BackTable Urology

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The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen here or on the streaming platform of your choice.

  1. قبل ٧ ساعات

    Ep. 291 Pelvic Pain Syndromes: Clinical Assessment & Strategies with Dr. Susan MacDonald

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

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  2. ١٧ فبراير

    Ep. 290 Urothelial Carcinoma: Consolidative Surgery & Treatment Approaches with Dr. Abhinav Khanna

    What do you do when metastatic urothelial cancer responds dramatically to systemic therapy? In this episode of BackTable Urology, Dr. Abhinav Khanna (Mayo Clinic) speaks with host Dr. Daniel Roberson about the growing question of consolidative surgery after enfortumab vedotin plus pembrolizumab. They discuss how EV-pembro has reshaped treatment expectations, why unexpected complete or near-complete responses are prompting tumor board debates about cystectomy, and how careful multidisciplinary decision-making guides which patients may be considered for surgery. --- SYNPOSIS The conversation reviews early outcomes showing high rates of pathologic downstaging and the possibility that many patients may avoid additional systemic therapy after surgery, while emphasizing this approach is not yet standard of care. Dr. Khanna highlights coordination with medical oncology, radiology, and pathology, postoperative considerations, and the potential future role of biomarkers such as ctDNA. Ultimately, the episode underscores the need for clinical trials and thoughtful patient selection as clinicians navigate integrating surgery into an evolving systemic therapy landscape. --- TIMESTAMPS 00:00 - Introduction02:19 - The Evolution of Urothelial Carcinoma Treatment05:23 - Rationale for Consolidative Surgery12:32 - Patient Selection Criteria15:23 - Surgical Approach and Considerations23:58 - Pathologic Findings31:34 - The Role of Radiation39:38 - Biomarkers44:10 - Prospective Trials and Future Directions53:06 - Guidance for Urologists --- RESOURCES Consolidative Surgery for Advanced Urothelial Carcinoma Following Induction Enfortumab Vedotin and/or Immune Checkpoint Inhibitor Therapy: A Multicenter Analysishttps://pubmed.ncbi.nlm.nih.gov/40425390/ Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancerhttps://www.nejm.org/doi/full/10.1056/NEJMoa2312117 Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancerhttps://www.nejm.org/doi/abs/10.1056/NEJMoa2401497

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  3. ١٠ فبراير

    Ep. 289 Insights into Urethroplasty & Reconstructive Care with Dr. Benjamin N. Breyer

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

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  4. ٣ فبراير

    Ep. 288 Active Surveillance for Intermediate Risk Prostate Cancer with Dr. Claire de la Calle

    When is active surveillance the right choice for intermediate-risk prostate cancer patients? In this episode of BackTable Urology, Dr. Claire de la Calle, Assistant Professor of Urology at the University of Washington, joins Dr. Ruchika Talwar to unpack how active surveillance has evolved beyond low-risk disease and why select Grade Group 2 patients may be appropriate candidates now with thoughtful patient selection. --- SYNPOSIS The conversation explores emerging tools that can refine surveillance decisions, including PSA density, MRI findings, genomic classifiers, and the growing role of AI-assisted pathology. Dr. de la Calle emphasizes the importance of nuanced patient counseling, acknowledging anxiety and long-term risk while reinforcing that time on active surveillance can be a meaningful win when oncologic outcomes remain comparable to upfront treatment. --- TIMESTAMPS 00:00 - Introduction02:58 - Current Evidence05:03 - Patient Selection Criteria12:11 - Importance of PSA Density and Monitoring Protocols18:12 - Pathology and Genomic Testing32:18 - Future Directions and Research36:33 - Key Takeaways --- RESOURCES ProtecT Trial: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancerhttps://www.nejm.org/doi/full/10.1056/NEJMoa2214122 Canary PASS Studyhttps://canarypass.org/ Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trialhttps://pubmed.ncbi.nlm.nih.gov/37137444

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  5. ٣٠ يناير

    Ep. 287 Urothelial Carcinoma: Understanding CTDNA and Precision Medicine with Dr. Amanda Nizam and Dr. Brad McGregor

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

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  6. ٢٧ يناير

    Ep. 286 Antibiotic Stewardship in Reconstructive Urology with Dr. Joshua Sterling

    In reconstructive urology, preventing infection often means prolonged antibiotic exposure, raising important questions about stewardship and long-term harm. In this episode of BackTable Urology, Joshua Sterling of Yale University joins host George Koch to examine how antibiotic stewardship and emerging insights into the urinary microbiome are reshaping infection management in reconstructive practice. --- SYNPOSIS The discussion centers on real-world clinical challenges, particularly in high-risk populations such as patients with neurogenic bladder, chronic catheterization, or prior reconstruction - groups in whom antibiotics are frequently used prophylactically or indefinitely. Drs. Sterling and Koch explore how well-intentioned prescribing patterns can contribute to resistance, dysbiosis, and recurrent infection, while often failing to address the underlying drivers of disease. Rather than framing infection control solely around eradication, the conversation considers a shift toward modulation of the urinary microbiome, drawing on lessons from gastroenterology, infectious disease, and transplant medicine. The episode concludes by outlining how a more nuanced, multidisciplinary approach may better serve reconstructive urology patients in the long term. --- TIMESTAMPS 00:00 - Introduction02:22 - Antibiotic Stewardship in Urology06:34 - Current Landscape of Antibiotic Use13:44 - Protocols and Practices in Reconstruction18:24 - Antibiotic Overuse and Misuse21:02 - Shifting the Microbiome25:12 - Chlorhexidine Irrigations32:38 - Future Directions38:27 - Implementing Antibiotic Protocols40:48 - Conclusions --- RESOURCES STOP-IT Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa1411162

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  7. ٢٠ يناير

    Ep. 285 Guide to Vaginal Rejuvenation: Myths, Realities, & Medical Insights with Dr. Ariana Smith and Dr. Karyn Eilber

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

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  8. ١٣ يناير

    Ep. 284 Integrating Gender Affirming Care Into Urology with Dr. Eric Walton

    Gender affirming surgery is becoming a more visible part of urologic practice, raising practical questions about surgical training, case volume, and multidisciplinary support. In this episode of BackTable Urology, Dr. Eric Walton of The Ohio State University joins Dr. George Koch to examine how gender affirming surgery is being integrated into contemporary urology. Dr. Walton discusses his path into reconstructive urology, structural barriers that limit patient access, and why expanding surgical training pathways is central to closing gaps in care. --- SYNPOSIS The conversation explores fellowship models, academic versus private practice settings, and the role of multidisciplinary teams in supporting surgical programs. Practical considerations around patient screening, care coordination, and insurance are addressed, reframing gender affirming surgery as a core component of modern urologic care rather than a subspecialty outlier. --- TIMESTAMPS 00:00 - Introduction00:52 - Journey to Gender Affirming Surgery03:29 - Specialized Training in Gender Surgery09:34 - Building a Gender Surgery Program27:54 - Providing Competent and Affirming Care32:54 - Future of Gender Affirming Surgery in Urology39:58 - Final Thoughts and Advice --- RESOURCES World Professional Association for Transgender Health (WPATH) Standards of Care:https://wpath.org/publications/soc8/

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The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen here or on the streaming platform of your choice.

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