Have you checked out the AUA/ASTRO/SUO’s recently released guidelines for salvage therapy in prostate cancer biochemical recurrence? In this episode of the BackTable Urology Podcast, guest Dr. Todd Morgan from the University of Michigan and host Dr. Aditya Bagrodia continue with part two of our series on prostate cancer biochemical recurrence management. --- This podcast is supported by: Veracyte https://www.veracyte.com/decipher --- SYNPOSIS The doctors focus on the difficulty in declaring a patient 'cured' and the implications of biochemical recurrence after treatment. Dr. Morgan highlights the importance of PSA in the postoperative setting and explores the role of the Decipher Prostate Genomic Classifier in personalizing treatment. He talks through the latest AUA/ASTRO/SUO consensus on biochemical recurrence guidelines, including the significance of early salvage therapy and the integration of advanced imaging techniques like PSMA PET scans. Further, Dr. Morgan emphasizes the role for multidisciplinary evaluation, patient counseling, and future directions of research to refine treatment options. This discussion underscores the transition from adjuvant to early salvage radiation as a standard practice and considers emerging biomarker strategies to inform treatment decisions. --- TIMESTAMPS 00:00 - Introduction 03:41 - Consensus Biochemical Recurrence Guidelines 08:56 - Evolution of Post-Prostatectomy Biochemical Recurrence Management 13:24 - Patient Counseling and Risk of Recurrence 17:42 - PSMA PET Scans 20:44 - Postoperative PSA Monitoring 28:35 - The Role of Radiation 31:56 - Hormone Therapy 39:00 - Salvage Lymphadenectomy 46:30 - Future Directions and Concluding Thoughts --- RESOURCES Veracyte https://www.veracyte.com/ Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline (2024) https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer

While benign prostatic hyperplasia (BPH) care has historically focused on immediate symptom management, often by way of long-term polypharmacy, leading urologists are now considering long-term bladder health when determining the most appropriate BPH treatment. In this episode of the BackTable Urology Podcast, Dr. Shawn West, a urologist practicing at McIver Clinic in Florida, discusses the contemporary management of BPH with host Dr. Jose Silva, emphasizing the newly appreciated role of first-line interventional therapy. --- This podcast is supported by: Teleflex UroLift https://www.urolift.com/ --- SYNPOSIS First, Dr. West delves into the initial patient consultation, diagnostic procedures, and the diverse treatment options for BPH including UroLift, GreenLight laser therapy, and Aquablation. Dr. West emphasizes the importance of individualized patient care, the role of objective symptom scoring systems, and the significance of setting realistic expectations for patients. The discussion also covers the benefits and challenges of different BPH treatments amidst the evolving landscape of minimally invasive urological procedures. --- TIMESTAMPS 00:00 - Introduction 03:59 - BPH and Voiding Dysfunction 10:21 - Patient-Centered Approach to BPH 19:46 - Diagnostic Workup for BPH 24:53 - Postoperative Catheter and Complications 25:02 - Aquablation 26:04 - UroLift 31:06 - Challenges with Median Lobes 41:02 - Postoperative Care 47:14 - Conclusion

Are you curious about the biotechnology startup world? Learn how our guest transitioned from trauma surgeon to entrepreneur in this episode of the BackTable Podcast. Dr. Chris Kinsella, CEO of Watershed Therapeutics and our host Dr. Bryan Hartley discuss the importance of using entrepreneurship to solve clinical needs. Watershed Therapeutics has created a novel bladder drug delivery platform to help women with recurrent urinary tract infections. --- SYNPOSIS The doctors systematically cover the process of identifying market needs, inventing solutions, bringing a product to the market, and managing risk. They also share examples of successful startup ventures and underscore the importance of perseverance, innovative thinking, and strategic market focus in forging a path to success. --- TIMESTAMPS 00:00 - Introduction 04:30 - The Birth of a Surgical Trainer 07:04 - Challenges and Innovations in Trauma Surgery 22:06 - Evaluating and Killing Ideas 28:27 - Challenging Assumptions 29:53 - Meeting a Co-Founder 33:07 - Developing the Solution 37:29 - Raising Funds 40:28 - Navigating Regulatory Challenges and Market Expansion --- RESOURCES Watershed Therapeutics: https://www.watershedtx.com/ Stanford Biodesign Innovation Fellowship: https://biodesign.stanford.edu/programs/fellowships/innovation-fellowships.html

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with PGY4 urologist Dr. Chloe Peters (University of Washington) and OB/GYN Dr. Beverly Gray (Duke University) about their work in women's health and advocacy, and how the Dobbs ruling has impacted their respective medical fields. --- SHOW NOTES First, the doctors explore the implications of state abortion laws on the OB/GYN and urology workforces and how they may directly impact where people choose to live and work. Dr. Peters and Dr. Gray explain the complexities of state abortion policies, as well as the differences between restrictive and nonrestrictive states. The Dobbs ruling in June 2022 gave individual states the power to regulate any aspect of abortion not protected by federal law, thus overturning Roe v. Wade. Both doctors emphasize that this ruling affects all urologists and OB/GYNs in private and academic settings, because they provide unsafe environments for patients who need them. Recent studies and surveys show how restrictive abortion laws are impacting the urology rank lists and applications. One in five applicants to the urology match took programs off their list because they are located in states with illegal abortion laws, and almost 60% said they would worry about their health and safety if they matched in a state with restrictive laws. In summary, all three doctors agreed that restrictive laws can have a direct impact on residency and urology recruitment efforts. Finally, they observe that the increasing diversity in the field of urology has encouraged younger, female members to advocate for better access to healthcare. They remain optimistic that the current generation can use their voices to create change and provide better access to care for all. --- RESOURCES American Urologic Association (AUA) Position Statement on the Supreme Court’s Decision to Overturn Roe v. Wade https://www.auanet.org/about-us/aua-statement-on-overturning-roe-v-wade American College of Obstetricians and Gynecologist (ACOG) Abortion Policy https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/abortion-policy Ryan Residency Training Program https://ryanprogram.org/

In this episode of BackTable Urology, urologists Dr. Jay Shah (Stanford University) and Dr. Brantley Thrasher (University of Kansas) discuss the importance of self-improvement and listening in leadership, a skill that has to be learned and honed over time. --- SHOW NOTES Dr. Brantley Thrasher reflects on a piece of advice he received several years ago when considering a leadership role he wasn't ready for. He emphasizes the importance of mentors, the power of honest conversation, and listening to show your team that they can trust you and be willing to follow your lead. He notes that when looking for a leadership role, it's important to know your skillset and to be honest with yourself and those around you. It is also important to recognize when someone is not the right fit for a particular leadership role and to be willing to be open and honest with them about it. He shares his experience of having to tell a friend that they don't have the skill set for the job, and how he has seen people treating their team in a disrespectful way. Finally, he also discusses his past experience as the chair of Urology at Kansas and president of the AUA and Society of Urological Oncology, as well as his current role as the chair of the Society of Academic Urology and the executive director of the American Board of Urology. Finally, he offers advice to those looking for a leadership role on how to assess if they have the skills for the job. He recommends books such as The Servant, Grit, The Road to Character, and The War of Art. --- RESOURCES The Servant: A Simple Story About the True Essence of Leadership by James C. Hunter https://www.amazon.com/Servant-Simple-Story-Essence-Leadership/dp/0761513698 Grit: The Power of Passion and Perseverance by Angela Duckworth https://www.amazon.com/Grit-Passion-Perseverance-Angela-Duckworth/dp/1501111108 The Road to Character by David Brooks https://www.amazon.com/Road-Character-David-Brooks/dp/0812983416 The War of Art by Steven Pressfield https://www.amazon.com/War-Art-Winning-Creative-Battle-audio-cd/dp/1501260626

In this episode of BackTable Urology, urologist Dr. Manoj Monga (UC San Diego) and clinical nutritionist Dr. Kristina Penniston (UW Madison) discuss the role of diet in kidney stone prevention and how urologists can partner with dietitians to create integrated stone clinics. --- SHOW NOTES First, the doctors explore how to adjust fluid intake based on the patient's body size and consistency of bowel movements. They also cover ways to be creative with fluids, including incorporating low sugar, low calorie, and low alcohol beverages into the diet, as well as scheduling and flavoring options. They review the importance of mineral content in hard and soft water, and the potential benefits of alkaline water. Finally, they discuss the recommended sodium intake per day. Next, Dr. Penniston explains that oxalate, a common component of kidney stones, is found in many plant foods, such as spinach, potatoes, sweet potatoes, beans, rhubarb, beets, nuts, and grains. She discusses how oxalate bioavailability can be reduced by the simultaneous consumption of foods and beverages containing calcium. Finally, she outlines the many non-dairy alternatives for calcium that are available. Lastly, the doctors discuss how certain diets can increase and decrease the acidity of the urine. They debate the effects of intermittent fasting on stone risk, as well as the healthiest diet to lose weight without increasing stone risk. They end by emphasizing the importance of lifestyle changes and how a balanced and varied diet is key to successful weight loss.

In this episode of BackTable Urology, Dr. Aditya Bagrodia invites Dr. Yair Lotan, professor of urologic oncology at UT Southwestern, and oncologist Dr. Suzanne Cole to discuss types of adjuvant treatment for high risk bladder cancer, including chemotherapy, radiation therapy, and immunotherapy. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES First, they discuss the benefits of neoadjuvant chemotherapy for bladder cancer, which includes a 5-10% absolute advantage and a 20% reduction in likelihood of dying. They also discuss potential barriers to neoadjuvant chemotherapy and the importance of having a discussion with a medical oncologist to determine eligibility for cisplatin-based treatment, such as MVAC chemotherapy. Next, they explore the differences between adjuvant and salvage therapy, as well as how to approach post-operative complications and counseling; it is important to discuss the risk of disease recurrence and initiate conversations about future chemotherapy early in treatment. Then, the doctors explore when to consider immunotherapy instead of cisplatin-based chemotherapy, the success rates of chemotherapy treatments, and the potential of cell-free DNA testing to predict outcomes. They consider the implications of false negatives and false positives and agree that clinical trials are important to gain a better understanding of the technology and how it could be used in personalized medicine. They also discuss when radiation therapy is appropriate for recurrence in the retroperitoneum and the use of metallic clips to create a target zone for radiation oncologists. Finally, they consider the difficulty of convincing patients to accept additional therapy and the lack of level 1 evidence for adjuvant therapy. However, they remain optimistic about the progress being made with upper tract studies, innovative new treatments, and the potential of biomarkers to predict response.

In this episode of BackTable Urology, Dr. Silva invites Dr. Ronald Cadillo to speak about the realities of reconstructive surgery and bladder neck reconstruction and explore the challenges of transitioning from performing oncologic surgeries to reconstructive surgeries. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/plWnX7 --- SHOW NOTES First, Dr. Cadillo shares his journey from being a urologist in Peru to coming to the United States in search of a better opportunity to help his family. Then, he discusses his experience of transitioning from open to robotic surgery. He discusses his experience with interviewing at programs and how he felt in the moment of being accepted into the robotic program at the University of Pennsylvania. Next, he describes the experience of completing a robotic boot camp. Dr. Cadillo faced challenges when returning to Puerto Rico, where there was a greater need for oncology and reconstructive surgeries. He learned that having a healthy obsession when learning new techniques is important, as well as having adequate resources, such as videos and mentors. In his opinion, practice and experience are the most important components of successful reconstructive surgeries. He then shares how he used mentorship and collaboration to deal with complex cases. Finally, he explains how the field of reconstructive urology in Puerto Rico has changed in the past four years with the arrival of a new generation of young urologists.

