BackTable Urology

The guidelines are in and the myths are out. In this episode of the BackTable Podcast, Dr. Suzette Sutherland hosts Dr. Melissa Kaufman and Dr. Giulia Ippolito to discuss the new 2025 AUA/SUFU guidelines on genitourinary syndrome of menopause (GSM). ---SYNPOSISThe doctors delve into what GSM is, its symptoms, and the new evidence-based clinical guidelines for screening, diagnosing, and treating this condition. The episode emphasizes shared decision-making, safe use of local low-dose vaginal estrogen, and addresses concerns related to hormone therapy and cancer risks. Additionally, the doctors cover non-hormonal interventions, the role of vaginal moisturizers and lubricants, and the use of vaginal lasers. The importance of follow-up and ongoing patient education is also highlighted. The conversation aims to equip clinicians with the knowledge to better manage GSM and improve patient outcomes.---TIMESTAMPS00:00 - Introduction 01:35 - Overview of the 2025 AUA/SUFU Guidelines02:27 - Guideline Development Process05:48 - Categories of Guidelines07:03 - Understanding GSM: Symptoms and Diagnosis10:28 - Patient Education and Shared Decision Making15:22 - Hormonal Interventions and Safety Concerns17:17 - Local Vaginal Estrogen: Recommendations and Usage23:12 - Compounded Estrogens and Alternative Therapies25:48 - Understanding Estrogen Dosage Forms26:11 - Introduction to DHEA and Its Benefits27:15 - Exploring Ospemifene as an Alternative28:05 - Guidelines for Treating GSM Symptoms30:11 - The Role of Vaginal Estrogen in UTI Prevention33:01 - Non-Hormonal Interventions for GSM35:39 - Laser Treatments for GSM39:59 - Addressing Cancer Risks with Vaginal Estrogen44:48 - Endometrial Surveillance and Follow-Up49:14 - Advocating for Vaginal Estrogen Use51:13 - Conclusion and Final Thoughts

How do you effectively treat your bladder cancer population with an insufficient supply of BCG? Dr. Amy Luckenbaugh, a urologic oncologist at Vanderbilt University Medical Center, joins host Dr. Ruchika Talwar to highlight challenges and solutions to managing bladder cancer amidst ongoing BCG shortages. --- This podcast is supported by an educational grant from UroGen Pharma. UGN-102 was approved by the FDA on June 12, 2025. --- SYNPOSIS Dr. Luckenbaugh and Dr. Talwar delve into the history and significance of BCG in bladder cancer treatment, exploring the reasons behind the shortages and discussing various coping strategies, including split dosing and alternative intravesical therapies like gemcitabine, docetaxel, and the new mitomycin hydrogel. The conversation also covers emerging treatments for high-risk patients, the role of radical cystectomy, and the importance of standardization and innovation in dealing with medication shortages. Dr. Luckenbaugh highlights the importance of patient quality of life, cost considerations, and the need for resilient pharmaceutical supply chains. --- TIMESTAMPS 00:00 - Introduction01:56 - History and Importance of BCG in Bladder Cancer03:21 - Challenges and Shortages of BCG06:36 - Managing BCG Shortages in Clinical Practice12:33 - New Alternatives and Treatments for Bladder Cancer23:28 - The Role of Cystectomy in Bladder Cancer Treatment26:12 - Future Directions and Final Thoughts --- RESOURCES BCG Shortage AUA Recommendations:https://www.auanet.org/about-us/bcg-shortage-info Reduced-dose bacillus Calmette-Guérin (BCG) in an era of BCG shortage: real-world experience from a tertiary cancer centre: https://pmc.ncbi.nlm.nih.gov/articles/PMC11951178/ Bladder Cancer Advocacy Network (BCAN):https://bcan.org/ Primary Chemoablation of Recurrent Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer With UGN-102: A Single-Arm, Open-Label, Phase 3 Trial (ENVISION)https://pubmed.ncbi.nlm.nih.gov/39446087/b FDA Approves Intravesical Mitomycin in Non–Muscle-Invasive Bladder Cancer:https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-mitomycin-intravesical-solution-recurrent-low-grade-intermediate-risk-non-muscle TAR-200 - SunRISe-3 Study:https://www.jnjmedicalconnect.com/products/tar-200/medical-content/tar-200-sunrise-3-study First results from TAR-200 - SunRISe-1 Study:https://www.jnj.com/media-center/press-releases/johnson-johnsons-tar-200-monotherapy-achieves-high-disease-free-survival-of-more-than-80-percent-in-bcg-unresponsive-high-risk-papillary-nmibcN-803 Plus BCG Treatment for BCG-Naïve or -Unresponsive Non-Muscle Invasive Bladder Cancer: A Plain Language Review:https://pmc.ncbi.nlm.nih.gov/articles/PMC11524197/

