BackTable Urology

By one estimate, half or more of all non-muscle invasive bladder cancer (NMIBC) is intermediate risk, yet the major guidelines still do not define it the same way, which leaves urologists sorting a large, mixed group of patients without a shared playbook for when to resect again, treat in the office, or start intravesical therapy. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Wesley Yip, urologic oncologist at City of Hope, to rethink what she calls the forgotten stepchild of bladder cancer: intermediate-risk non-muscle invasive bladder cancer (NMIBC). Dr. Yip explains why he sees the category as a catch-all rather than a single biological entity, by his estimate covering 50 to 60 percent of NMIBC, why he now relies on the International Bladder Cancer Group (IBCG) definition, and why tumor grade comes first, ahead of multiplicity, size, and recurrence timing. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:24 - Defining Intermediate-Risk NMIBC07:53 - Case Presentation and the Initial TURBT10:42 - Evaluating the First Recurrence13:09 - High-Grade Cytology and Blue Light Cystoscopy15:01 - The Burden of Repeat TURBT16:57 - Office Fulguration and Chemoablation20:23 - Chemoablation Tolerability and Patient Selection24:24 - Intravesical Chemotherapy and Treatment Barriers28:08 - New Formulations and Upcoming Trials33:12 - Recurrence After Chemoablation and De-escalation38:00 - Future Directions and Patient-Centered Endpoints42:39 - Closing Remarks --- More about this episode Working through the case of a healthy 67-year-old man with recurrent low-grade Ta disease, the two discuss what to document at the first resection, how to counsel patients, when to return to the operating room, and when office fulguration, intravesical chemoablation, or intravesical chemotherapy with gemcitabine and docetaxel makes more sense. They cover the cumulative burden of repeat transurethral resection, practical lessons from bringing chemoablation into the clinic, how to read new trial data, and when to de-escalate surveillance. Dr. Yip closes with his hopes for the next five years: a biology-based definition and trials that measure fewer recurrences, fewer procedures, and better quality of life. --- Resources Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35718695/ Intermediate-risk Non-muscle-invasive Bladder Cancer: Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group. Eur Urol Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/41076366/ All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors. J Urol. 2022https://pubmed.ncbi.nlm.nih.gov/35770498/ Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline EAU Guidelines on Non-muscle-invasive Bladder Cancerhttps://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer Bladder Cancer Advocacy Network (BCAN)https://bcan.org Dr. Wesley Yip, City of Hope physician profilehttps://www.cancercenter.com/physician-directory/wesley-yip Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

By his own estimate, an AI scribe gives one urologist about two hours of his day back, and an evidence tool built into it has taught him something new in the clinic almost every day. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes back Dr. David Canes, urologist at Lahey Hospital & Medical Center and founder of WellPrept, to talk about how urologists can practically put AI to work. Dr. Canes explains why he sees this moment as a renaissance for physicians, how an AI scribe turned him from author into proofreader, by his estimate saving about two hours a day, and why evidence tools running alongside the scribe now answer questions in the exam room, including a question about post-prostatectomy dysorgasmia, a complaint that rarely comes up in clinic. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:32 - Getting Started With AI in Practice07:24 - AI Scribes and Cognitive Load14:18 - AI Evidence Tools at the Point of Care18:41 - Context, Pre-Charting, and Evidence in the Exam Room24:52 - AI for Email and Personal Workflow29:09 - Building a Permanent AI Memory34:20 - AI Skepticism, Privacy, and Intellectual Honesty40:47 - Will AI Replace Physicians?46:39 - Pre-Charting, Patient Education, and Care Journeys49:27 - Reducing the In-Basket Burden53:04 - Where to Start With AI55:27 - Closing Remarks --- More about this episode The conversation then moves beyond the clinic. Dr. Canes describes an AI layer on email that flags what cannot wait, and a permanent AI memory built from plain text files that keeps research, licenses, talks, and family life organized, with a firm rule that no protected health information goes anywhere without a business associate agreement. He and Dr. Talwar discuss what work is worth delegating to AI, push back on a recent JAMA perspective arguing that autonomous AI may outperform physicians, and run through tools for pre-charting, patient education, postoperative care journeys, and front-desk calls. Dr. Canes closes with simple advice for exhausted physicians: ask the AI you already use to build you a 90-day plan. --- Resources Will Autonomous AI Exceed AI-Aided Physicians as the Best Medical Care? JAMA. 2026https://jamanetwork.com/journals/jama/fullarticle/2852952 The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis. Eur Urol. 2005https://pubmed.ncbi.nlm.nih.gov/15716202/ WellPrepthttps://www.wellprept.com BackTable Urology Episode 55: Patient Preparation Made Easy: The WellPrept Storyhttps://www.backtable.com/shows/urology/podcasts/55/patient-preparation-made-easy-the-wellprept-story Dr. David Canes, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-david-canes Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Every prostate cancer biomarker returns a number, but the real question is whether that number changes what you do next for the patient. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Amir Lebastchi, urologic oncologist at Keck Medicine of USC, to discuss how biomarkers are moving prostate cancer care from numbers to meaningful clinical decisions. They define what makes a biomarker clinically useful, organize the growing list of blood, urine, and tissue tests into pre-biopsy, post-negative-biopsy, and post-diagnosis settings, and talk through where these tests fit alongside MRI after an elevated PSA. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Cleveland Diagnosticshttps://www.isopsa.com/ --- Timestamps 00:00 - Introduction02:59 - Clinical Utility and a Framework for Biomarkers08:43 - Workup of an Elevated PSA11:42 - Pre-Biopsy Blood and Urine Tests13:29 - Equivocal MRI, Outside Imaging, and Community Practice20:26 - Patient Factors and Practical Considerations24:44 - Case: Elevated PSA and a Negative MRI30:11 - Case: Biopsy Approach and Discordant Results34:41 - Counseling on PSA Limitations and Overdiagnosis37:05 - Biomarkers in Active Surveillance and Renaming Grade Group 140:56 - AI and the Future of Biomarkers44:38 - Take-Home Points and Closing Remarks --- More about this episode The discussion covers equivocal MRI findings, patient counseling, and the practical impact of age, family history, and race when interpreting PSA levels. Through real cases, Dr. Lebastchi explains when he repeats a PSA, how he performs a templated transperineal biopsy, and why a negative MRI plus a negative biomarker can give him the confidence to forgo a biopsy. They also touch on active surveillance, the debate over renaming grade group 1 prostate cancer, and how AI may help future tests guide treatment intensity rather than just risk category. Dr. Lebastchi closes with the clinician’s obligation to know all available tests and use those that truly inform management. --- Resources Early Detection of Prostate Cancer: AUA/SUO Guideline (2023)https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines Clinical validation of IsoPSA, a single parameter, structure-focused assay for improved detection of prostate cancer: A prospective, multicenter study. Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35840465/ Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients With Elevated PSA. Urology. 2023https://pubmed.ncbi.nlm.nih.gov/36965817/ Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. J Clin Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35436144/ The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer. J Natl Cancer Inst. 2023https://pubmed.ncbi.nlm.nih.gov/37285311/ Dr. Amir Lebastchi, Keck Medicine of USC physician profilehttps://keckmedicine.org/provider/amir-h-lebastchi Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How is suction technology changing what it means to be “stone-free” after ureteroscopy? On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Karen Stern, endourologist at Mayo Clinic Arizona, for a practical discussion of how ureteroscopy is evolving in the era of suction. They discuss how thin-slice CT has revealed just how much stone typically remains after surgery, why dusting versus fragmenting is now a patient-dependent choice, and what to consider when selecting between suction sheaths, aspiration scopes, and traditional access. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Dornierhttps://www.dornier.com/backtable --- Timestamps 00:00 - Introduction02:16 - Residual Stone and Defining Success04:59 - Dusting, Fragmentation and Suction Devices07:15 - Patient Selection, OR Setup and Laser Settings11:39 - Evidence, Stone Clearance and Infection Risk15:39 - Community Adoption and Technique Pearls20:05 - Integrated Systems and Artificial Intelligence22:29 - Take-Home Points and Closing Remarks --- More about this episode The doctors discuss patient selection, OR setup, stenting, and why stones over a centimeter benefit most from a suction approach. Dr. Stern shares her tips for suction device setup, irrigation and suction settings, and how even a short learning curve can make these techniques routine. They review infection risks, evidence on residual stone volume, pearls for community adoption, and look ahead to integrated laser-suction platforms and AI tools that may one day help define when a case is truly finished. Dr. Karen Stern closes with advice for urologists on the fence: every technology works, but the best choice is the one that fits your practice. --- Resources Are We Overreporting Post-Op Sepsis? The Difference Between Reported and Verified Rates of Post-Ureteroscopy Sepsis Using the Sepsis 3 Criteria at a Single Institution. J Endourol. 