BackTable Urology

What happens when urologists look beyond the clinic and take on leadership in the life sciences industry? In this episode of BackTable Urology, host Dr. Raj Pruthi talks with Dr. Kelly Parsons and Dr. Pat Keegan about their journeys from academic urology to executive roles in biotech and pharma. They discuss what motivated their transitions, how physician expertise adds value in industry, and the realities of life outside of traditional clinical practice. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction05:36 - Choosing a Non-Clinical Path11:07 - Reactions from Mentors and Peers14:31 - What Feels Most Fulfilling18:31 - A Typical Week in Biotech26:04 - Working with Investors31:21 - Additional Degrees and MBA Debate35:31 - Is it Risky to Leave Clinical Practice?44:13 - Networking and Next Steps47:59 - Wrap Up --- More about this episode The conversation explores the day-to-day work of industry leaders, the impact of advanced degrees like MBAs, and the importance of networking for physicians considering a nonclinical path. Drs. Parsons and Keegan reflect on the challenges and rewards of leaving clinical medicine, the support and reactions from mentors and peers, and what they miss most about patient care. They also share practical advice for urologists and other specialists who are curious about new career opportunities beyond the exam room. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Robotic technology is expanding what’s possible in reconstructive urology, prompting surgeons to rethink traditional approaches and consider new minimally invasive procedures. In this episode of BackTable Urology, Dr. Ziho Lee joins host Dr. George Koch to explore the rapid evolution of robotic reconstructive surgery and its expanding role in complex pelvic and retroperitoneal procedures.They discuss the the role of single-port platforms, new strategies for managing ureteral strictures and urinary diversion, and how research, training, and patient-reported outcomes are shaping the future of minimally invasive urologic care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction03:10 - Bridging Reconstruction and Robotics07:41 - Where Robots Help Most14:33 - Ureteral Rest16:41 - 20% Nephrectomy Rule19:04 - Single Port Indications20:55 - Ileal Ureter Tips and Tricks22:34 - Robotic Reconstruction Course28:55 - Case: VUAS Repair39:35 - Final Advice --- ResourcesUreteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictureshttps://pubmed.ncbi.nlm.nih.gov/33639184/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

What role does prostate artery embolization (PAE) play in modern prostate cancer care? In this episode of BackTable Urology, Dr. Nainesh Parikh (Interventional Radiology at Moffitt Cancer Center) and Dr. Kosj Yamoah (Radiation Oncology at Moffitt Cancer Center) join Dr. Ruchika Talwar (Vanderbilt University) to discuss how PAE could become a key adjunct in optimizing radiation therapy outcomes. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:44 - Why Use PAE in Cancer04:08 - Neoadjuvant and Salvage Use07:26 - Radiation Planning Benefits12:51 - PAE vs. Surgery18:36 - SBRT Access20:48 - Current Evidence and Trials25:29 - Patient Selection32:18 - PAE After Radiation36:56 - When to Avoid PAE40:29 - Long-Term Implications44:28 - Conclusions --- More about this episode They review how PAE can improve lower urinary tract symptoms and reduce prostate volume, potentially optimizing patients for radiation therapy, including stereotactic body radiotherapy (SBRT) and brachytherapy. The discussion highlights early clinical data and patient selection considerations such as gland size and symptom burden. Finally, they examine post-radiation applications, technical challenges, and current limitations, emphasizing the need for larger, multicenter trials to better define PAE’s role in prostate cancer treatment pathways. --- Resources Prostate Artery Embolization in the Setting of Prostate Cancer: Review and Opinionhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11775958/

What are the key decision points in managing renal, bladder, and urethral trauma? In this episode of BackTable Urology, Dr. Niels Johnson (Vanderbilt University Medical Center) joins host Dr. George Koch (Ohio State University) to discuss the 2025 American College of Surgeons (ACS) best practice guidelines for genitourinary trauma. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction05:09 - Who Manages GU Trauma?13:53 - Purpose of ACS Guidelines16:13 - Development of ACS Guidelines20:01 - Foley Catheter Debate23:26 - Renal Trauma26:40 - Imaging Protocols and Delays29:30 - Bladder Trauma and Special Populations33:15 - Urethral Injuries38:02 - Genital Wounds and Antibiotics39:42 - Transfer Criteria and Resources41:26 - Conclusions --- More about this episode Dr. Johnson and Dr. Koch review the rationale for developing multidisciplinary guidelines and the variability in genitourinary trauma care across institutions. The discussion highlights key management principles, including non-operative strategies for renal trauma, decision-making in bladder and urethral injuries, and how urinary diversion impacts orthopedic and trauma surgical planning. The episode also addresses considerations for special populations, long-term functional outcomes, and practical implementation tools, such as the ACS gap analysis checklist, designed to improve coordination and quality of care across trauma systems. --- Resources ACS Best Practices Guidelines: Management of Genitourinary Injuries (August 2025)https://www.facs.org/media/ya5hcu0s/genitourinary_guidelines.pdf