This week on the BackTable Urology Podcast, Dr. Jose Silva invites Dr. Seth Bechis onto the show to discuss the diagnosis and treatment of BPH with Rezum, a minimally invasive surgical that uses water vapor to dissolve prostate tissue. --- CHECK OUT OUR SPONSOR Boston Scientific Rezum Water Vapor Therapy https://www.bostonscientific.com/rezum --- SHOW NOTES First, the doctors emphasize the importance of establishing a relationship between primary physicians and urologists to improve the referral times of patients with BPH. They also discuss how involving patients in the cystoscopy process can help them with the decision-making process and maintaining better bladder health in the long run. Then, Dr. Bechis summarizes current BPH treatments, and how to effectively manage post-treatment patient expectations. He emphasizes the importance of over preparing patients for the potential side effects of BPH treatments, and strategies for adjusting their expectations. They also discuss the ideal candidates and prostate sizes for Rezum therapy. Additionally, Dr. Bechis discusses the technical aspects of the procedure, including his anesthesia regimen, needle placement, antibiotic prophylaxis, and postoperative care. Finally, they explain the importance of following up on a PSA test annually after a prostate procedure and how to manage anxious patients who may be checking their PSA too frequently. As urologists, they have to counsel patients upfront about all of their options, so having flexibility to take different paths is helpful if their priorities change. Lastly, they touch on the idea of performing prophylactic procedures as a preventative measure.

On this episode of BackTable Urology, Dr. Jose Silva and Dr. Jay Simhan, director of reconstructive urology at Fox Chase Cancer Center, discuss how urologists can demonstrate their value to hospital systems. --- SHOW NOTES First, Dr. Simhan explains the changing nature of urology practice. He opts for the term “health systems urologist” over “private practice urologist” because many urologists are managed by smaller medical groups that are owned by larger hospital groups. He notes that this multi-tiered system of management can cause tension around decision making and increase senior leadership turnover when hospital finances change. Then, Dr. Simhan explains the four ways that doctors can generate value, which is clinical productivity, departmental service, academics or research, and teaching. Clinical productivity is often measured by the RVU system, which assigns a certain number of value units to a procedure. Hospital systems may encourage urologists to choose surgical procedures over office-based procedures to increase RVUs. Although RVUs are arbitrarily set by the Centers for Medicare & Medicaid Services (CMS), each hospital or medical group can increase the number of RVUs per procedure to their own discretion. Dr. Simhan believes that urologists should band together to negotiate fair RVU systems. Finally, they end the episode by discussing concrete ways to demonstrate value as a urologist. Generally, minimizing complications and maximizing RVUs is helpful. Dr. Simhan advises urologists who are joining a new system to build their name and referral network to earn a long term contract. Usually, there is no RVU requirement in the first employment contract. In the later years, he recommends putting in the effort to understand productivity metrics and downstream costs and revenues in order to maximize earnings and potential.

On this episode of BackTable Urology, Dr. Jay Shah (Stanford University) and Dr. James McKiernan (Chair of Urology, Columbia University / New York Presbyterian Hospital) discuss practical tips to develop and maintain successful mentor-mentee relationships in medicine. --- SHOW NOTES First, Dr. McKiernan explains how he started his mentorship journey, which started when he began to build a research team. He explains that the residents and medical students received advice from him while working on his team. He notes that forced mentor-mentee relationships never work because both sides need to have shared priorities and values. His decision to take on a mentee depends on whether the trainee in question could potentially benefit him and the field of urology as a whole. For a mentee to fulfill these criteria, they must show interest in projects, have willingness to put time into the relationship, and complete all tasks to the best of their ability. Next, Dr. McKiernan discusses how organizations can develop successful mentorship programs. He suggests building in structured, recurring meetings for both sides to prioritize the relationships. He also notes that hiring faculty members who want to mentor and who prioritize using their protected time for education can greatly increase the ease of establishing a mentorship program. He also discusses the importance of racial and gender diversity in leadership positions, but does not think that they should be barriers to mentorship. Finally, he emphasizes that mentorship meetings are not performance evaluations, as discussions should focus on the future goals and priorities of the mentee.

On this episode of BackTable Urology, Dr. Jose Silva invites endocrinologist Dr. Rodrigo Valderrabano onto the show to discuss the impact of testosterone replacement therapy on hypogonadic patients and prostate cancer survivors. --- SHOW NOTES First, Dr. Valderrabano explains the role of testosterone in the body, which is to create the male phenotype and to maintain sexual function and muscular strength. There is a strong relationship between bone building and testosterone, as testosterone is converted to estrogen to maintain bone density. He then explains what constitutes low testosterone, which is difficult to define due to testing imprecision, fluctuating hormone levels throughout the day, and other comorbidities, like obesity. To be diagnosed with hypogonadism, patients will need at least 2 lab tests and display clinical symptoms as well. For all patients who are interested in starting testosterone replacement therapy (TRT), Dr. Valderrabano measures total and free testosterone, sex hormone binding globulin, and LH and FSH to determine if the patient has primary hypogonadism or secondary hypogonadism. Next, the doctors discuss different methods of testosterone delivery, such as injections, gels, patches, pellets, pills, and intranasal sprays. Dr. Valderrabano prefers to use gel, as it mimics the natural daily release of the hormone and results in less pituitary interference. However, he notes that the patient must be careful not to transfer the gel onto household contacts. Dr. Silva prefers to give testosterone injections. Then, the doctors discuss how recent literature disproves the claim that testosterone replacement therapy causes BPH/LUTS symptoms. Finally, Dr. Valderrabano speaks about his research trial focused on giving TRT to prostate cancer survivors who have hypogonadism. His patient cohort includes prostate cancer patients who have a low risk of disease recurrence are at least 2 years into remission, have normal PSA levels, and are on no other hormone therapy treatments. His main outcomes are physical and sexual health. He also explains his data collection methods and collaboration with other institutions. Lastly, he emphasizes that physicians must collaborate with their patients to balance the risk of disease recurrence and their quality of life to determine if TRT is a good option for them.

Are you a 2025 Urology Match applicant or a residency program faculty member? In this week’s episode of the BackTable Urology podcast, guests Dr. Mihir Shah, Dr. Gina Badalato, and Dr. Lindsay Hampson provide guidance on navigating urology residency interviews. Their discussion offers insights from a residency leadership, department faculty, and medical student’s point of view with host Yash Shah. --- SYNPOSIS The episode covers tips for both virtual and in-person interviews, strategies for conversational engagement, and advice for how applicants should evaluate programs. They further detail aligning personal values with program culture, describing past challenges, and lowering interview anxiety through effective practice. The conversation offers applicants invaluable preparation tips to approach the interview process with confidence and a positive attitude. --- TIMESTAMPS 00:00 - Introduction 02:32 - Virtual vs. In-Person Interviews 07:02 - Preparing for Residency Interviews: Tips and Strategies 17:29 - The Role of Research 20:43 - Pivoting to Leadership and Advocacy 22:01 - Behavioral Questions: Tips and Examples 26:22 - Discussing Difficult Subjects 28:26 - Choosing the Right Residency Program 33:10 - Post-Interview Communication 36:24 - Final Advice

On this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Matt Allaway (Perineologic Biopsy), and Dr. Juan Javier-DesLoges (UC San Diego) discuss benefits and procedural tips for the transperineal prostate biopsy. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/6Pc55q --- SHOW NOTES First, the doctors discuss why they invested in learning to perform transperineal biopsy. Dr. Allaway explains that transrectal biopsy can lead to rectal bleeding, infections, and sepsis. He also believes that the perineal approach offers the proper trajectory to sample the prostate appropriately. Next, they discuss the equipment required for transperineal biopsies, such as probes, ultrasounds, grid steppers, and needle sheaths. They weigh the pros and cons of performing the procedure in the office versus in the clinic. Additionally, they discuss different costs and features of different probes. Next, they discuss their techniques for obtaining the transperineal biopsy, including tips for patient positioning, probe maneuvers, and local anesthetic injections. Dr. Javier-DesLoges uses a local injection of lidocaine, normal saline, and sodium bicarbonate. Dr. Allaway then shares his advice on how to deal with obstacles, such as stool burden and rectal gas. They end the episode by highlighting the importance of collaboration and learning from others’ techniques. Dr. DesLoges strongly recommends the AUA course on transperineal biopsies as an educational resource. --- RESOURCES Perineologic https://perineologic.com/aboutpl-2/

On this episode of BackTable Urology, Dr. Mike Hsieh (UC San Diego) interviews Dr. Larry Lipshultz (Baylor College of Medicine) about his journey to becoming a renowned specialist in male infertility and reproductive medicine. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- SHOW NOTES First, Dr. Lipshultz explains how he became interested in urology through working in a basic sciences surgery laboratory with a urologist. He became passionate about doing research in male infertility as an intern after hearing a Grand Rounds lecture. Before his residency ended, he was sent to El Paso, Texas by the military, where he was able to start his own semen analysis laboratory to treat male infertility patients. He then accepted an AUA fellowship and followed a mentor to UT Houston for training in male infertility. He eventually transitioned to Baylor College of mEDICINEand stayed after fellowship to join the faculty. Next, Dr. Lipshultz reflects on major events in his life, such as the opportunity to perform trailblazing surgeries, like gender-affirming surgeries and vasovasostomies, and graduating productive male infertility fellows. He gives advice on balancing clinical duties and research, the importance of goal setting, and mentoring junior faculty. Finally, the doctors discuss the future of men’s health. Dr. Lipshultz disagrees with the concept of direct-to-consumer marketing and “low T clinics”, as he believes they do not exist to serve the patient’s best interest. He is excited about new research implicating that testosterone may have other health benefits besides treating erectile dysfunction and that male infertility may be an indirect measure of men’s health. He encourages urologists to explore running their own IVF clinics and incorporate biotechnology into their practices as well.

