BackTable Urology – Details, episodes & analysis

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.