BackTable Urology

Are biomarkers the missing link in personalized prostate cancer care? What is the practical role of biomarkers across the prostate cancer treatment continuum? In this episode of BackTable Urology, Dr. Udit Singhal (University of Michigan) joins Dr. Ruchika Talwar (Vanderbilt University) to explore the evolving role of genomic classifiers and biomarkers in prostate cancer care. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVeracytehttps://www.veracyte.com/decipher-prostate --- Timestamps 00:00 - Introduction04:58 - Current State10:07 - Interpreting High Risk Scores13:25 - Intermediate Risk Decisions16:18 - Imaging vs. Genomics18:26 - Advanced Disease Evidence22:02 - AI and Clinical Trials29:52 - Conclusions --- More about this episode They review commonly used assays, including Prolaris, Oncotype Dx, Decipher, and ConfirmMDx and emphasize how these tools complement traditional clinical and pathologic risk factors. The discussion highlights practical applications across the disease continuum from initial diagnosis and active surveillance to intermediate-risk management and post-prostatectomy salvage decisions. They also explore emerging AI-driven tools and ongoing trials, highlighting the importance of contextualizing biomarker data within the broader clinical picture and using it to inform, rather than dictate, patient-centered care. --- 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

When does urodynamics actually change management and when is it unnecessary? In BackTable Urology’s latest collaboration with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), Dr. Howard Goldman and Dr. David Ginsberg join Dr. Giulia Ippolito to discuss the evidence-based use of urodynamics across a range of clinical scenarios. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction 05:04 - Case: Male Urinary Retention12:38 - Case: Failed Sling18:44 - Case: Parkinson’s OAB21:50 - Case: Post-Prostatectomy26:48 - Prolapse Without Urodynamics32:29 - Obstruction Workup36:16 - Refractory OAB42:49 - Interstitial Cystitis45:18 - Recurrent UTI Evaluation50:16 - Conclusions --- More about this episode They review guideline-driven indications and limitations of urodynamic testing, emphasizing that many common conditions do not routinely require testing. Through case-based discussion, they highlight situations where urodynamics can meaningfully inform care, such as complex neurogenic patients and cases requiring differentiation between obstruction and detrusor underactivity. The conversation highlights the importance of clinical judgment, targeted use of adjuncts such as uroflow, and aligning testing with decision-making to optimize patient outcomes.This podcast is supported by the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU). --- Resources Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study)https://pubmed.ncbi.nlm.nih.gov/34702331/ --- 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

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health. --- This podcast was developed in collaboration with: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) https://sufuorg.com/home.aspx --- SYNPOSIS The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function. --- TIMESTAMPS 00:00 - Introduction02:07 - Defining Vaginal Rejuvenation04:31 - Common Procedures and Misconceptions10:00 - Insurance and Coverage of Procedures12:00 - Laser and Radiofrequency Therapies18:06 - Vaginal Estrogen and Lift of Black Box Warning19:55 - The Role of Systemic Hormone Therapy26:52 - Vaginal Rejuvenation Misconceptions32:17 - Pelvic Floor Physical Therapy and Timing of Procedures34:20 - Regional Variations in Therapeutic Availability38:36 - Gender Inequity in Healthcare40:12 - Final Thoughts --- RESOURCES Joint Report on Terminology for Cosmetic Gynecologyhttps://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

What determines success in the early years of urology practice? In this BackTable Urology episode, produced in collaboration with the Society of Women in Urology (SWIU), this episode of the BackTable Urology Podcast brings on Dr. Raveen Syan, Dr. Helen Hougen, and host Dr. Michelle Van Kuiken to discuss the transition to early career practice in urology. --- SYNPOSIS Together, the doctors explore the realities that new attendings face, from building efficient clinical systems to managing complications and building support networks. Drawing from personal experience, the guests offer practical guidance on mentorship, recognizing when a role or environment may no longer be the right fit, and building a sustainable, fulfilling professional life. --- TIMESTAMPS 00:00 - Introduction02:54 - Early Challenges06:13 - Finding Support and Building Systems11:49 - Balancing Work and Personal Life15:52 - The Importance of Saying Yes Early On18:16 - Mentorship and Finding Allies22:29 - Decision Making and Cognitive Biases24:36 - Managing Complications27:31 - Prioritizing Clinical Goals38:45 - Knowing When to Leave42:09 - Final Reflections --- RESOURCES Annie Dukehttps://www.annieduke.com/ Aristotle’s 10 Rules for a Good Lifehttps://www.theatlantic.com/ideas/archive/2023/08/aristotle-10-rules-happy-life/674905/ Personal Productivity: How to work effectively and calmly in the midst of chaoshttps://www.cvdtraining.pitt.edu/wp-content/uploads/2023/01/Johnson2009_Essays.pdf Understanding Academic Medical Centers: Simone’s Maximshttps://aacrjournals.org/clincancerres/article/5/9/2281/287826/Understanding-Academic-Medical-Centers-Simone-s