On this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Daniel Costa (UT Southwestern), and Dr. Xiaosong Meng (UT Southwestern) discuss patient selection and procedure for TULSA-PRO, a new transurethral ultrasound ablation system that incorporates real-time MR imaging, as a focal treatment option for prostate cancer. --- CHECK OUT OUR SPONSOR Profound Medical TULSA-PRO https://profoundmedical.com/ --- SHOW NOTES First, the doctors discuss the benefits of using MRI with transurethral ultrasound ablation (TULSA), which include direct visualization of anatomy, margins, and boundaries. They compare TULSA to other forms of focal management, such as cryoablation, brachytherapy, stereotactic body radiation therapy (SBRT). Compared to these methods, TULSA has lower risk of rectourethral fissures and preserves the posterior plane better, making salvage procedures more viable. Then, the doctors discuss ideal candidates for TULSA therapy, which include patients with intermediate risk and localized disease, patients with lesions in lateral or anterior portion of prostate, patients with medium sized prostates, low risk patients with lower urinary tract symptoms (LUTS) who do not want to undergo active surveillance. Patients with large calcifications may not be ideal candidates for TULSA, as the calcifications can be a shield for the ultrasound beam. The doctors recommend ordering a CT/MRI scan first to identify if calcifications are present to assess their sizes and locations. During imaging, it is also important to make sure the tumor is not close to key anatomical elements, such as the neurovascular bundle. When deciding between different focal therapies, it is important to balance oncological outcomes and quality of life preservation. Thus, the treatment decision should be a collaboration between patients, their families, the radiologist, and the urologist. The doctors also discuss special considerations for salvage therapy patients, brachytherapy patients, patient with urethral strictures, and patients with a prior history of TURP. Next, the doctors explain how to prepare patients for TULSA. The patient’s colon has to be emptied in order to reduce MRI noise during the procedure. Additionally, the doctors help patients understand the immediate side effects of the procedure, which can include reduced semen volume, urgency incontinence from bladder and prostate irritation, and temporary erectile dysfunction, and semen retention. After the procedure, the urinary catheter will have to be left inside for five days to two weeks, depending on the volume of the prostate removed. There is a 20-25% chance of recurrence. Finally, they discuss specifics of the TULSA procedure. Dr. Costa and Dr. Meng perform these procedures at the university hospital, as they need access to MRI and anesthesia. They discuss the optimal MRI window for the procedure, patient positioning, as well as their two sweep method. The total procedure time is dependent on the volume of ablation and number of sweeps, but the average total time is 3 hours. Patients are discharged on the same day, and no narcotics are prescribed. Finally, they discuss the progress of a new prospective multi-center randomized trial comparing focal TULSA therapy to surgery for intermediate risk prostate cancer patients. --- RESOURCES TULSA Procedure https://tulsaprocedure.com/tulsa-procedure/about-tulsa-procedure/ Profound Medical https://profoundmedical.com/

On this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Rana McKay, a medical oncologist at UC San Diego, discuss guidelines and advances in prostate cancer treatment. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/B9kR7B --- SHOW NOTES First, they define three types of prostate cancer. Metastatic castration-sensitive disease refers to patients with metastatic cancer who have low testosterone levels because of androgen deprivation therapy (ADT). Nonmetastatic castration-resistant disease is nonmetastatic cancer with testosterone levels unresponsive to ADT. This category is harder to define as the classification varies based on imaging modality. Finally, metastatic castration-resistant disease is the most lethal type of prostate cancer, as there is an unmet need in developing therapeutics for these patients. Traditionally, the castrate level is defined as a testosterone level <50 ng/dL. Then, the doctors discuss different types of ADT, which include GnRH agonists, GnRH antagonists, and anti-androgen receptor medications. When explaining ADT to her patients, Dr. McKay always identifies the class of the agent and common side effects (i.e.- bone composition changes, metabolic changes, and mood and libido changes). Dr. McKay notes that she has observed many patients who have had success with ADT and shares lifestyle tips that she recommends to mitigate the side effects of ADT. Next, the doctors summarize treatment options for different types of prostate cancer patients, including those with de novo metastatic prostate cancer, metastatic hormone sensitive disease, biochemically recurrent disease, and chemotherapy naive patients. In addition, they reflect on past landmark trials and current prospective trials about different combinations of therapies. They end the episode by discussing lutetium-177 as a new therapy for prostate cancer. --- RESOURCES Veracyte Decipher Prostate Genomic Classifier https://www.veracyte.com/diagnostics/prostate-cancer Prostate Cancer Foundation https://www.pcf.org/ Zero Prostate Cancer https://zerocancer.org/

In this episode of BackTable, Dr. Bagrodia interviews Dr. Sia Daneshmand, chief of urologic oncology at the University of Southern California, about the research trials and treatment of stage II seminomas. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oOcODJ --- SHOW NOTES FIrst, Dr. Daneshmand defines stage II seminomas, which are seminomas that have spread outside of the testicles to the retroperitoneal lymph nodes. Stage II seminomas are further subclassified into IIa, b, or c depending on size and number of affected lymph nodes. This disease stage can present on Initial seminoma diagnosis or occur after a relapse of a stage I seminoma. There are 3 options for standard treatment for stage II seminomas: radiation therapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Dr. Daneshmand recommends a monotherapy option to minimize toxicities and explains which treatment modalities are best for each subtype of stage II seminomas. Then, the doctors discuss common side effects of each modality. Radiation may cause cardiotoxicity, fatigue, enteritis, and secondary malignancy. Chemotherapy may cause neurotoxicity, nephrotoxicity, infertility, and tinnitus or hearing loss. The doctors also discuss RPLND as a therapeutic option. Dr. Daneshmand explains that some patients may be hesitant at first to choose this option, as this has been a large open surgery with lengthy hospitalizations in the past. However, his technique involves only making a small midline incision and using an extraperitoneal approach. His RPLND patients usually only stay in the hospital for one day and fully recover by 2 to 3 weeks. He also discusses prospective RPLND trials on stage II seminomas, including his own research project. Both doctors agree that patients should be involved in shared decision making in order to weigh the cure rate against the comorbidity rate of each therapy. Finally, Dr. Daneshmand speculates on the future of seminoma treatment, which he believes lies in advancements of individualized treatment based on biomarker data.

In this episode of BackTable, Dr. Bagrodia interviews Dr. William Flanary, a physician-comedian popularly known as Dr. Glaucomflecken, about lessons he has learned as a two-time testicular cancer survivor and the importance of humor in medicine. --- CHECK OUT OUR SPONSOR Veracyte https://www.veracyte.com/decipher --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/VJvXZx --- SHOW NOTES First, Dr. Glaucomflecken shares about his first diagnosis of testicular cancer. During his third year of medical school he felt a lump in his testicle, which led to a quick workup, diagnosis, and a full orchiectomy. The diagnosis was emotionally difficult, as he was in his mid-twenties and healthy. He returned to comedy, a skill he had developed in high school and college, to cope with his diagnosis. This time, however, he started to practice medical-based comedy with his new experiences as a medical student. He recounts other discussions he had about his cancer, such as fertility, the possibility of chemotherapy, and active surveillance. Four years after his first orchiectomy, he received his second diagnosis of testicular cancer during his last year of residency. He recounts feeling distraught and overwhelmed, as questions about fertility, hormone replacement, medical expenses, and postponing residency became more serious. He decided to have a full orchiectomy and testosterone replacement therapy, which solved his issues with fatigue and irritability. Additionally, his wife got him involved in testicular cancer support groups and foundations, including one called First Descents, an organization that encourages young adults with cancer to explore the outdoors. He notes that young patients are often overlooked in cancer support groups and encourages cancer patients to find their support networks outside of friends and family as well. Then, Dr. Flanary discusses his experience with suffering from cardiac arrest in 2020, which led to his wife doing ten minutes of chest compressions to keep him alive. He reflects on this event and concludes that it taught him how to be a better physician to his patients by making sure he involves patients’ families and encouraging him to address medical insurance issues directly. Finally, Dr. Flanary discusses how he uses humor to advocate and educate patients on social media. He notes that comedy can stimulate conversation and debate and encourages physicians to have social media presence. --- RESOURCES Knock Knock Hi Podcast https://podcasts.apple.com/us/podcast/knock-knock-hi-with-the-glaucomfleckens/id1659572053 First Descents https://firstdescents.org/

En este episodio de BackTable Urology, Dr. Jose Silva entrevista a Dr. Jose Saavedra, un especialista de salud sexual en Puerto Rico, sobre tratamientos mínimamente invasivos y cirugía para Peyronie's disease. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/BVuIxP --- SHOW NOTES Primero, Dr. Saavedra reflexiona sobre su trayectoria médica antes de establecer su práctica privada, Puerto Rico Sexual Wellness Clinic. Después de la formación en cirugía general durante 3 años, escogió la urología como su especialidad por la habilidad de mejorar la calidad de vida de pacientes. Después, él habla sobre su evaluación para curvatura del pene. Usualmente sus pacientes desarrollan la curvatura y sufren 3-6 meses de síntomas antes de buscar su ayuda. Síntomas importantes incluyen dolor general durante la penetración y dolor referido en testículos. Es importante preguntar sobre su historial sexual y la posibilidad de un trauma escondido. Para él, la habilidad de obtener y mantener una erección es la medida más importante para evaluar la función del pene. Explica también en cuáles pacientes recomienda el vacuum erection device, los NSAIDs, y gabapentin también. Adicionalmente, habla sobre la onda de choque (shockwave therapy), que solamente recomienda para el manejo de dolor porque no resuelve el plaque. Próximo, explica los detalles de cómo realiza sus inyecciones en la clínica y las ventajas del vacuum erection device. Además, la satisfacción, la ansiedad, y el “body dysmorphic syndrome” son sus indicaciones para la cirugía. Finalmente, describe sus técnicas quirúrgicas y consejos para pacientes para la recuperación.

En este episodio de BackTable Urology, Dr. Jose Silva entrevista a Dr. Ramon Virasoro sobre los tratamientos diferentes para estrecheces uretrales. --- SHOW NOTES Primero, Dr. Virasoro habla sobre su camino a ser urólogo reconstructivo en los Estados Unidos. Empezó su educación en Buenos Aires pero obtuvo un fellowship de reconstrucción urológica en Eastern Virginia Medical School debajo de la tutela de Dr. Gerald Jordan. Dr. Virasoro refleja en su decisión de escoger esta especialidad y también los obstáculos de ser un graduado médico internacional. Decidió quedarse en la medicina académica después de terminar su entrenamiento. Próximo, Dr. Virasoro habla sobre su práctica de reconstrucción, incluso sus estudios primeros y procedimientos más comunes para pacientes con estrecheces ureterales. Aunque los síntomas son importantes, cree que la información radiológica es clave. Los doctores también están de acuerdos de que la selección de pacientes es importante también; es importante comprender la causa, la locación, y el tamaño de la estrechez porque hay técnicas mejores para cada tipo del estrechez. Entonces, discuten sobre los tratamientos diferentes para esta condición. Para estrecheces cortos sin tratamiento previo, una dilatación con globo tiene un alto nivel de éxito. Sin embargo, si la paciente con un estrecho largo o uno que ya tenía muchos procedimientos, el globo tiene un bajo nivel de éxito. En estos casos, una reconstrucción con injerto puede ser mejor. Los doctores evalúan diferentes tipos de injertos, incluso desde la lengua y desde la mejilla. También hablan de complicaciones después de la cirugía, como la pérdida de sensación, neuropraxia, y rabdomiolisis. Adicionalmente, Dr. Virasoro aboga por la preservación de vasos sanguíneos en sus casos de reconstrucción. En casos difíciles, él siempre involucra al paciente en la discusión para escuchar sus goles y preferencias. Hará una lista de los pros y contras de cada tratamiento y dará al paciente la capacidad de elegir el tratamiento. Los doctores hablan sobre la reparación concurrente de las fístulas y el desarrollo del globo con paclitaxel también (Optilume). Finalmente, Dr. Virasoro habla de sus experiencias internacionales de voluntariado con las organizaciones de Physicians for Peace y Safe Surgery and Anesthesia for Everyone. --- RESOURCES Safe Surgery and Anesthesia for Everyone (SAFE) https://www.safesurgery4all.org/ Physicians for Peace https://www.physiciansforpeace.org/