2026https://doi.org/10.1177/08927790251394736 Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath Versus Mini-Percutaneous Nephrolithotomy for Treatment of 2-3 cm Renal Stones: An International, Multicenter, Randomized, Noninferiority Trial. Eur Urol. 2026https://doi.org/10.1016/j.eururo.2025.06.001 Dr. Karen Stern, Mayo Clinic physician profilehttps://www.mayoclinic.org/biographies/stern-karen-l-m-d/bio-20464490 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Same risk group, very different benefit. Can biomarkers help identify who needs treatment intensification in prostate cancer? On this episode of BackTable Urology, Dr. Ruchika Talwar and Dr. Angela Jia, a radiation oncologist at University Hospitals Cleveland Medical Center, break down the difference between prognostic and predictive biomarkers and how genomic testing is informing the way clinicians counsel patients. They review trial data suggesting that men with a low genomic score may gain little from adding hormone therapy, along with early prospective evidence that the luminal B subtype may help identify who benefits most from intensification. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Verasytehttps://www.veracyte.com/ --- Timestamps 00:00 - Introduction02:08 - Prognostic vs. Predictive Biomarkers06:34 - The NRG/RTOG 0815 Biomarker Cohort10:15 - Applying a Low Genomic Score in Clinic15:16 - Genomic Classifiers After Prostatectomy18:52 - RTOG 9601, SPPORT and the Salvage Evidence24:39 - Stage Migration and the Case for an ARPI28:13 - Ordering and Reading the Genomic Report34:31 - Common Mistakes in Interpretation37:31 - Where Genomics Could Go Next41:03 - Reflex Testing, EMR Integration and AI44:44 - Closing Remarks --- More about this episode The conversation covers practical application of test results, counseling with absolute risk numbers, and the pitfalls of stretching predictive claims beyond their evidence. Dr. Jia explains the limits of biopsy sampling, how stage migration with advanced imaging may shift baseline risk, and why a large portion of the genomic score remains unexplained by standard variables. The episode closes with a look at reflex testing, the potential role of AI, and the longer-term goal of giving patients clear, individualized benefit estimates for each treatment option. --- Resources NRG/RTOG 0815: A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT00936390 NRG-GU006 (BALANCE): A Phase II Randomized Trial of Salvage Radiotherapy With or Without Apalutamide in Recurrent Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT03371719 Feng FY, et al. Validation of a 22-Gene Genomic Classifier in Patients With Recurrent Prostate Cancer: An Ancillary Study of the NRG/RTOG 9601 Randomized Clinical Trial. JAMA Oncol. 2021https://pubmed.ncbi.nlm.nih.gov/33570548/ Pollack A, et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT). Lancet. 2022https://pubmed.ncbi.nlm.nih.gov/35569466/ Zhao SG, et al. Associations of Luminal and Basal Subtyping of Prostate Cancer With Prognosis and Response to Androgen Deprivation Therapy. JAMA Oncol. 2017https://pubmed.ncbi.nlm.nih.gov/28494073/ Patel KR, Nguyen PL, et al. Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413 and 9902 Phase 3 Trials. Eur Urol Oncol. 2026https://pubmed.ncbi.nlm.nih.gov/39542826/ Grist E, et al. Tumor transcriptome-wide expression classifiers predict treatment sensitivity in advanced prostate cancers (STAMPEDE). Cell. 2025https://pubmed.ncbi.nlm.nih.gov/40865526/ Jia AY, et al. Cross-Comparison Individual Patient-Level Analysis of Three Gene Expression Signatures in Localized Prostate Cancer in Over 50,000 Men. JCO Precis Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/40479622/ Dr. Angela Jia, University Hospitals physician profilehttps://www.uhhospitals.org/doctors/Jia-Angela-1902338718 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How do you decide if a neurogenic bladder is a safety problem or a quality of life problem for each patient, and how do you move from guideline risk categories to a real surveillance plan? On this episode of BackTable Urology, Dr. Anjali Kapur interviews Dr. Benjamin Brucker, professor of urology and director of neuro-urology at NYU Langone Health, about navigating neurogenic lower urinary tract dysfunction. They start with the AUA and SUFU guideline framework, covering history, physical exam, mobility, cognition, voiding diaries, and risk stratification to sort patients into low, unknown, or high risk. Dr. Brucker outlines the findings that move a patient between categories and the workup needed, from renal ultrasound and urodynamics to identifying unsafe storage pressures and elevated post-void residual. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byMedtronic --- Timestamps 00:00 - Introduction03:20 - Initial Evaluation Under the AUA and SUFU Guidelines05:39 - Risk Stratification and Surveillance13:08 - Role of Fluoroscopy in Urodynamics14:55 - Spinal Cord Injury and Detrusor Sphincter Dyssynergia17:35 - Multiple Sclerosis, Parkinson Disease, and Stroke23:13 - Cognitive and Functional Status in Therapy Selection25:16 - Neuromodulation in the Neurogenic Population29:07 - Catheter Management and Sphincterotomy35:49 - Medical Therapy, Chemodenervation, and Surgical Escalation42:50 - Asymptomatic Bacteriuria and Antibiotic Stewardship46:04 - Gaps in Practice and Research on the Horizon50:48 - Closing Remarks --- More about this episode The conversation dives into the nuances of managing neurogenic bladder by underlying disease, from