BackTable Urology

When a male patient presents with lower urinary tract symptoms, should you blame the bladder or bust the prostate? In this SUFU-sponsored episode of BackTable Urology, Dr. Benjamin Brucker (NYU) and Dr. Craig Comiter (Stanford) join host Dr. Chris Tenggardjaja (Kaiser Permanente) for a discussion on evaluating and treating male LUTS using a bladder-and-outlet framework. --- This podcast was developed in collaboration with: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx --- SYNPOSIS Through a case-based approach, they review initial evaluation strategies including symptom history, validated questionnaires, uroflowmetry, post-void residual measurement, and when tools like voiding diaries can help clarify the diagnosis. The conversation then moves to management, outlining a stepwise approach from behavioral interventions and medications to surgical options when symptoms persist. The doctors discuss how prostate anatomy, side effect profiles, and patient priorities guide treatment selection, when urodynamics may add diagnostic clarity, and why addressing outlet obstruction early may help prevent more difficult-to-treat bladder dysfunction over time. --- TIMESTAMPS 00:00 - Introduction06:31 - Workup for Frequency and Nocturia11:41 - When to Use a Voiding Diary19:18 - Behavioral Therapy26:40 - Post-Finasteride Syndrome30:03 - Surgical Options44:41 - Nocturia Counseling47:32 - Botox With Outlet Surgery49:47 - When to Order Urodynamics54:14 - Bladder or Prostate? --- RESOURCES Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home

Not every pediatric GU injury fits neatly into the guidelines. In this episode of BackTable Urology, trauma reconstructive urologist Dr. Travis Pagliara (Hennepin County Medical Center) joins hosts Dr. Arthi Hannallah and Dr. Niccolo Passoni to walk through practical management of pediatric renal, bladder, urethral, and genital injuries. Through case-based discussion, they highlight diagnostic decision-making, when to observe versus intervene, and how to approach these patients in the acute setting. --- SYNPOSIS The conversation also explores operative pearls, the role of technologies like the Optilume balloon, and why thoughtful short-term follow up is critical for both patient outcomes and clinician learning. Together, they emphasize a measured, conservative mindset whenever appropriate to minimize morbidity while delivering high-quality trauma care. --- TIMESTAMPS 00:00 - Introduction03:07 - Kidney and Ureteric Trauma19:16 - Urethral Trauma34:42 - MRI vs Ultrasound47:56 - Collaboration in Reconstructive Urology52:26 - Testicular Trauma57:29 - Epididymal Injury01:02:35 - Follow-Ups Matter01:05:14 - Foreign Body Stories01:06:52 - Career Advice

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

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

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

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

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

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

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

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/

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

The microhematuria guideline just changed. Here’s what clinicians need to know. In this episode of BackTable Urology, Dr. Daniel Barocas (Vanderbilt University) joins host Dr. Ruchika Talwar to break down the 2025 updates to the American Urological Association (AUA) Microhematuria Guideline and why these changes matter in everyday practice. --- SYNPOSIS They walk through the evidence driving the updates, including revised risk stratification and the expanding role of urinary biomarkers. The conversation highlights how these recommendations affect patient evaluation, imaging decisions, and shared decision-making, with an emphasis on balancing cancer detection, patient burden, and responsible use of healthcare resources. --- TIMESTAMPS 00:00 - Introduction01:33 - What Prompted the Guidelines Update?02:59 - Challenges of a Negative Microhematuria Evaluation06:21 - Initial Evaluation Guidelines07:58 - Risk Stratification18:11 - Imaging in Hematuria Workups21:16 - Use of Urinary Biomarkers33:25 - Potential Future Guideline Updates37:17 - Takeaways for Urologists --- RESOURCES AUA/SUFU Microhematuria Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/microhematuria

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

Can genomic classifiers close the gap between what we see and what a tumor will do? In this episode of BackTable Urology, Dr. Carissa Chu (UCSF) joins Dr. Ruchika Talwar (Vanderbilt) to explore how genomic classifiers are reshaping the way clinicians diagnose and manage bladder cancer. --- This podcast is supported by: Veracytehttps://www.veracyte.com/decipher-bladder --- SYNPOSIS They discuss the limitations of traditional staging systems and how molecular subtyping is providing deeper insight into tumor biology, treatment response, and prognosis. Dr. Chu highlights where these classifiers can be integrated into real-world clinical decision-making today, where the evidence is still emerging, and which ongoing trials may define the next era of precision medicine in urologic oncology. --- TIMESTAMPS 0:00 - Introduction3:01 - Overview of Genomic Classifiers9:34 - Risk Stratification15:22 - Current Evidence for Genomic Classifiers22:07 - Clinical Implications of Biomarkers27:23 - Ordering Genomic Classifiers33:46 - Future Directions37:57 - Final Takeaways --- RESOURCES Alignment of molecular subtypes across multiple bladder cancer subtyping classifiershttps://pubmed.ncbi.nlm.nih.gov/38480079/ GUSTO Trialhttps://fundingawards.nihr.ac.uk/award/NIHR128103