In this episode of BackTable, Dr. Jose Silva interviews Dr. Aaron Schneider, a pharmacist, and Dr. Jordan Grant, a urologist, about compounding pharmacies and their uses in providing medications to treat urological conditions. --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- SHOW NOTES First, the doctors define compounding, which is the process of creating special treatments for unique populations of patients. Compounding a medication can involve a multitude of actions, such as removing an allergen, eliminating a preservative, changing typical route of administration, and more. Dr. Grant and Dr. Schneider explain how in 2016, ReviveRX, their compounding pharmacy, realized the need for compounding urologic medications, especially to treat infertility, erectile dysfunction, and low testosterone. Additionally, the doctors explained how ReviveRX provides a unique type of intracavernosal injection that is freeze dried to help increase the shelf life and distribution efficiency of the product. Although insurance companies may not cover the cost of compounded medications, some patients with allergies to medications have seen great improvement in side effects with medication compounded to their unique needs. Next, Dr. Grant discusses his testosterone replacement therapy regimen for patients with low free testosterone levels. He explains how he integrates hCG and FSH into the treatment plan if patients have concerns about declining fertility. Then, Dr. Schneider provides an overview of the history of hCG use and regulations in commercial and compounding pharmacies. Finally, the doctors wrap up by explaining how other doctors can order from ReviveRX and steps they can take to ensure the quality of products from compounding pharmacies. --- RESOURCES ReviveRX https://reviverx.com/

Intrarenal pressure monitoring during ureteroscopy is a complex but crucial component of performing safe procedures. In this episode of the BackTable Urology Podcast, urologist Dr. Julie M. Riley from the University of Arkansas for Medical Sciences shares expert insights on ureteroscopy, focusing on intrarenal pressure monitoring, procedural techniques, and new technologies aimed at improving patient safety. --- This podcast is supported by: Boston Scientific Urology https://www.bostonscientific.com/en-US/about-us/core-businesses/urology-pelvic-health.html --- SYNPOSIS Dr. Riley discusses the benefits of access sheaths, the utility of new devices including LithoVue Elite, and strategies for minimizing infection. She highlights the benefits and intended use cases of this new technology, and further outlines potential complications and challenges in using this new tool. Dr. Riley also shares her own approaches to complex patients, and her predictions for the future of ureteroscopy. --- TIMESTAMPS 00:00 - Introduction 03:10 - Ureteroscopy and Patient Candidacy 04:12 - Complications 09:50 - Technological Advances 13:30 - Practical Tips 32:59 - Looking Ahead --- RESOURCES Boston Scientific https://www.bostonscientific.com/en-US/home.html

In this episode of BackTable, Dr. Jose Silva and Dr. Justin Dubin chat about the benefits and pitfalls of using social media to network with colleagues and to educate patients about urological conditions. --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- SHOW NOTES First, Dr. Dubin explains why he created his own social media presence, which was to control his own narrative online. However, he realized that he could also form valuable connections with other doctors through social media, which motivated him to develop his social media from a professional standpoint. For instance, he was able to connect with other researchers virtually and publish papers. He encourages other urologists to create professional social media accounts but to also portray themselves authentically. Next, he explains his job search after fellowship. He had to consider his own priorities, most important of which was to have a clinic focused on men’s health, not just general urology. Additionally, he only refers patients to primary care physicians he would go to himself. Next, he and Dr. Silva discuss the workup for patients with low testosterone. According to guidelines, treatment is warranted if the patient has a low testosterone level and is symptomatic. Dr. Dubin emphasizes the importance of explaining to young patients that testosterone replacement therapy can cause infertility through azoospermia or anejaculation. Dr. Silva debunks the myth that testosterone replacement causes prostate cancer. Then, the doctors discuss the benefits of the expanding field of telemedicine. Dr. Dubin explains that telemedicine mitigates the stigma of erectile dysfunction and increases the convenience and accessibility of urologic care. Finally, Dr. Silva and Dr. Dubin comment on the increasing incidence of misinformation from social media about urologic conditions. Dr. Dubin summarizes a paper he published about harmful myths propagated by non-medical personnel on TikTok and Instagram. Both of the doctors agree that podcasts, such Dr. Dubin’s Man Up Podcast, can provide accurate information to patients. Dr. Silva notes the importance of outreach to younger patients, who utilize social media more and are more prone to misinformation. --- RESOURCES ReviveRx https://reviverx.com/ Man Up Podcast “The broad reach and inaccuracy of men’s health information on social media: analysis of TikTok and Instagram” (Dubin, 2022) https://www.nature.com/articles/s41443-022-00645-6 “Never Eat Alone: And Other Secrets to Success, One Relationship at a Time” by Keith Ferrazzi https://www.penguinrandomhouse.com/books/227558/never-eat-alone-expanded-and-updated-by-keith-ferrazzi-and-tahl-raz/

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Ali Kasraeian, a private practice urologic oncologist in Jacksonville, about different techniques and research on prostate cancer screenings. --- CHECK OUT OUR SPONSOR ExosomeDX https://www.exosomedx.com/ --- SHOW NOTES First, Dr. Kasraeian explains his interest in prostate cancer care. His father was a urologic oncologist who started a private practice, which he subsequently joined after completing his surgical training. He currently serves as a member of the Florida Prostate Cancer Advisory Council (FPCAC), a governor-elected board that raises public awareness for prostate cancer and brings practitioners and patient advocates together to advocate for this illness. Next, the doctors discuss the optimal time to screen for prostate cancer. Dr. Kasraeian notes that the national guidelines can be confusing for primary care providers and patients because they are constantly changing. Additionally, different organizations have different guidelines. In his practice, he recommends obtaining PSA levels at 45 years of age if the patient has not had any risk factors or family history of prostate cancer. Dr. Kasraeian notes that he looks at PSA velocity instead of single elevated PSA value to make decisions about subsequent steps. Then, he employs other screening methods, such as MRI scans and urine based biomarkers, if this is the case. He notes that biomarkers are useful because they can predict the risk of aggressive prostate cancer developing. Then, he will move onto obtaining a prostate biopsy if needed. The order of screening method will depend on the patient and their preferences. He emphasizes the importance of educating patients on the reasoning behind each screening test to allow them to become advocates of their own preventative cancer care. He then speaks about his personal experience spending a year in Paris and learning how to incorporate MRI as a screening test in his own private practice. He ends the episode by discussing the future directions of prostate cancer screenings and care by making comparisons between the trajectory of prostate cancer and that of breast cancer, and commenting on the use of biopsy alongside the increasing capabilities of MRI scans.

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Jason Wynberg, director of endourology at NYU Langone Health in Brooklyn, about his percutaneous nephrolithotomy (PCNL) technique and innovations. --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/LmSqn0 --- SHOW NOTES First, Dr. Wynberg explains his workup for a potential PCNL patient. He considers stone size, stone density, preexisting comorbidities, and patient preferences. He uses CT scans, retrograde pyelograms, and flexible ureteroscopy to study the anatomy of the patient. Next, he explains how he gets his own access through retrograde access while the patient is in the supine position. Then, he discusses the trademark patent he currently holds for a PCNL kit, which includes a puncture wire, sheath, and coaxial microintroducer. The kit allows urologists to put a retrograde puncture wire through a flexible ureteroscope. He notes that this kit decreases renal trauma and allows the papillary puncture to be aligned with the infundibulum. He also reflects on the challenges of developing his kit and finding industry partners to support development. Although he had to wait 7 years to commercialize his technology, he saw the prolonged time as a benefit because he was able to improve its design before commercial release. Finally, he explains his technique for using the PCNL kit and offers advice for different difficult scenarios during PCNL. He emphasizes that, in the end, skilled surgeons ensure the success of PCNLs, not just the equipment they use. --- RESOURCES ReviveRX https://reviverx.com/ --- The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen on BackTable.com/Urology or on the streaming platform of your choice. Get notified when new episodes drop! Subscribe to the BackTable Urology Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates. Apple ► https://podcasts.apple.com/us/podcast/backtable-urology/id1563577139 Spotify ► https://open.spotify.com/show/32LoLeG0gYyJcNyloN8Cvi YouTube ► https://www.youtube.com/channel/UCCV3si2GQV6kWzig93ymEWg?sub_confirmation=1 LinkedIn ► https://www.linkedin.com/company/backtable-urology/ Twitter ► https://twitter.com/_backtableuro Instagram ► https://www.instagram.com/_backtableuro/ Newsletter ► https://www.backtable.com/shows/urology/subscribe

In this episode of Legends in Urology, Dr. Manoj Monga, chair of urology at UC San Diego, interviews Dr. Ralph Clayman, a world renowned minimally invasive urologic surgeon, about his path to medicine and perspectives on the future of urology. --- SHOW NOTES First, Dr. Clayman speaks about his childhood in New Jersey and his extensive family background in medicine, which encouraged him to pursue a career as a physician. He attended Grinnell College in Iowa for undergraduate, then UC San Diego for medical school. Dr. Clayman then went to the University of Minnesota for his surgical residency. During his intern year, he decided to do a urology rotation and was drawn to the specialty instantly. He also explains how he met his wife in medical school and elements of a successful relationship. Next, he defines success, which he believes is the ability to solve problems creatively and with humility. Dr. Clayman also speaks about the future direction of urologic surgery, which he believes points towards improving and expanding upon minimally invasive surgery and medications to treat common conditions, such as kidney stones. Finally, he shares his life lessons he has learned, such as taking advantage of mentorship opportunities, delineating the separation of work and home life, and the importance of resilience.