When a male patient presents with lower urinary tract symptoms, should you blame the bladder or bust the prostate? In this SUFU-sponsored episode of BackTable Urology, Dr. Benjamin Brucker (NYU) and Dr. Craig Comiter (Stanford) join host Dr. Chris Tenggardjaja (Kaiser Permanente) for a discussion on evaluating and treating male LUTS using a bladder-and-outlet framework. --- This podcast was developed in collaboration with: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx --- SYNPOSIS Through a case-based approach, they review initial evaluation strategies including symptom history, validated questionnaires, uroflowmetry, post-void residual measurement, and when tools like voiding diaries can help clarify the diagnosis. The conversation then moves to management, outlining a stepwise approach from behavioral interventions and medications to surgical options when symptoms persist. The doctors discuss how prostate anatomy, side effect profiles, and patient priorities guide treatment selection, when urodynamics may add diagnostic clarity, and why addressing outlet obstruction early may help prevent more difficult-to-treat bladder dysfunction over time. --- TIMESTAMPS 00:00 - Introduction06:31 - Workup for Frequency and Nocturia11:41 - When to Use a Voiding Diary19:18 - Behavioral Therapy26:40 - Post-Finasteride Syndrome30:03 - Surgical Options44:41 - Nocturia Counseling47:32 - Botox With Outlet Surgery49:47 - When to Order Urodynamics54:14 - Bladder or Prostate? --- RESOURCES Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home

What do the 2025 AUA guidelines change about how we evaluate and manage chronic male pelvic pain? In this episode of BackTable Urology, Dr. Susan MacDonald (Penn State) joins host Dr. George Koch (Ohio State University) to break down the new American Urological Association (AUA) guidelines on chronic male pelvic pain, including chronic prostatitis / chronic pelvic pain syndrome and chronic scrotal content pain. --- SYNPOSIS They review a structured approach from initial evaluation and physical examination to pain management. The discussion outlines an evidence-informed, multimodal management framework incorporating medications, pelvic floor physical therapy, behavioral health interventions, neuromodulators, and selective procedural strategies, with an emphasis on realistic expectation setting in this complex patient population. --- TIMESTAMPS 00:00 - Introduction01:41 - Path to Chronic Pelvic Pain Work08:19 - Getting Involved with the AUA13:02 - Developing Guidelines19:56 - Initial Patient Evaluation27:11 - Setting Expectations32:05 - Making the Diagnosis35:17 - Success Rates and Counseling Patients39:51 - Central Sensitization44:31 - Physical Exam Recommendations49:26 - Non-Pharmacologic Options54:38 - Follow Up Cadence01:02:24 - Chronic Scrotal Pain vs CPPS01:08:26 - Conclusion --- RESOURCES Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

Is transecting urethroplasty still the default, or is reconstructive urology moving beyond it? In this episode of BackTable Urology, Dr. Ben Breyer (University of California San Francisco) joins host Dr. George Koch (Ohio State University) to discuss evolving approaches in reconstructive urology with an emphasis on complex stricture cases. --- SYNPOSIS Throughout the conversation, Dr. Breyer reflects on his path into the subspecialty and breaks down the evolution of reconstructive practice, particularly the shift from anastomotic urethroplasty to non-transecting techniques. Dr. Breyer and Dr. Koch also discuss managing complex urethral strictures, including cases involving prior radiation and inflammatory conditions, while emphasizing thoughtful patient selection and surgical planning. Finally, they explore the current training landscape, challenges in patient access to subspecialty reconstructive care, and why patient-reported outcomes will play a central role in shaping future innovation in urethral reconstruction. --- TIMESTAMPS 00:00 - Introduction05:40 - Evolution of Surgical Techniques10:01 - Managing Complex Cases14:19 - Education and Training in Reconstructive Urology23:45 - The Future of Reconstructive Urology28:45 - The Journey of a Reconstructive Urologist30:45 - Challenges in Urology Training and Practice35:35 - Addressing Urologist Shortages in Rural Areas48:34 - Innovations and Research in Reconstructive Urology57:25 - Final Thoughts

Is the era of cisplatin over, or are we simply becoming more precise about who benefits from it? As perioperative strategies in bladder cancer continue to evolve, emerging tools like circulating tumor DNA (ctDNA) are playing a bigger role in how clinicians assess recurrence risk and tailor treatment. In this episode of BackTable Tumor Board, host Alan Tan, medical oncologist at Vanderbilt-Ingram Cancer Center, is joined by bladder cancer experts Dr. Amanda Nizam and Dr. Brad McGregor to discuss recent advances in the diagnosis and treatment of urothelial carcinoma. --- SYNPOSIS The doctors examine the evolving management of muscle-invasive bladder cancer (MIBC), including the role of neoadjuvant and adjuvant therapies, the integration of immunotherapy, and the recent approval of enfortumab vedotin plus pembrolizumab. The discussion explores the rapidly changing perioperative landscape, the prognostic utility of ctDNA, and how biomarkers such as HER2 and FGFR are influencing treatment selection across disease states. They also address bladder preservation strategies, management of treatment-related toxicities, and the importance of multidisciplinary coordination. The episode concludes with a forward-looking discussion on emerging therapies and the potential to improve cure rates in bladder cancer. --- TIMESTAMPS 00:00 - Introduction01:44 - Overview of Bladder Cancer Treatment04:54 - Patient Staging and Treatment Goals10:12 - Bladder Preservation vs. Radical Cystectomy16:39 - Emerging Trials and Future Directions22:40 - ctDNA and Precision Medicine33:50 - Metastatic Disease and Biomarker Strategies42:16 - Managing Neuropathy in Metastatic Treatment48:44 - HER2 and FGFR in Bladder Cancer54:15 - Future Directions in Bladder Cancer Treatment --- RESOURCES EV-302/303 Trialhttps://newsroom.astellas.com/2023-12-15-PADCEV-R-enfortumab-vedotin-ejfv-with-KEYTRUDA-R-pembrolizumab-Approved-by-FDA-as-the-First-and-Only-ADC-Plus-PD-1-to-Treat-Advanced-Bladder-Cancer NIAGARA Regimenhttps://www.nejm.org/doi/full/10.1056/NEJMoa2408154 KEYNOTE-905 Studyhttps://www.annalsofoncology.org/article/S0923-7534(25)04894-X/fulltext