper, Utah. The waitlist hears first.