In this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Ruchika Talwar, a urologic oncology fellow at Vanderbilt University Medical Center, discuss her personal journey to becoming an advocate and how other urologists can get involved in policy making. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/wWaqJd --- SHOW NOTES First, Dr. Talwar explains how she got interested in advocacy. Before college, she had always been interested in issues and causes, so she originally wanted to be a politician. After participating in a summer program, she realized she didn’t want to be a politician and instead pursued undergraduate majors in biology and legal studies. To her, medicine and politics were always intertwined. She was active in the American Medical Association (AMA) in medical school and the American Urologic Association (AUA) in residency. Next, Dr. Talwar explains what advocacy means to her, which is picking a topic and trying to make a broad impact. She chooses to advocate through organized medicine because she believes that organized medicine creates a unified voice necessary to guide politicians in making correct policy decisions. Although she participates in advocacy at a national level through AUA conferences and Capitol Hill visits, there are also other levels of advocacy to engage in, such as advocacy at the department or state level. She emphasizes that advocacy has helped her fight burnout, as she feels like she has a voice in the larger medical system. Dr. Talwar cites many historical examples of the benefits that advocacy from urological societies has brought to patients. For example, organized urology has done much to improve insurance coverage of PSA screenings and Medicare policies. During these times, she notes that updating and checking emails from the AUA and forwarding emails to colleagues is critical. Another way that urologists have been able to advocate for health equity is to share patient stories with lawmakers, which may make a bigger impact than sharing research statistics. She mentions that the AUA policy arm is able to connect urologists with their specific congressional representatives and sends out legislative priority surveys to AUA members. She encourages other trainees to get support from their program leadership to pursue advocacy by sharing tangible ways that they can improve their department and relaying patient stories. The doctors also discuss differences in generational perspectives when it comes to advocacy. Older generations of urologists may not think the AUA should play an active role in policy making, but younger generations think AUA should be more active in policy making. Dr. Talwar encourages younger urologists to apply for leadership positions, especially female and minority urologists. Finally, the doctors discuss the upcoming AUA Summit, an annual fly-in advocacy event. During this conference, urologists will be able to decide the AUA’s legislative policies for the year, such as coding and reimbursement, retention and diversity of workforce, and research funding. Urologists will be able to meet with their congressional offices and representatives as well. --- RESOURCES 6th Annual AUA Summit Registration: https://www.auasummit.org/ AUA Public Policy & Advocacy Committees: https://www.auanet.org/about-us/aua-governance/committees/public-policy-and-advocacy-committees

In this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Ari Hakimi (Memorial Sloan Kettering Cancer Center), and Dr. Nirmish Singla (Johns Hopkins University), discuss the value and indications for germline testing in renal cell carcinoma (RCC). --- SHOW NOTES First, the doctors explain basic information about germline mutations and kidney cancer. Although historical data has shown that 5% of kidney cancers are inherited, recent efforts to increase testing through commercial testing and large scale efforts at cancer centers have proven that 8-10% of kidney cancers are inherited. Von Hippel Lindau (VHL) syndrome is the most prototypical kidney cancer predisposition syndrome, but there are other less common ones as well. Extrarenal manifestations of VHL syndrome include pancreatic tumors, pancreatic cysts, pheochromocytomas, retinoblastomas, and CNS hemangioblastomas. These tumors have a variable penetrance, but African Americans and women are more likely to have hereditary RCC. The doctors recommend asking newly diagnosed RCC patients about a broad spectrum of their family history that includes cancer and non-malignant conditions, such as uterine leiomyomata. Dr. Hakimi notes that some patients will confuse germline testing with somatic tumor testing, so urologists will have to explain to patients that the VHL mutation was found in their tumor, not in their blood or saliva. Extended physical exams to look for syndromic conditions can also be performed. A thorough cutaneous exam to look for fibrofolliculomas, leiomyomas, facial angiofibromas, and cafe-au-lait spots can help indicate the presence of a familial syndrome. According to guidelines, all patients diagnosed with RCC under 46 years of age should be recommended to have germline testing. Dr. Bagrodia mentions that having experienced genetic counselors and setting up thorough dot phrases to send to patients explaining their results is helpful for him. Dr. Singla adds that medical geneticists have the ability to counsel the patients more extensively on the risks and benefits of giving consent to go forward with genetic testing. They can also provide psychosocial support and education for the patients. The doctors then move on to discuss how germline mutations may lead to different treatment modalities. Precision surgery, or utilizing pretest probability information about a tumor to guide surgical approach, may be possible with germline testing. Additionally, testing may help surgeons to decide whether to perform a retroperitoneal lymph node dissection (RPLND). Next, the doctors discuss belzutifan, which is an oral drug used to treat VHL familial syndrome tumors. Finally, they discuss the use of tumor sequencing for research purposes and share what they are most excited for in the field of RCC research.

In this episode of BackTable Urology, Dr. Aditya Bagrodia, Dr. Kara Watts (Montefiore Medical Center), Dr. Minhaj Siddiqui (University of Maryland), and Dr. Arvin George (University of Michigan) discuss active surveillance for prostate cancer. --- SHOW NOTES First, the doctors discuss workup for prostate cancer. They usually obtain an MRI prior to the diagnostic biopsy, but this decision may change in the face of inadequate infrastructure, insurance, and resources. Dr. Siddiqui notes that patients may be distressed when first hearing about their diagnosis, as prostate cancer may be the first serious illness they’ve been diagnosed with. Dr. George recommends discussing the diagnosis in person after pathology is confirmed. Additionally, Dr. Bagrodia uses the WellPrept app to send patients educational material about prostate cancer before they meet with him again. Next, they discuss the general regimen for active surveillance patients within the first year of diagnosis. Dr. Watts orders an MRI 6 months after the diagnostic biopsy because inflammation from biopsy may be present in the first couple of months. Dr. Minhaj believes that deciding on when to do an MRI scan also depends on the patients’ preferences and personalities. They also discuss different types of biopsies and the use of confirmatory biopsies. The doctors also agree that removing the term “cancer” from grade group 1 prostate cancer could potentially minimize financial toxicity and patient anxiety. For patients who still want to pursue treatment, Dr. Bagrodia believes that urologists should have the refusal to treat patients who push for inappropriate treatment. Finally, the doctors consider additional factors that may encourage them to consider treatment in low grade prostate cancer, such as a family history of cancer, BRCA mutations, lower urinary tract symptoms, and select molecular biomarkers and pathology characteristics. Dr. George states that the designation of high versus low volume cancer does not matter and should not be a trigger for treatment. Dr. Minhaj notes that for him, younger age is a stronger indication for active surveillance in order to avoid the morbidity of treatment. Finally, the doctors explain their personal active surveillance regimens and tips for transitioning patients with more serious conditions off of active surveillance once their prostate cancers have been proven to be stable. --- RESOURCES WellPrept https://wellprept.com/

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. Todd Morgan, chief of urologic oncology at the University of Michigan, about benefits and indications for germline testing in prostate cancer patients. --- SHOW NOTES First, the doctors discuss the formal definition of germline testing, which is identifying inherited DNA mutations known to be pathological. This is different from molecular testing, which detects molecular markers specific to tumor cells. The term “genomic testing” is a broad and vague term that may confuse patients. Germline testing may be beneficial to patients and their families by notifying them to undergo cancer screening earlier. 12% of metastatic prostate cancer patients and 5 to 10% of localized prostate cancer patients have a germline mutation. Next, they discuss critical criteria for germline testing besides having a high grade and high stage cancer. Dr. Morgan recommends germline testing for all prostate cancer patients with metastatic cancer. He also believes that taking a thorough family history is fundamentally important in deciding whether or not to order testing. He emphasizes the importance of collecting information about other family members with other types of cancer, their age of diagnosis, their relationship to the patient, and their mortality from cancer. Patients may not know family history well, but he has a low threshold of testing if he suspects a pattern of heritability. Then, Dr. Morgan explains how germline testing may affect decision making. For patients with localized and low risk disease, he notes that prompt treatment may be beneficial in patients with a BRCA2 mutation, but there is still not enough evidence to eliminate active surveillance as an option. For high-risk disease, he always recommends treatment over active surveillance, regardless of germline mutation. For patients who have a BRCA2 mutation but no diagnosis of prostate cancer, he counsels them in his high risk prostate clinic. These patients receive close screening measures, such as lower PSA level thresholds, identification of urine biomarkers, and MRI scans. Additionally, the doctors discuss various testing companies. They do not recommend using 23 and Me as a comprehensive screening panel because it is exceedingly limited in the germline mutations it tests. Dr. Morgan also emphasizes that as the ordering physician, he is responsible for giving the patient the result of the test. If there is a positive result on germline mutation testing, he refers the patient to genetic counselors, who are equipped to deal with conversations regarding mutations that have non-urological implications as well. Finally, they end the discussion by chatting about different research trials about germline testing.

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. David Penson, professor and chair of urologic oncology at Vanderbilt University, about the indications and benefits of surgery for high risk prostate cancer. --- SHOW NOTES First, Dr. David Penson gives the traditional definition of high-risk prostate cancer, which is a PSA level over 20 ng/mL, a Gleason grade greater than 10, and a cancer staged at T2 or higher. However, he notes that in recent years, a more heterogeneous criteria has developed, so some patients with a Gleason grade greater than 8 and a T3 stage can also be considered high risk. Dr. Penson believes that pathological analysis is the best criteria to use when assessing risk and also uses MRI to distinguish between T2 and T3 patients and look for the median lobe before surgery. In his personal experience, he has noted that some patients will find online information about prostate cancer as a relatively benign chronic disease. For patients with high risk cancer, it is important to emphasize that the conventional active surveillance approach for low risk prostate cancer will not be beneficial. Both doctors agree that sending their patients curated, quality information is important and recommend using the WellPrept app. The doctors also discuss different imaging modalities involved in staging, such as PSMA PET scan, a bone scan, and prostate MRI. Before surgery, patients may receive neoadjuvant treatment. In the past, GnRH agonists were used, but long term data showed that patients receiving this type of therapy in addition to surgery had the same recurrence rate as patients who underwent surgery alone. Recently, newer neoadjuvant treatments, like PARP inhibitors, have been developed. Next, Dr. Penson speaks about choosing surgery versus radiation therapy (RT) as a primary treatment. The main risk of prostatectomy is its impact on continence and sexual dysfunction. The downside of radiation therapy is that the possibility of surgery as a therapeutic option is eliminated and its side effects, such as irritating urinary symptoms. Dr. Penson also notes that nerve sparing prostatectomies may be cancer sparing. In his opinion, if patients have impotence at baseline, nerve sparing surgery is not beneficial because of the risk of leaving positive margins. Contraindications to surgery include rectal involvement, a history of multiple abdominal surgeries, severe heart disease, bladder neck involvement, and a high volume nodal disease. Ideal prostatectomy patients are ones who have high grade disease contained in the prostate (T2) and patients with preexisting lower urinary tract symptoms (LUTS). Finally, the doctors discuss the use of nomograms to determine the extent of cancer control and the need for additional therapy. Dr. Penson has limited use for nomograms. He believes that they can generally be used to predict mortality, but not cure rates. He prefers to base prognosis on postoperative results. If the postoperative pathology report comes back with widely positive margins or bladder neck involvement, he discusses RT as an adjuvant treatment with his patients. For this reason, he emphasizes the need for collaboration with radiation oncologists and multidisciplinary tumor boards. --- RESOURCES WellPrept App: https://wellprept.com/

En este episodio de BackTable Urology, Dr. Jose Silva entrevista a Dr. Ramphis Morales sobre su trayecto de ser urólogo reconstructivo y su práctica privada de cirugía de afirma de género en Puerto Rico. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/GRW13w --- SHOW NOTES Primero, Dr. Morales discute términos básicos en la comunidad transgenero desde el punto de vista médico. Prefiera usar el término “afirmación de género”, en vez de "reasignación de género” o “cambio de género”. Tambien, enfatiza la diferencia entre el sexo y el género. Entonces, explica por qué escogió un programa de urología reconstructiva en Temple University. Aunque ocurrió la pandemia de COVID-19 en 2020, recibió la oportunidad de aprender sobre la cirugía de afirma de género bajo la tutela de buenos mentores. Próximo, él discute el proceso gradual de establecer su propia práctica privada dedicada a ayudar a los pacientes transgéneros. Se dio cuenta de que había una falta de urólogos en Puerto Rico y quería ofrecer un servicio discreto pero muy necesario a la isla. Adicionalmente, explica su proceso de evaluación inicial de sus pacientes. Primero, un paciente necesita un diagnóstico de disforia de género. La mayoría de sus pacientes ya empiezan la terapia hormonal antes de pedir la cirugía. Dr. Ramphis nota las preferencias del paciente, diferencias anatómicas, y niveles de hormonales anormales antes que la cirugía también. Adicionalmente, los médicos discuten la colaboración con otras especialidades. Dr. Morales opina que la reconstrucción genital es el trabajo del urólogo, debido a su conocimiento profundo de la anatomía. Sin embargo, explica que hay un rol para la cirugía plástica en reconstrucción de otras partes del cuerpo y también en microcirugías involucrando los “free flaps”. Finalmente, Dr. Morales refleja las complicaciones que ha visto como resultado de reconstrucción genital, como estenosis de canal después de vaginoplastia y vaginectomía incompleta. Menciona también la importancia de cuidar la salud de la próstata, porque los hombres transgéneros pueden desarrollar cáncer prostático también. Por eso, es importante educar a médicos y pacientes sobre este tema importante. Los doctores terminan el episodio con una discurso sobre el futuro de la práctica privada de Dr. Morales y la posibilidad de establecer un programa educativo de reconstrucción genital para los residentes médicas.