detrusor sphincter dyssynergia after spinal cord injury to the variable patterns in multiple sclerosis, Parkinson disease, and stroke. Dr. Brucker explains the role of videourodynamics, the importance of matching therapy to cognition and mobility, and how to counsel patients on medical therapy, neuromodulation, catheterization, and surgery. They discuss antibiotic stewardship for asymptomatic bacteriuria, gaps between guidelines and real-world care, and what new devices and bladder transplant might mean for the future. The episode closes with a reminder that management is about treating the whole person, not just the diagnosis. --- Resources Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/adult-neurogenic-lower-urinary-tract-dysfunction Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol. 2021https://doi.org/10.1097/JU.0000000000002235 Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. J Urol. 2021https://doi.org/10.1097/JU.0000000000002239 Vurture G, Peyronnet B, Palma JA, et al. Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J. 2019.https://doi.org/10.5213/inj.1938086.043 Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). https://sufuorg.com/ American Urological Association (AUA)https://www.auanet.org/ First human bladder transplant, UCLA Health, 2025.https://www.uclahealth.org/news/release/first-human-bladder-transplant-performed-ucla Dr. Benjamin Brucker, NYU Langone Health physician profilehttps://nyulangone.org/doctors/1235295619/benjamin-m-brucker Dr. Benjamin Brucker, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-benjamin-brucker Dr. Anjali Kapur, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-anjali-kapur --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What is the difference between mentorship, sponsorship, and coaching in a physician’s career, and how can coaching influence your professional development? On this episode of BackTable Urology, Dr. Helen Bernie interviews Dr. Emilie Johnson and Dr. Angie Smith about the transformative impact of career coaching for urologists. They break down how coaching differs from mentorship and sponsorship, who stands to benefit most, and the real value of having a conversation focused entirely on your goals and growth. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast was developed in collaboration withSociety of Women in Urologyhttps://swiu.org/home.aspx --- Timestamps 00:00 - Introduction03:21 - Mentorship, Sponsorship, and Coaching06:23 - Paths Into Physician Coaching11:39 - Who Should Seek a Coach15:56 - What a Coach Does Differently22:57 - Anatomy of a Coaching Session28:21 - Coaching Frameworks and Tools35:14 - Uncovering Unrecognized Goals42:12 - Coaching Beyond the Workplace47:16 - Advice for the Undecided Urologist52:08 - Closing Remarks --- More about this episode The discussion explores what a coaching session looks like, from low-stakes one-offs to multi-month programs, and the frameworks and tools that stick, like strengths-based assessments, DiSC, and the career portfolio exercise. Dr. Smith shares insights from her credentialed coaching program, while Dr. Johnson explains how coaching changes everything from listening at home to decision-making in the OR. The episode closes with advice on finding the right coach, recognizing when you are ready, and why coaching is about unlocking what you already know. --- Resources Society of Women in Urology (SWIU)https://www.swiu.org/ Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial (Dyrbye et al., JAMA Internal Medicine, 2019)https://doi.org/10.1001/jamainternmed.2019.2425 International Coaching Federation, credentialing and coach education requirements (ACC, PCC, MCC)https://coachingfederation.org/credentialing/prepare-for-icf-credential-application/education-training-requirements/ UNC School of Medicine coaching programs, Office of Faculty Affairs and Leadership Developmenthttps://www.med.unc.edu/facultyaffairs/coaching-culture/ VIA Character Strengths Survey, the free strengths assessment Dr. Smith recommendshttps://www.viacharacter.org/ CliftonStrengths (Gallup)https://www.gallup.com/cliftonstrengths/en/home.aspx --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Adrenal lesions now turn up on four to ten percent of cross-sectional scans, and every urologist needs a reliable way to sort out the harmless ones from the dangerous ones. On this episode of BackTable Urology, co-hosts Dr. Gina Badalato and Dr. Chris Anderson speak with Dr. Ben Ristau to share a practical, case-based framework for evaluating adrenal lesions. They walk through imaging criteria, the essential hormonal workup, size thresholds for surgery, the rare but crucial role of biopsy, and the operative planning that separates a smooth adrenalectomy from a crisis. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast was developed in collaboration with Society of Academic Urologistshttps://sauweb.org/ --- Timestamps 00:00 - Introduction03:42 - Imaging Criteria for Adrenal Adenoma08:15 - Framework for Hormonal Workup12:48 - Mild Autonomous Cortisol Secretion16:20 - Adrenal Venous Sampling21:12 - Genetic Syndromes and Pheochromocytoma25:40 - Suspected Pheochromocytoma Case31:19 - Alpha Blockade Before Surgery35:36 - Intraoperative Hemodynamic Swings40:50 - Adrenocortical Carcinoma Case45:00 - Managing Adrenal Vein Avulsion48:00 - Closing Remarks --- More about this episode The discussion opens with a 3.4 centimeter lipid-rich adenoma and the two questions that drive every evaluation, whether the lesion is malignant and whether it is functional. Dr. Ristau walks through the overnight 1 mg dexamethasone suppression test, the aldosterone to renin ratio, plasma free metanephrines and adrenal venous sampling, then explains why mild autonomous cortisol secretion is the most commonly missed diagnosis. Later cases cover preoperative alpha blockade for pheochromocytoma, the blood pressure swing that follows adrenal vein ligation, and open resection for suspected adrenocortical carcinoma. They close with pearls on surgical judgment, resident teaching, and the importance of systematic protocols in adrenal mass evaluation. --- Resources CUA guideline: Diagnosis, management, and follow-up of the incidentally discovered adrenal mass (endorsed by the AUA, Rowe et al., CUAJ 2023)https://cuaj.ca/index.php/journal/article/view/8248 European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, with ENSAT (Fassnacht et al., Eur J Endocrinol 2023)https://doi.org/10.1093/ejendo/lvad066 AACE / AAES Medical Guidelines for the Management of Adrenal Incidentalomashttps://pro.aace.com/disease-state-resources/pituitary-and-neuroendocrine/clinical-practice-guidelines/american Discrepancies in the Recommended Management of Adrenal Incidentalomas by Various Guidelines (Journal of Urology)https://www.auajournals.org/doi/10.1097/JU.0000000000001342 Society of Academic Urologistshttps://sauweb.org/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What does a urologist actually need to know to confidently manage advanced prostate cancer in the clinic? On this episode of BackTable Urology, host Dr. Ruchika Talwar interviews Dr. Kristen Scarpato, director of the advanced prostate cancer clinic at Vanderbilt University Medical Center, and Dr. Jason Hafron, chief medical officer of the Michigan Institute of Urology. They break down how the landscape has shifted, why more patients stay in urology for treatment, and how to select and monitor therapy based on disease state, comorbidities, and patient goals. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Bayer https://www.bayer.com --- Timestamps 00:00 - Introduction02:41 - Shift to Urology-Led Advanced Prostate Management07:07 - Sorting Therapies by Disease State10:33 - Treatment Intensification and Doublet Therapy17:54 - ARPI Selection and the Four Ps Framework25:46 - Managing Financial Toxicity29:30 - Monitoring, Labs, and Imaging34:11 - Red Flags and Comanagement36:49 - When to Refer to Medical Oncology41:11 - Future Directions and Practice Economics46:33 - Closing Remarks --- More about this episode The discussion covers sorting therapies by disease state rather than drug class, doublet and triplet intensification, the nuances of choosing between abiraterone, enzalutamide, apalutamide, and darolutamide, and Dr. Hafron’s “four Ps” framework for drug selection. Dr. Scarpato addresses financial toxicity, surveillance protocols, and red flag symptoms. Both guests share their referral triggers for medical oncology, approaches for oligometastatic disease and metastasis-directed therapy, and practical tips for running an advanced prostate cancer clinic. --- Resources Advanced Prostate Cancer: AUA/SUO Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/advanced-prostate-cancer Trial Design and Objectives for Patients With Prostate Cancer: Recommendations From the Prostate Cancer Working Group 4 (JCO)https://ascopubs.org/doi/10.1200/JCO-25-02834 ARACOG (AFT-47): Darolutamide vs Enzalutamide and Cognitive Function, ClinicalTrials.gov NCT04335682https://clinicaltrials.gov/study/NCT04335682 ARASENS: Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer (NEJM)https://www.nejm.org/doi/full/10.1056/NEJMoa2119115 PSMAddition: 177Lu-PSMA-617 Plus Standard of Care in mHSPC, ClinicalTrials.gov NCT04720157https://clinicaltrials.gov/study/NCT04720157 Medicare Plan Finder, referenced on air for comparing Part D out-of-pocket drug costshttps://www.medicare.gov/plan-compare/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can private practice and academic residency programs work together to shape the next generation of urologists? On this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Javier Castillo about launching an academic residency within a busy private urology group in Puerto Rico. They highlight the business, training, and research challenges involved, as well as the innovations that make real collaboration possible. Dr. Castillo also reflects on why building character in trainees is just as important as teaching surgical skill. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:04 - Launching a Residency and Building the Practice08:13 - Teaching in the OR and Progressive Responsibility13:58 - Clinic, Administration, and Resident Training16:38 - Expanding BPH Treatment Options25:21 - Creating a Research Culture and AI Projects32:42 - AI Uroflow Project and Follow Up40:21 - BPH Case Workup and Shared Decision-Making47:11 - Patient Goals and Procedure Selection55:43 - Sacral Neuromodulation and New Technologies01:00:19 - Teaching Character and Mentorship01:03:07 - Closing Remarks --- More about this episode The conversation explores how to teach residents in the OR while maintaining efficiency, build a research culture, and leverage advanced technologies like AI-driven home uroflowmetry. Dr. Castillo and Dr. Silva discuss individualized BPH treatment, expanding procedural options, and aligning care with patient goals. The episode closes with practical lessons on mentorship, character, and the strategies that make a residency program thrive for both trainees and patients. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can reconstructive urologists improve quality of life for cancer survivors beyond the initial cure? On this episode of BackTable Urology, Dr. George Koch interviews Dr. Hiren Patel about building a comprehensive survivorship practice that addresses the long-term needs of patients following genitourinary cancer treatment. They discuss moving beyond post-prostatectomy ED and incontinence to include management of radiation sequelae, immunotherapy effects, and urethral strictures, as well as the role of patient-centered communication, care coordination, and technology. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:26 - Redefining Survivorship11:29 - Why Survivorship Practices Matter17:53 - Workup and Aligning Care21:05 - Managing Active Cancer Scenarios27:20 - Building a Survivorship Program30:12 - Growing Referrals and Optimizing Workflow39:24 - System Support and Research Gaps44:04 - Tech Advances in Reconstruction48:50 - Single-Port Retroperitoneal Case59:55 - Tips, Tricks, and Wrap-Up --- More about this episode The conversation covers patient expectation setting, logistics of establishing a survivorship clinic, aligning care with patient goals, and multidisciplinary collaboration with oncology and primary care. Dr. Patel highlights strategies to reduce ER visits and system burden, the importance of continuity, and advances such as single-port robotic retroperitoneal ureteral reconstruction. The episode concludes with practical tips on trust-building, workflow optimization, and advocating for survivorship programs within larger health systems. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

With so many treatment options for bladder outlet obstruction, how do you select the best approach for each patient? On this episode of BackTable Urology, host Dr. Jose Silva is joined by Dr. John DiBianco for a practical discussion on evaluating lower urinary tract symptoms and matching patients with the right intervention. They emphasize confirming that symptoms are truly due to benign prostatic hyperplasia (BPH) before proceeding, and walk through triggers for intervention, including quality-of-life impact, UTIs, renal impairment, high post-void residual, bladder stones, and retention. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:24 - Complex BPH Referrals and Symptom Assessment06:07 - Deciding When to Operate11:12 - Imaging and Prostate Sizing14:27 - When to Use Cystoscopy and Urodynamics16:43 - Incorporating Patient Preferences21:53 - Medical Therapy and Pills23:45 - Decision Aids and Personal Experience27:13 - Managing HoLEP Complications and Leakage32:57 - Advances in HoLEP Technique36:07 - TURP Indications and Outcomes38:36 - Special Considerations: Radiation and UroLift39:58 - ThULEP vs. HoLEP41:17 - Redo Surgery Strategies43:52 - Counseling Through Case Scenarios56:16 - Future Directions in BPH Treatment59:05 - Wrap Up and Credits --- More about this episode The conversation covers everything from surveillance and imaging-based prostate sizing to when to use cystoscopy and urodynamics for complex or high-risk patients. Drs. Silva and DiBianco compare procedure options like HoLEP, TURP, GreenLight, UroLift, PAE, iTind, and aquablation, highlighting how factors like prostate size, morphology, history, and patient goals drive decision-making. They discuss durability, redo surgery issues, management of radiation patients, and postoperative care including leakage management and pelvic floor therapy. The episode wraps up with future directions in BPH procedures and practical counseling tips for patient satisfaction. --- Resources Love this episode? Check out BackTable.com and search “BPH” to get more information on a variety of the surgical options discussed in this episode, including HoLEP, Aquablation, PAE, and more! Further resources include the BackTable App, which has a course on treating Benign Prostatic Hyperplasia. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Medtronic Pelvic Healthhttps://urgencyisreal.com/ --- Timestamps 00:00 - Introduction04:00 - Shared Decision-Making06:51 - Clinic Efficiency10:38 - Expanding OAB Therapy Options12:27 - Long-Term OAB Care17:41 - Building an OAB Program18:18 - Staff Training and Follow-Up25:32 - OAB Navigator Implementation27:14 - Navigation Outcomes28:39 - Scaling with Staff and Epic30:35 - Algorithm Resources34:08 - Neuromodulation Advances38:37 - New Tibial and Battery-Free Devices40:56 - Quality of Life in OAB Care46:11 - Access and Adoption51:22 - Streamlining Therapy Discussions52:47 - Closing Remarks --- More about this episode The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey. --- Resources Patient navigation for overactive bladder improves access to carehttps://link.springer.com/article/10.1007/s00192-019-04085-7 --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What are the key considerations for choosing between surveillance, surgery, and chemotherapy in testicular cancer? On this episode of BackTable Urology, host Dr. Rich Matulewicz is joined by Dr. Sean Kern and Dr. Sam Funt for an in-depth discussion on clinical approaches to testicular cancer. They start with a real-world case, reviewing initial evaluation, imaging, tumor markers, and counseling on fertility, body image, and hypogonadism. The conversation highlights how nuanced patient selection influences decisions between surveillance, surgical intervention, and adjuvant chemotherapy. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:40 - Initial Case Workup and Counseling06:28 - Why Testicular Cancer Happens09:17 - Management Considerations with Post-Orchiectomy Pathology19:21 - RPLND Benefits and Drawbacks23:39 - Surveillance Schedule and Long Term Follow Up28:17 - Second Tumor Risk30:36 - Evolving Seminoma Treatment37:57 - RPLND Selection Factors40:10 - Adjuvant Chemo Debate and Pathology46:06 - Closing Takeaways --- More about this episode The episode explores postoperative management, including long-term surveillance, risk of a second tumor, and strategies for lifelong follow-up. The doctors discuss evolving practice in the management of low-volume stage II seminoma, the increasing use of RPLND to reduce chemo and radiation exposure, and the importance of extended patient counseling over multiple visits. The discussion emphasizes individualized care, the role of new diagnostics, and the need for reassurance and support throughout the treatment journey. --- Resources Society of Urologic Oncology https://suonet.org/home.aspx --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can high-stakes surgical cases be optimized for teaching while ensuring patient safety and trainee growth? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Kelvin Moses about intentional strategies for surgical education, especially during complex urologic oncology operations. They discuss workflows that prioritize preoperative planning, structured debriefs, and progressive autonomy for trainees, as well as the importance of psychological safety and open communication with patients and families. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:19 - Teaching In High Stakes Cases07:57 - Rethinking See One, Do One, Teach One10:24 - Assessing Trainee Readiness14:29 - Preop Preparation 16:06 - Teaching Cues in the OR 17:42 - Tips for Trainees21:40 - Intentional Teaching24:02 - Teaching Rare and Complex Cases26:40 - Anticipating Complications and Debrief After Disaster33:09 - Psychological Safety In the OR37:41 - Reflections on Past, Current, and Future Training Models43:56 - Patients And Trainees46:51 - Takeways --- More about this episode The conversation explores practical intraoperative teaching cues, tips for trainees such as visualization, recording cases, and repetition, and methods for relating rare cases to more common procedures. Dr. Moses reflects on the strengths and challenges of past, present, and future training models, including the debate over whether surgical education has gone “too soft.” The episode emphasizes the value of mentorship, transparency with patients, and the need to continually adapt surgical training for the next generation. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Is an elevated prostate-specific antigen (PSA) the beginning or the end of the prostate cancer workup? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Tarik Benidir to explore the “PSA problem,” explaining why PSA is biologically useful but clinically imprecise, often leading to false positives, unnecessary biopsies, and detection of indolent disease. They discuss a rational, patient-centered approach to elevated PSA, including when to repeat the test, how to interpret results in the context of age, race, family history, and prostate size, and the use of PSA density and age-adjusted norms instead of rigid cutoffs. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byCleveland Diagnosticshttps://www.isopsa.com/ --- Timestamps 00:00 - Introduction04:03 - Why PSA Can Be Misleading06:43 - Approach to Elevated PSA and Initial Workup09:51 - MRI, PSA Density, and Biomarker Testing14:31 - Guidelines, Diagnostics, and When to Biopsy20:16 - Comparing 4K, IsoPSA, and Other Biomarkers25:23 - Choosing Between Transperineal and Transrectal Biopsy28:42 - Management Considerations for Elderly and Comorbid Patients33:09 - Active Surveillance, Recurrence, and Long-Term Monitoring40:47 - Key Takeaways and Closing Remarks --- More about this episode The conversation highlights the role of reflex biomarkers, MRI scans, and selective biopsy strategies to reduce unnecessary procedures and focus on identifying clinically significant cancers. Dr. Benidir explains how to weigh MRI results, when to use biomarkers, and how to approach decisions in elderly or comorbid patients. They also discuss new biopsy modalities, active surveillance, and future directions for optimizing PSA-based screening and management. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Medtronichttps://www.medtronic.com/en-us/e/patients-caregivers/urinary/overactive-bladder.html --- Timestamps 00:00 - Introduction04:05 - Case One: Recurrent UTIs05:19 - Workup Basics08:50 - Non-Antibiotic Prevention11:42 - Antibiotic Prophylaxis Options15:16 - Case Two: Asymptomatic Bacteriuria 19:14 - Case Three: Complex Patients19:58 - Male vs. Female UTIs21:22 - Neurogenic Bladder Workup22:52 - Elderly Patients and ID Consults25:01 - Case Four: Transplant ESBL25:23 - Machine Learning for Antibiotics 29:49 - Catheter Biofilms31:55 - Embedded Bladder Reservoirs35:23 - Recurrent UTI Vaccine36:23 - Future of Recurrent UTIs39:04 - Wrap Up --- More about this episode The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic. --- Resources Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Recurrent low-grade, intermediate-risk bladder cancer presents a unique treatment challenge: recurrence is common, progression is uncommon, and the burden of repeated procedures can add up quickly. On this episode of the BackTable Urology Podcast, Dr. Ruchika Talwar interviews Dr. Charles “Chas” Peyton about how to manage intermediate-risk bladder cancer patients while balancing disease control and quality of life. They discuss the cumulative impact of repeated TURBTs and explore the evolving role of office-based treatments and chemoablative therapies as alternatives to the traditional treatment cycle. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction05:58 - Comparing Office Ablation and OR TURBT08:26 - TURBT Impact on Quality of Life11:37 - Uncovering Hidden Patient Burdens and Costs14:44 - Integrating Chemoablation into Practice18:20 - ENVISION QoL Study Setup22:04 - Comparing TURBT Preferences27:40 - Counseling Risk-Averse Patients29:10 - Community Adoption Advice31:59 - Upcoming Clinical Trials35:28 - Biomarkers and Expanding Access36:23 - Final Thoughts and Closing Remarks --- More about this episode The conversation covers practical strategies like office-based surveillance and fulguration for small recurrences, identifying triggers for returning to the OR, and recognizing the hidden burdens of TURBT complications such as hematuria, incontinence, and unplanned ER visits. Dr. Peyton reviews the role of chemoablative options for selected patients, discusses trial data on patient-reported outcomes, and addresses the mixed evidence, high costs, and need for individualized decision-making. The episode also explores new intravesical and FGFR-targeted therapies, underscores the importance of cost-conscious adoption and biomarkers, and considers how management approaches must evolve, especially in community practice settings. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How can you use social media to educate, empower, and inspire as a physician while staying true to your professional values? On this episode of BackTable Urology, guest host Dr. Maheetha Bharadwaj talks with Dr. Rena Malik and Dr. Fenwa Milhouse about building an authentic online presence that educates, inspires, and connects. The conversation highlights the power of visibility, the challenges of professional boundaries and misinformation, and the potential for social media to expand both patient outreach and career opportunities. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction04:17 - Getting Started on Social Media12:24 - Finding Your Niche17:04 - Being a Woman in Urology18:40 - Impact On Patient Care23:59 - Doctor-Patient Boundaries28:33 - Social Media Pitfalls38:53 - Creator Monetization45:58 - Advice for New Creators --- More about this episode They share insights from years of content creation, including tips for getting started, finding your niche, and balancing clinical work with online engagement. The discussion covers issues unique to women in urology, the impact of social media on patient care and doctor-patient boundaries, how to avoid burnout, and strategies for monetization and staying true to your message. The episode wraps up with practical advice for new creators and reflections on the privilege and responsibility of inspiring future urologists. --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Hypospadias can be surgically corrected early in life, but many patients drop out of care before puberty or adulthood, leaving important urinary and sexual health concerns unaddressed. On this episode of BackTable Urology, Dr. Arthi Hannallah and Dr. Nicco Passoni talk with Dr. Vinaya Bhatia about improving lifelong engagement for people with hypospadias. They highlight advances in surgical technique, the role of research, and how digital tools like the WYSH platform help keep patients and families connected to care. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction04:22 - Hypospadias Overview and Symptom Chronology09:14 - Not A One Size Fits All: Developing WYSH13:28 - Reengaging Families and Patients20:04 - Adult Urology Sequelae25:08 - Demystifying Surgery and Improving Training34:00 - Centers of Excellence Debate36:56 - Future Goals and Wrap Up --- More about this episodeThe discussion covers the development and impact of the WYSH platform, strategies for supporting long-term follow-up, and the learning curve of hypospadias surgery. Dr. Bhatia shares insights on better training, the creation of centers of excellence, and the importance of ongoing research and family engagement to improve quality of life at every stage. --- ResourcesWorldwide Yearly Screening for Hypospadias: https://clinicaltrials.gov/study/NCT06966375 --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app