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

When it comes to GU cancers, fear and uncertainty often shape a patient’s treatment decisions well before the clinical data does. Dr. Hung-Jui (Ray) Tan of UNC Health sits down with host Dr. Ruchika Talwar to unpack why decision-making around small renal masses, low-risk prostate cancer, and other GU conditions can be so challenging. Dr. Tan explains the concept of decisional conflict, a patient’s internal uncertainty about the “right” course of action, and how it predicts downstream satisfaction and health outcomes. --- SYNPOSIS Dr. Tan shares practical, evidence-based strategies for improving decision-making conversations, from clearer framing to simple visual aids that reduce anxiety. They discuss how patients often perceive much greater risk of metastasis than what data shows, and why “turning down the temperature” is essential before discussing options. They also touch on evolving tools, including AI, that may improve how clinicians communicate risk and support patients through uncertainty. --- TIMESTAMPS 00:00 - Introduction01:02 - Journey to Decision Science05:59 - Research on Decision Making14:41 - Shared Decision Making in Practice22:39 - Resources for Shared Decision Making39:54 - Improving Decision-Making Conversations --- RESOURCES Decisional conflict among patients newly diagnosed with clinical T1 renal masses: a prospective studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11233232/ Decisional Quality in Patients With Small Renal Masseshttps://pubmed.ncbi.nlm.nih.gov/29574123/ Impact of renal mass biopsy on decision-making experience for clinical T1 renal masseshttps://pubmed.ncbi.nlm.nih.gov/41151063/ MUSIC Patient and Provider Resources for Shared Decision Makinghttps://musicurology.com/programs/kidney/ P3P - Prostate Cancer Shared Decision Making Resourcehttps://www.p3p4me.org/users/login Best Case/Worst Case Treatment Decision Toolhttps://patientpreferences.org/best-case-worst-case/ Better Conversations Treatment Decision Toolhttps://patientpreferences.org/better-conversations/

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

Can we reduce OR waste without compromising patient care? In this episode of BackTable Urology, Dr. Sunil Patel (Johns Hopkins) joins host Dr. Ruchika Talwar (Vanderbilt) to explore strategies for improving environmental sustainability in surgical practice. --- SYNPOSIS They discuss the scope of OR-generated waste, the impact of plastics and carbon emissions, and emerging data linking environmental exposures to carcinogenesis. Dr. Patel highlights evidence supporting reusable vs. single-use instruments, shares examples of successful waste-reduction initiatives, and emphasizes the importance of cross-disciplinary collaboration to make sustainable practices achievable across healthcare systems. --- TIMESTAMPS 0:00 - Introduction3:29 - Current State of OR Waste20:09 - Strategies to Reduce Waste24:52 - Impact of Climate Change on Patients33:55 - Future Directions40:27 - Conclusion

When standard therapy fails, it does not have to be the end of the road for high-risk bladder cancer patients. Modern treatments, biomarkers, and clinical studies have opened up new avenues for treating recurrent non-muscle invasive bladder cancer (NMIBC). The penultimate episode of the 2025 NMIBC Creator Weekend™ series features urologic oncologists Dr. Vignesh Packiam, Dr. Mark Tyson, and Dr. Sarah Psutka discussing how they navigate complex bladder cancer scenarios. --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The doctors share treatment strategies, staging processes, and post-therapy patient management techniques. They address recurrent disease, approaches to different stages of cancer, the role of biomarkers in determining treatment paths, and considerations for both high-risk and intermediate-risk patients. Additionally, the episode touches on new treatments, clinical trials, and patient quality of life post-treatment. --- TIMESTAMPS 00:00 - Introduction02:08 - Case Study: Initial Patient Assessment04:59 - Surgical Considerations and Techniques10:22 - Managing Bladder Cancer Recurrence11:15 - Treatment Options and Clinical Trials15:12 - Advanced Treatment Strategies28:14 - Closing Remarks and Credits --- RESOURCES VISTA Trial https://abstracts.mirrorsmed.org/abstracts/vista-phase-3-trial-vicinium-epcam-targeted-pseudomonas-exotoxin-bcg-unresponsive-non BRIDGE Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10515442/ CORE-008 Trialhttps://www.sciencedirect.com/science/article/abs/pii/S1078143924010147 GAIN Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10176900/

For the first time in history, a human bladder was transplanted. Dr. Nima Nassiri (UCLA) joins Dr. Ruchika Talwar to share how his team completed this landmark operation alongside a kidney transplant. He walks through the clinical scenario, key steps in donor and recipient selection, and how years of preclinical work informed the operative approach. --- SYNPOSIS The conversation explores the broader future of bladder transplant surgery, from ethical considerations to the potential for merging bladder transplantation with tolerance-induction protocols that could one day eliminate the need for lifelong immunosuppression. Dr. Nassiri reflects on the importance of patient-first decision-making, teamwork, and careful innovation as the field moves toward new possibilities in restorative urology and transplant medicine. --- TIMESTAMPS 00:00 - Introduction02:51 - The Path to Bladder Transplant Surgery05:00 - Scientific Challenges and Barriers06:45 - Patient Selection and Initial Outcomes12:28 - Quality of Life Considerations14:18 - Performing the First Bladder Transplant18:59 - Donor Matching21:28 - Ethical Considerations24:51 - Research Gaps and Future Prospects --- RESOURCES Clinical Trial: Vascularized Composite Bladder Allograft Transplantationhttps://www.clinicaltrials.gov/study/NCT05462561 Clinical Trial: Retro-active Immunological Tolerance in Patients With Well-functioning Pre-existing HLA-identical Kidney Transplantshttps://clinicaltrials.gov/study/NCT05525507