Catch up on the latest breakthroughs in bladder cancer management. In this episode of the BackTable Urology Podcast, Dr. Bogdana Schmidt (University of Utah) speaks with Dr. Andrea Apolo, a medical oncologist at the National Cancer Institute, about recent advancements in bladder cancer treatment presented at the 2024 European Society of Medical Oncology (ESMO) Congress. --- SYNPOSIS They review pivotal trials like the NIAGARA and AMBASSADOR studies, the TAR-200 drug delivery system, the use of bladder-sparing treatment, and the role of ctDNA as a biomarker. Further, they detail the effectiveness of systemic therapies such as gemcitabine and pembrolizumab, the implications of perioperative immunotherapy, and the future role of antibody-drug conjugates. The conversation highlights the trend towards less invasive approaches while improving survival rates from bladder cancer. --- TIMESTAMPS 00:00 - Introduction 03:49 - NIAGARA Trial 09:10 - Challenges in Bladder Cancer Treatment 18:56 - AMBASSADOR Trial 25:30 - Adjuvant Immunotherapy 29:30 - Exploring Biomarkers and ctDNA 36:34 - Surgery and Less Invasive Therapies 46:31 - Future Directions in Bladder Cancer Treatment --- RESOURCES ESMO https://www.esmo.org/

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Marc McGuire and Patrick Scheffler about their personal experiences with prostate cancer, from diagnosis to remission. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/y6LGqe --- SHOW NOTES First, Marc and Patrick share how they were initially screened for prostate cancer using PSA levels. When both of their labs showed elevated PSA levels, they were surprised because they had no symptoms of cancer. Then, they share how they felt while awaiting consultation with a urologist after their lab results. Both of them tried to educate themselves about PSA levels and prostate health and spoke to different medical professionals in the meantime. Although Dr. Bagrodia notes that many men hold back abnormal PSA results from their families because of uncertainty or stigma, both men agreed that their families were their biggest support system during this time. Then, Marc and Patrick discuss receiving the results of the prostate biopsy. Both men emphasize the importance of having a positive attitude and being proactive about making treatment plan decisions. Marc encourages patients and their families to have a list of questions ready for the urologist in order to stay organized. Dr. Bagrodia adds that he sends resources to patients before meeting with them, so they can educate themselves before he has the first discussion about their diagnosis. He also emphasizes the importance of vetting educational materials before sending them out. Next, the men reflect on how they chose a treatment option for their prostate cancer. Both of them decided to enroll in clinical trials and also underwent nerve-sparing prostatectomies. They both agree that different specialties have different opinions on how their cancer should be treated, so multidisciplinary teams at tumor boards often come up with the best approach to present to patients. Marc emphasizes that patients should be proactive and not push decision-making onto their physicians. Patrick also discusses how he mentally prepared himself for the side effects (i.e. urinary incontinence, erectile dysfunction) after his prostatectomy. Additionally, Patrick and Marc explain how they felt when receiving various follow up PSA draws and scans after surgery. Dr. Bagrodia notes that follow up measures may cause patients lots of anxiety as well. Marc and Patrick both emphasize the importance of a positive attitude during the post-operative period. Lastly, they discuss germline testing for familial conditions and agree that it provides more knowledge and preparation for their children, who may benefit from earlier screenings and treatments.

In this episode of BackTable Urology, Dr. Esther Han (USMD Hospital) and Dr. Richard Santucci (Crane Center) discuss genital gender affirming surgery techniques and postoperative management. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/ij2MdK --- SHOW NOTES First, Dr. Santucci discusses his career pivot from academic trauma reconstruction to private practice gender affirming reconstruction. After 17 years at Detroit Medical Center as director of trauma reconstruction fellowship, he left his position to learn gender-affirming surgery at the Crane Center in Austin, Texas. He was drawn to gender affirming surgery because of the dynamic techniques and novel research in the field. Next, the doctors review of vocabulary for transgender patients. Dr. Crane notes that vocabulary is always changing and advises doctors to not assume a patient’s gender or surgical preferences based on appearance. Additionally, Dr. Han explains why using the word “normal” over medically correct terms can confuse and cause discomfort in patients. Next, Dr. Santucci summarizes the gender affirming surgeries he performs. He explains trans women surgeries, such as full vaginoplasty and vulvoplasty. In trans men, he performs metoidioplasty and phalloplasty. However, Dr. Santucci emphasizes that patients are given the freedom to customize their own surgeries by picking which anatomical parts they would like to keep, change, or remove. Complications, such as urethral strictures and infections may occur in all these surgeries. Additionally, he emphasizes the need for addressing fertility with trans men, as some of them would like to keep their ovaries for egg harvesting. Then, the doctors discuss the recent change in World Professional Association for Transgender Health (WPATH guidelines), which now only require one letter from a therapist instead of two in order to receive genital surgery; however, insurance companies may require more letters. The doctors also contemplate the presence of post-operative regret, since gender affirming surgery is difficult to reverse. Dr. Santucci explains that regret is often tied to postoperative complications. Then, he delves deeper into the management of phalloplasty complications, such as postoperative incontinence, postoperative infections, and erosions. He also emphasizes the importance of prostate cancer screening for trans women. Although it is rare, the prostate cancer they develop is testosterone independent, making it more difficult to treat and more aggressive. Finally, Dr. Santucci shares what a typical week in his life looks like and reflects on how multidisciplinary collaboration in the OR has made his operations more efficient and effective.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Petar Bajic speak about various ways that the men’s health field is evolving, such as the rise of direct-to-consumer services, the need for more community urologists, and ways to de-stigmatize common men’s health conditions. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/AcDjsu --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- SHOW NOTES First, the doctors discuss the popularity of direct-to-consumer (DTC) healthcare. Both doctors agree that this option may seem appealing to some patients because of anonymity, privacy, and convenience. However, Dr. Bajic notes that DTC services may be dangerous because DTC services do not routinely identify red flags of other major medical issues and do not provide preventative health care or routine screenings. Additionally, Dr. Silva and Dr. Bajic reflect on their own experiences of treating patients who have experienced avoidable complications after receiving DTC treatments and prescriptions. Furthermore, they brainstorm ways to educate patients about dangers of DTC medications without proper medical consultations. They agree that spreading awareness to patients and families and breaking down boundaries that men may have about incontinence and erectile dysfunction may be good places to start. However, Dr. Bajic notes that there is a beneficial role in integrating licensed medical care with the use of e-pharmacies to lower the cost of medications for patients. Next, they discuss the growing need for community urologists in rural and urban areas. They weigh the pros and cons of a shorter surgical residency and the creation of purely medical urology fellowships. Then, they discuss potential a need for advanced practice providers and implications for the scope of urological practice.

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Peter Steinberg, director of quality and safety in the Division of Urology at Beth Israel Deaconess Medical Center, about practical tips and his personal experience in improving quality and safety. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/dyLGud --- SHOW NOTES First, Dr. Steinberg explains how he found quality and safety as his niche in academic medicine. He was named in a malpractice lawsuit as a resident, which encouraged him to think about safety and complications in OR. Furthermore, he became interested in root cause analysis at his institution and discovered that he was skilled at improving the efficiency and results of a process. Next, he and Dr. Silva define and discuss quality, which they agree is delivering safe and effective outcomes in efficient time and lower cost to patients. Quality includes getting rid of waste processes, such as patients waiting for too long, not utilizing physician talent, extraneous movement within a system, and extra steps in a process in general. Dr. Steinberg explains that although surgeons already think in an efficient and high quality manner, they are underrepresented in quality and safety discussions. If solutions are simple, he encourages members of a healthcare team to deal with issues themselves or within their direct teams. For bigger problems with more complex solutions, challenges arise if higher administration needs to get involved to implement solutions. However, he gives a few tips for speaking with administration, such as speaking administrative language and performing an impact effort matrix to find high impact projects with low effort. Additionally, he shares acronyms for quality improvement projects, like SMART goals (specific, measurable, achievable, relevant, timely) and PDSA cycles of improvement (plan, do, study, act ). Next, he defines safety as the process of minimizing errors in order to meet a promised standard of care. Safety events can include preventable harm, adverse events, and near misses. Some big areas where safety may be compromised are medications, universal protocols, support staff and equipment, patient selection, use of techniques/maneuvers, and fire safety. To ensure the correct patient and side for operations, he encourages the use of two identifiers and time out procedures, even for in office procedures. He always reads labels and sticker labels for his medications. Furthermore, he encourages private practice doctors to engage in some form of M&M boards to categorize their complications, like in academic centers. Finally, he summarizes that safety issues are often systemic and undetectable instead of the result of a single action.