How are local and international teams working together to offer reconstructive urology in resource-constrained settings? This week on BackTable Urology, Dr. Jane Kurtzman (University of Utah) joins Dr. George Koch (Ohio State University) to discuss the realities, challenges, and opportunities of international surgical work. --- SYNPOSIS They break down how global urology programs differ in structure, why cultural understanding is foundational, and what sustainable models look like in practice. The conversation highlights unmet reconstructive needs in low- and middle-income countries, evolving models for subspecialty development, and the growing role of long-term partnerships in shaping the future of global urology. --- TIMESTAMPS 0:00 - Introduction4:46 - Understanding Healthcare Systems Abroad8:12 - Need for Global Urology13:39 - Role of Reconstructive Urology Abroad21:57 - Current Programs27:20 - GU Impacts39:35 - Building Capacity through Training49:00 - Past Successes58:38 - Future Directions1:14:12 - Getting Involved --- RESOURCES GU Impactshttps://medicine.utah.edu/surgery/urology/gu-impacts IVUMedhttps://www.ivumed.org/ Urology Care Foundationhttps://www.urologyhealth.org/humanitarianism

If you’re navigating pregnancy, postpartum, or return-to-work stress, you are not alone. In this BackTable Urology × SWIU collaboration, Dr. Danielle Velez (Rutgers Health) joins host Dr. Helen Bernie (Indiana University Health) for a candid conversation on navigating parental leave, lactation, and the emotional turbulence of stepping back into clinical practice. Together, they unpack boundary-setting, finding a support system, protecting partnership time, and giving yourself grace through each stage of early parenthood. --- SYNPOSIS The discussion highlights the power of mentorship, community, and transparency, especially for physicians balancing patient care and family life. From combo-feeding and night nannies to sleep deprivation, identity shifts, and the six-month reevaluation rule, both guests share wisdom they hope future trainees and new parents won't have to learn alone. This episode is a reminder that things get easier with time, that asking for help is strength, not weakness, and that paying it forward makes the path smoother for the next generation. --- TIMESTAMPS 00:00 - Introduction03:07 - Support Systems, Mentorship and Maternity Leave09:03 - Navigating Lactation and Pumping19:21 - Lactation Resources25:58 - Finding Your Village and Outsourcing Tasks34:31 - Balancing Parenthood and Career42:26 - Sleep Deprivation and Protecting Your Schedule55:14 - Maintaining Spousal Relationships59:20 - Rebuilding Your Practice Post-Maternity Leave01:03:56 - Final Thoughts and Advice for New Parents --- RESOURCES Dr. MILK (Mothers Interested in Lactation Knowledge) Support Grouphttps://www.drmilk.org/

One of the most common dilemmas in urologic oncology: what do you do when a patient has T1 disease in both the bladder and the ureter? In the final episode of the 2025 NMIBC Creator Weekend™ series, Dr. Vignesh Packiam, Dr. Mark Tyson and Dr. Sarah Psutka share how they approach complex bladder cancer cases with upper tract involvement. --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The doctors discuss complex bladder cancer cases, sequencing treatments for patients with dual ureteral and bladder T1 disease, the impact of cystectomy on quality of life, and the use of blue light cystoscopy and intravesical therapy. They also delve into the rise of bladder cancer in younger patients, considerations for low-grade intermediate-risk disease, and emerging therapeutic options. --- TIMESTAMPS 00:00 - Introduction05:52 - Upper Tract Positive Cytology Dilemma09:10 - Cystectomy Considerations15:55 - Developing Better Patient-Reported Outcomes20:26 - Challenges with New Therapeutics26:31 - Deescalating Treatment for Low-Grade Cancer33:29 - Closing Remarks --- RESOURCES CISTO Trialhttps://pubmed.ncbi.nlm.nih.gov/37980511/