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Jonathan Clavell, a men’s health specialist, about workup and treatment options for Peyronie’s disease. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/6wT7AR --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- SHOW NOTES First, Dr. Clavell explains that Peyronie’s patients have extremely variable presentations. They can have distal or proximal curvatures, penile shortening, pain, hourglass deformities, and calcified plaques. However, Dr. Clavell believes that listening to the patient is the most important thing a urologist can do, as most patients take years to seek treatment and may be very distraught about their diagnosis. He notes that most men he sees are already in a stable phase (3 months of no change in curvature), as they are referred to him by other urologists. He also notes that penile pain is not unique to Peyronnie’s disease; patients need to also have an acquired penile deformity as well to be given an accurate diagnosis. Dr. Clavell emphasizes that the treatment option and duration should be based on the degree of bother and degree of erectile function, instead of by the degree of curvature. Then, Dr. Clavell summarizes the surgical and non-surgical options for Peyronie’s disease. He notes that medications, such as pain medication and Cialis are always available. Additionally, non-pharmacological penile rehabilitation therapies, such as traction therapy and vacuum therapy have helped some of his patients. He notes that traction therapy combined with Xiaflex injections can be useful in patients who can still maintain good erections; however, injections should not be used in men with erectile dysfunctions or calcified plaques. In these patients, a penile prosthesis is indicated. Other complex cases that will require surgery are Peyronie’s patients with severely calcified plaques, severe deformities, two points of angulation, corporal wasting, and an unstable penis. Besides penile implantation surgery, two other surgical options for Peyronie’s disease are grafting and plication surgery. The risks of all surgeries should be discussed with patients. Finally, Dr. Clavell explains his advanced surgical techniques for penile implant surgeries, such as alternative incision sites and the modified sliding technique. --- RESOURCES Dr. Clavell’s Youtube Channel: https://www.youtube.com/@clavelluro Dr. Clavell’s Website: https://houstonmenshealth.com/

In this episode of BackTable Urology, Dr. Angie Smith (UNC Chapel Hill) and Dr. Rena Malik (University of Maryland) discuss practical tips for developing a growth mindset in medicine. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/jkLckg --- SHOW NOTES First, Dr. Malik defines growth mindset as the belief that you can do something or accomplish something that you don’t know how to do yet. Both doctors agree that adopting this mindset also requires expecting failures along the way, asking for help, and sharing your vulnerabilities with colleagues and trainees. Then, both of them share personal experiences about when developing growth mindsets were difficult for them and how they overcame self-doubt. Dr. Malik suggests journaling to think about long-term goals and assess personal obstacles. Dr. Smith encourages doctors to set aside time for self care and reflection. Next, the doctors discuss how to cultivate a growth mindset in situations they might not wholeheartedly enjoy all the time, like seeing patients in the clinic instead of being in the operating room. Dr. Smith shares how meaningful conversations with her patients brought her joy in the clinic and advocated for more time to engage in these conversations. Dr. Malik was able to streamline her charting through a detailed intake form and utilizing dot phrases so she could spend less time charting in the office and at home. Finally, the doctors discuss ways to encourage their colleagues to adopt a growth mindset as well. Both agree that encouraging colleagues to question their negative attitudes and stopping the propagation of negative attitudes and stories is helpful to building a more positive workplace environment. --- RESOURCES Mindset by Carol Dweck https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/ Chatter by Ethan Kross https://www.ethankross.com/chatter/ Dr. Malik’s Website http://www.renamalikmd.com Dr. Malik’s YouTube Channel https://www.youtube.com/channel/UCV66hp0qxx2Xq273N0bo7uQ Dr. Malik’s Twitter http://twitter.com/RenaMalikMD

In this episode of BackTable Urology, Dr. Bagrodia discusses cultivating a healthy culture inside and outside of the operating room with Dr. Chris Kane, Dean of Clinical Affairs at UCSD and CEO of the UCSD Physician Group. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/rVQG40 --- SHOW NOTES First, the doctors discuss the definition of culture, which Dr. Kane defines as the norms of behavior and relationships within an organization. Culture can include dress code, meeting rules, and punctuality. Most of the time, institutional culture is established in an unspoken way. Dr. Kane emphasizes the importance of having a conscious strategy to create a healthy culture and reiterates that trust is a crucial foundation for motivating cultural changes. Next, the doctors discuss helping team members find meaning in their work. Dr. Kane recommends that surgeons share patient gratitude with their other colleagues who are not frontline medical workers. He acknowledges his staff’s contributions during meetings and expresses his gratitude through written notes. He also recommends communication training for everybody on his team. Then, he shares tips for assessing organizational culture. He believes that it is most important to ask team members what they think the overarching goal of the institution is and to assess the attrition rate through exit surveys. He emphasizes that behavioral norms matter most, as department leaders often lead by example. One detrimental practice is favoritism, which Dr. Kane regards as disrespectful to other team members. Additionally, he shares his personal experiences with changing cultures at different institutions and utilizing change management theories. Finally, Dr. Kane shares general leadership advice. He highlights the importance of creating a patient-centered environment, leading by influence rather than authority, and the power of positivity.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Stephen Nakada, chair of urology at the University of Wisconsin, discuss indications and benefits of extracorporeal shock wave lithotripsy (ESWL). The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/Ebk55a --- CHECK OUT OUR SPONSOR ReviveRX https://reviverx.com/urology/ --- SHOW NOTES First, the doctors discuss ideal candidates for ESWL. Dr. Nakada considers 2 centimeters as the maximum stone size for ESWL. The stone must be low density (<1000 Houndsfield units) on CT, and the skin-to-stone distance must be less than 10 centimeters. Other contraindications to ESWL include patients with coagulopathy and patients with a solitary kidney. Dr. Nakada mentions that PCNL and a trial of passage are more common treatments for kidney stones. He also emphasizes the importance of continual stone analysis because stone composition can change over time, thus changing the probability that ESWL will work. He prefers to observe patients in their 70’s / 80’s and patients with calyceal stones. He also mentions that it is important to mention the higher failure rates of ESWL when compared to other treatments in the initial discussion with the patient. Next, Dr. Nakada describes his ESWL technique. He continues to deliver shock waves to the stone until he cannot see it with fluoroscopy. For obstructing stones, he gives contrast to check for complete fragmentation. Additionally, he mentions that urologists might have to wait 6-8 months after the procedure for the patient to pass their stones, so the conventional 3 months is not a good benchmark for re-treatment. If there is one fragment that is too large to pass, he will perform a second lithotripsy. He states that there is no role for a third lithotripsy. Next, Dr. Silva and Dr. Nakada discuss why ureteroscopy has eclipsed ESWL. They come to the conclusion that more residents are trained to do PCNL, there is a strict criteria for ESWL, and heavier patients usually cannot meet the skin-to-stone distance. The doctors then discuss imaging for kidney stones and Dr. Nakada notes that ultrasound is unreliable to gauge stone size. Although he always gets a CT scan without contrast before the procedure, a postoperative CT scan may be difficult to obtain because of cost limitations. Finally, the doctors discuss their post-procedural recommendations. Dr. Nakada sends all his patients home with Flomax and a single dose of antibiotics. He avoids narcotics and NSAIDs and recommends Tylenol. FInally, he schedules a follow-up KUB 2 weeks after the procedure.

In this episode of BackTable Urology, Dr. Bagrodia and Dr. Jay Raman, the chair of urology at Penn State Health, discuss advancements and future directions of medical education for trainees. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/s82N5z --- SHOW NOTES First, the doctors discuss the need for medical education to incorporate multimedia and active learning into residency curriculums and CME courses. Dr. Raman notes that although the copious amounts of articles and videos online may be overwhelming, integrating quality videos, textbook chapters, and journal articles into a standardized curriculum for urology residents can teach them the fundamentals of urology. Additionally, he notes that this approach takes into consideration different learning styles. Dr. Bagrodia emphasizes how the AUA core curriculum has leveled the playing field for trainees, as it has standardized education across all training programs. He suggests a model of having residents do pre-work by learning from the AUA curriculum on their own time and then using valuable in-person time with attendings to review case examples. Dr. Raman agrees that meeting in person for resident lectures or conference courses should be interactive and incorporate active learning exercises. They then reflect on the social value of getting together in order to network and discuss cases casually, but concede that virtual meetings can be more convenient for family life and comfort. Next, the doctors discuss the role of simulation in education. Dr. Bagrodia notes that simulation increases practice opportunities for residents, which makes them safer and more competent surgeons. Dr. Raman is excited about virtual reality technology, which makes simulation more feasible and realistic for many training programs. The doctors then discuss the possibility of incorporating simulation into board exam certifications. Dr. Raman explains the traditional arc of residency training and proposes changes to this arc to help align resident education better with their future practice types and meet the current need for more general urologists. Finally, they end the episode by addressing the need to expand resident and CME education beyond clinical education to include topics like social determinants of health, time management, wellness, and environmental stewardship.

In this episode of BackTable Urology, Dr. Bagrodia and Dr. Jay Simhan, director of reconstructive urology at Fox Chase Cancer Center, discuss how to demonstrate value at a private or academic physician job. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/DU5Nmx --- SHOW NOTES The doctors first briefly discuss the process of obtaining a physician job. Dr. Simhan believes that physicians should negotiate their contracts only out of necessity. He encourages new attendings to demonstrate their own value to the administrators who create their contracts. Next, the doctors move onto advice for the first 3 months in a new job. Both doctors agree that the goal should be to learn who people are and earn their respect, whether they are residents, trainees, other attendings, nurses, MAs, or administrators. Dr. Simhan also emphasizes the importance of building your own cultural philosophy and deciding what you care about. Then, the doctors discuss the traditional 3 A’s: available, affable, and able. Dr. Simhan notes that for a new physician, availability and affability are probably more heavily weighted for new hires. Dr. Bagrodia believes that accountability should be the 4th A because physicians should know when to accept their mistakes and move forward. Finally, Dr. Simhan explains how he had to learn the landscape of his new department at Fox Chase Cancer Center in order to figure out how he could build and fit in his reconstructive urology program. Finally, the doctors discuss how to engage in tactful self-promotion to demonstrate your value. Dr. Simhan explains that recognition is not a negative result to seek, as it can fuel your passion (e.g. bigger patient base, support for funding, etc.). He encourages doctors to have a personal website, to always update referring doctors after clinical visits and surgeries, and to be available to trainees and nurses. Additionally, Dr. Bagrodia advises physicians to meet with their department chairs and mentors to discuss progress and ask for help. He discourages physicians from giving unsolicited advice to their colleagues. Finally, the doctors share some of their miscellaneous tips for demonstrating value within a hospital system. Dr. Bagrodia notes that it is helpful to be prepared with talking points, ideas, and solutions when meeting with hospital administrators. Dr. Simhan adds that it is important to fully commit to the responsibilities that you agree to take on.

Inequality persists in pay and career advancement between male and female urologists. In this episode of the BackTable Urology Podcast, Dr. Suzette Sutherland hosts Dr. Yahir Santiago-Lastra from the University of California San Diego. They discuss the gender wage gap in medicine, particularly amongst urologists. --- This podcast is supported by: Photocure https://www.photocure.com/ --- SYNPOSIS Dr. Santiago, a Latina from Puerto Rico and a first-generation physician, highlights the latest data on pay, research funding, and professional advancement for women physicians. They debunk common myths, discuss the importance of transparency, and emphasize the need for inclusive work environments. The conversation also covers the economic phenomena underlying current discrepancies and the benefits of fostering diversity. This episode offers valuable insights for leaders on retaining and nurturing talent within their organizations. --- TIMESTAMPS 00:00 - Introduction 06:28 - Impact of Menopause and Women’s Health 10:33 - Gender Gaps in Urology 31:52 - The Meritocracy Myth 35:56 - The Abrasiveness Trap and Gender Schema 40:04 - Navigating Work Personalities 47:54 - Leadership and Inclusivity in Organizations 51:30 - Tokenism vs. True Inclusion 56:58 - The Benefits of a Diverse Workforce --- RESOURCES Photocure https://www.photocure.com/

In this cross-specialty episode of BackTable OBGYN, Dr. Amy Park chats with Dr. Jose Silva, a board certified urologist and co-host of BackTable Urology, about the workup, counseling, and management of urinary incontinence and pelvic organ prolapse. --- SHOW NOTES The co-hosts begin by briefly discussing the workup for pelvic organ prolapse (POP). Dr. Park identifies common symptoms of prolapse and special exams (e.g. Pelvic Organ Prolapse Quantification System or POP-Q and urodynamics) that may be utilized for initial evaluation. She then explains the clinical indications for treatment of isolated POP, in addition to POP with concomitant urinary incontinence. Drs. Park and Silva then transitioned to cover the management of urinary incontinence. The two co-hosts reveal the benefits of pelvic floor physical therapy and other conservative management options, such as core-centric exercises and weight loss. In length, they elaborate on the benefits and takeaways of using sling procedures versus urethral bulking agents (e.g. Bulkamid). When discussing these topics, the co-hosts bring to light the possible differences in approach between Urogynecologists and Urologists. In regard to urethral bulking agents for treatment of urinary incontinence, Drs. Park and Silva highlight the potential role for stem cell injections. In addition, Dr. Park provides a tip to maximize patient comfort during in-office periurethral injections for urethral bulking. When focusing on sling procedures, Dr. Park highlights her preferred approach and encourages listeners to become proficient in the approach of their choosing. Lastly, they describe their approaches to treatment of stress urinary incontinence. In their discussion, Drs. Park and Silva consider factors such as patient age, desire for future fertility, and pregnancy. When wrapping up the episode, Dr. Park emphasizes the importance of patient counseling when it comes to management of these conditions, as well as practicing shared decision making to determine the best next steps for her patients. --- RESOURCES Nager CW, et al. Design of the Value of Urodynamic Evaluation (ValUE) trial: A non-inferiority randomized trial of preoperative urodynamic investigations. Contemp Clin Trials. 2009 Nov;30(6):531-9. doi: 10.1016/j.cct.2009.07.001. Epub 2009 Jul 25. PMID: 19635587; PMCID: PMC3057197. Erin A. Brennand, Shunaha Kim-Fine. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial, Contemporary Clinical Trials Communications, Volume 3, 2016, Pages 60-64, ISSN 2451-8654, https://doi.org/10.1016/j.conctc.2016.04.004. M. Abdel-Fattah, D. Cooper, T. Davidson, M. Kilonzo, M. Hossain, D. Boyers, et al. Single-Incision Mini-Slings for Stress Urinary Incontinence in Women New England Journal of Medicine 2022 Vol. 386 Issue 13 Pages 1230-1243. DOI: 10.1056/NEJMoa2111815 https://doi.org/10.1056/NEJMoa2111815. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011 Jan-Mar;4(1):75-81. Epub 2011 Feb 25. PMID: 21505577; PMCID: PMC3056425.

In this episode, guest host Dr. David Canes interviews Dr. Matthew Allaway about PrecisionPoint, his medical device for transperineal prostate biopsy, and his journey towards changing the paradigms of prostate cancer diagnosis. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/0Lmsku --- SHOW NOTES Dr. Allaway starts by outlining his path to medicine. The choice to pursue urology was largely influenced by his personal cancer diagnosis. He cites cancer as the greatest lesson in his life, since it brings an enhanced level of empathy to his patient care and inspires him to contribute to the field of urology. Throughout his career, he has always examined his procedures for logical sense – if a process was inefficient, he tried to devise ways to make improvements for patient care. In 2013, Dr. Allaway decided to switch from the transrectal to transperineal approach for prostate biopsies. With the traditional transrectal approach, he found unacceptably high rates of infection and failure to detect cancers in the anterior prostate region. He started performing transperineal biopsies with a freehand technique, using ultrasound in one hand and a biopsy probe in the other. He built a database of his own patients, which showed an increased cancer detection rate. His technique eventually evolved into the PrecisionPoint transperineal access system. He originally started marketing the device at American Urological Association (AUA) meetings, through booths and video competitions. Although Dr. Allaway works in private practice and not academia, he was able to form connections with institutions and key opinion leaders to encourage adoption of the transperineal approach. PrecisionPoint has been accepted by early adopters, and his team is now working to capture a larger share of the biopsy market. Importantly, they are also marketing the device to patients, since patients can also recognize the safety and diagnostic benefits, and being the ultimate consumers of healthcare, can influence urologists to adopt the device. Dr. Allaway also gives advice for budding entrepreneurs. He highlights the need to link the device to a specific clinical need, research existing devices, check the your device’s feasibility and pricing strategy, and find good mentors who will allow you to learn from their mistakes. In terms of product marketing, he encourages entrepreneurs to look beyond the United States and explore worldwide markets to increase the chances of product adoption. His confidence in PrecisionPoint grew when he received positive feedback from other urologists about the simple elegance of the device. Finally, Dr. Allaway discusses the importance of truly believing in your product. He says that if you are ashamed of your product’s price, you have priced it wrongly. He encourages entrepreneurs to focus on their product’s benefit to society, rather than profitability. --- RESOURCES Precision Point: https://perineologic.com/precisionpoint/ American Urological Association: https://www.auanet.org/ Zero to One by Peter Thiel: https://www.amazon.com/Zero-One-Notes-Startups-Future/dp/0804139296

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with two fellow urologic oncologists, Dr. Timothy Clinton (Brigham and Women’s Hospital) and Dr. Eugene Pietzak (Memorial Sloan Kettering), about the management of BCG-refractory non muscle-invasive bladder cancer. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/h8YiBe --- SHOW NOTES First, the doctors define BCG-refractory cancer from the clinical and FDA viewpoint. They emphasize the importance of determining the difference between BCG-resistant cancer and residual tumor from the primary resection. Blue light cystoscopy can help in confirming that the original tumor was totally resected. The doctors warn that although the initial response to BCG may be promising, there is still a chance of cancer recurrence. The success rate of BCG depends on the patient and tumor characteristics. Next, they discuss BCG-intolerant patients. BCG has many side effects such as frequency and urgency symptoms and bladder spasms. Some patients will have a systemic immune response resulting in flu-like symptoms. However, most of these side effects are self-limiting and should resolve after the induction course. They also discuss how to deal with the current BCG shortage. They first prioritize starting an induction course and view the maintenance course as a secondary priority. An erythematous and inflamed bladder can either be a result of BCG cystitis or a carcinoma in situ (CIS). The doctors agree that if the bladder is inflamed and the patient has a positive cytology, they would obtain a bladder biopsy to look for recurrent high-grade cancer. If the biopsy is positive, they would start a second induction course of BCG and introduce another form of therapy, like intravesical gemcitabine or an immune checkpoint modulator. If the bladder is inflamed and the patient has a negative cytology or a negative biopsy, they would continue with a BCG maintenance course and follow up. Cystectomy is a curative option for BCG-refractory bladder cancer. Patients with tumors with high risk features such as lymphovascular invasion and varying histology are good candidates for cystectomy. Patient comorbidities, age, and willingness are also important factors in the decision. Dr. Bagrodia also recommends getting a CT scan to check for nodal metastases. Both Dr. Clinton and Dr. Pietzak agree that it is beneficial to introduce the idea of cystectomy early and explain that the procedure does not prevent patients from living a fulfilling life. Finally, the doctors discuss recent BCG and gemcitabine clinical trials as well as new research about non-BCG therapies.

In this special episode, Dr. Phil Pierorazio (University of Pennsylvania) invites Dr. Rana McKay (UC San Diego) and Dr. Raquibul Hannan (UT Southwestern) about treatment options for renal cell carcinoma (RCC) patients in preparation for the 2022 International Kidney Cancer Symposium in Austin, Texas. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/ffUyI5 --- SHOW NOTES First, the doctors discuss their excitement for the 2022 IKCS. They have benefited greatly from participating in collaboration and networking, improving their wellness strategies, learning about new clinical trials, and debating difficult cases at academic conferences like IKCS. Next, Dr. Pierorazio presents four different difficult RCC classes to the doctors and asks for an outline of their treatment plans. He starts with localized disease and works towards more aggressive and nodally invasive cancer. For each case, Dr. McKay and Dr. Hannan explain recent developments in clinical trial data, side effect considerations, and the importance of assessing patient comorbidities. All three doctors draw conclusions based on their previous patients as well. Additionally, Dr. McKay explains why it is important to understand what the patient understands about their cancer diagnosis before presenting these treatment options to patients. Dr. Pierorazio has learned to ask patients about their greatest cancer-related fear in order to guide his treatment decisions. Dr. Hannan advises doctors to look at the failure rates of clinical trials along with the success rates. Cases presented: Localized clear cell RCC patient with 1 kidney Adjuvant chemotherapy for a post-nephrectomy patient with T3a clear cell RCC Papillary RCC patient with a 10 cm mass and a 10 cm para aortic lymph node Chromophobe RCC patient with an 8 cm renal mass and spinal metastasis

In this episode, Dr. Aditya Bagrodia speaks with Dr. Manoj Monga, chair of the urology department at UC San Diego, about his unique journey to becoming a urologist as well as extra-academic passions that have led him to understand the importance of advocacy. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/B9LqOK --- SHOW NOTES First, Dr. Monga shares the story of his childhood. As an Indian born and raised in Belfast, Ireland, he had to adapt to living among a different culture and religion. In his childhood, he was surrounded by bomb scares and bomb drills because of the religious and political conflict in Ireland. His parents ultimately made the decision to move to Ontario, Canada for family safety. He finished his schooling in Ontario, Canada and noted that his decision to pursue medicine was more based on a path of least resistance rather than initial passion. He chose medicine out of practicality, but was interested in a musical career because he played the french horn, trumpet, and saxophone. He still plays musical instruments and has realized that many musical skills, such as practice and challenging himself, have translated into medical skills. He then speaks about his early career. Dr. Monga did not start out with an ultra-focused goal of becoming a urologist. He started as a categorical general surgery intern at Tulane because of his interest in trauma and reconstructive surgery. In his second year in Louisiana, he gained his first exposure to urology and decided to fill an empty spot in the urology residency program. However, he took a 1 year research gap at Tulane to study endourology, pyelonephritis, and andrology. He noted that this year helped him with aligning his career with his wife’s career and prompted him to think about an academic career. He finished residency and trained at a variety of institutions, such as UC San Diego and the Cleveland Clinic. Then, Dr. Monga reflects about his transition to UC San Diego as the chair of urology during the pandemic. It was difficult to leave his family at first, but he was impressed by the teamwork and selflessness of his department. Shortly afterwards, he became the secretary of AUA, a position that was fulfilling, but also one that challenged his time management skills. Finally, Dr. Monga explains why taking action and being an advocate is so important in his professional and personal life. Inspired by recent events, he has taken multiple trips to provide medical relief in Ukraine. He found that the refugee history he encountered abroad resonated with him and motivated him to create a better world for his kids by developing meaningful passions. He encourages using urology for social responsibility by advocacy and raising funds for important causes instead of stopping at social media to raise awareness. Finally, Dr. Monga sums up three big lessons he has learned. First, he is fortunate for the open paths and family/mentor support. Second, he has learned to temper his enthusiasm for simple answers to complex issues. Finally, he realizes the importance of sharing experiences to let people who are suffering know that they are not alone.