Physical performance, recovery, longevity–are these outcomes part of your urology practice? In this episode of BackTable Urology, Dr. Vonda Wright, a renowned orthopedic surgeon and expert in aging and longevity, joins Dr. Amy Pearlman to discuss the intersection of surgical practice, longevity medicine, and patient-centered healthcare in urology. --- SYNPOSIS The discussion covers the significance of whole-person care in surgery and the critical role of empathy in surgical practice. Dr. Wright shares her experiences from her extensive career and research, including her innovative work in hip arthroscopy and advocacy for performance-based care for middle-aged patients. The surgeons also explore the impact of hormonal health on physical performance and quality of life, the value of tailored exercise and nutrition plans, and practical strategies for optimizing long-term vitality in both men and women. Dr. Wright emphasizes the need for healthcare professionals to lead by example in prioritizing their own well-being while staying informed on emerging science that supports longevity and quality of life. --- TIMESTAMPS 00:00 - Introduction13:50 - Urology Applications in Orthopedics24:18 - Optimizing Longevity and Lifestyle29:08 - Musculoskeletal Syndrome of Menopause42:12 - Approach to Protein Intake and Supplements50:48 - Practicing Longevity Medicine53:26 - Final Thoughts --- RESOURCES Unbreakable: A Woman’s Guide to Aging with Power by Dr. Vonda Wright:https://www.drvondawright.com/resources/books/unbreakable

Is one outdated warning label standing between millions of women and safe, effective care? In this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, a urologist specializing in female pelvic medicine and reconstructive surgery at UC San Diego, joins host Dr. Suzette Sutherland to discuss the black box warning on vaginal estrogen, its historical context, and the ongoing advocacy efforts to update outdated FDA guidelines. --- SYNPOSIS The conversation covers the importance of low-dose vaginal estrogen in treating genitourinary syndrome of menopause (GSM), the fear surrounding hormone therapy due to misinterpreted data from the Women's Health Initiative (WHI) study, and the inequities faced in women's health, particularly in the context of hormone replacement therapies. They discuss the legislative and advocacy strategies needed to enact change, emphasizing the role of professional societies, legislative efforts, patient advocacy, and industry support in overcoming the barriers to updating the black box warning. --- TIMESTAMPS 00:00 - Introduction03:43 - History Behind the Estradiol Black Box Warning13:44 - The FDA Citizen Petition18:18 - Gender Inequity in Medicine24:05 - The Role of Organizational Guidelines in Patient Advocacy28:51 - Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM)32:57 - Medicare Spending and Legislative Advocacy44:56 - Recap and Future Directions --- RESOURCES (TRAVERSE Trial) Cardiovascular Safety of Testosterone-Replacement Therapyhttps://www.nejm.org/doi/full/10.1056/NEJMoa2215025 Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Studyhttps://doi.org/10.1093/jnci/djac112 (ASCO Study) Use of local estrogen therapy among breast cancer patients in SEER-MHOS databasehttps://doi.org/10.1200/JCO.2025.43.16_suppl.578 Vaginal estrogen use in breast cancer survivors: a systematic review and meta-analysis of recurrence and mortality riskshttps://doi.org/10.1016/j.ajog.2024.10.054

Have we been wrong about testosterone and prostate cancer all along? In this episode of BackTable Urology, Dr. Abraham Morgentaler, who pioneered the modern use of testosterone therapy, joins Dr. Amy Pearlman to discuss the evolving understanding of testosterone therapy in clinical practice and its implications on patient care. --- SYNPOSIS Dr. Morgentaler shares insights from his decades-long career, including his pivotal research that refuted the presumed harms of testosterone therapy and belief that it contributes to the development of prostate cancer. The conversation explores the evolution of testosterone therapy, its misunderstood role in prostate cancer, and the need for broader clinical recognition of testosterone deficiency. The discussion also explores potential future applications of testosterone therapy, including its role in perioperative optimization and the growing need for nuanced, evidence-based guidelines in men’s health care. --- TIMESTAMPS 00:00 - Introduction08:45 - The Evolution of Testosterone Therapy20:10 - Challenging Conventional Wisdom on Testosterone34:04 - Reevaluating Testosterone and Prostate Cancer51:20 - Testosterone and Prostate Cancer Recurrence55:44 - Managing Testosterone Therapy in Prostate Cancer Patients01:12:45 - Final Thoughts --- RESOURCES The Sex Doctors:https://www.amazon.com/The-Sex-Doctors/dp/B0DCJQ5B5Q

Often misunderstood as end-of-life care, palliative care is actually about improving quality of life at any stage of serious illness. In this episode of BackTable Urology, Dr. Ashwin Kotwal, a geriatrician and palliative care physician at UCSF, and Dr. Pauline Filippou, a urologic oncologist at Kaiser Permanente in Northern California join hosts Dr. Gina Badalato and Dr. Lindsay Hampson to discuss the importance of palliative care in the field of urology. --- SYNPOSIS The episode covers how palliative care can improve quality of life for patients with serious illnesses, the challenges and opportunities of integrating palliative care into urology practice, and specific training resources and frameworks for effective communication and symptom management. From addressing common misconceptions to providing practical advice on implementing palliative care, this episode is an essential guide for trainees and urology professionals looking to deepen their understanding of palliative care and enhance their practice. --- TIMESTAMPS 00:00 - Introduction03:04 - Understanding Palliative Care04:43 - Misconceptions and Communication Strategies07:45 - Integrating Palliative Care in Urology10:26 - Collaborative Approaches and Multidisciplinary Teams15:48 - Training and Education for Trainees20:25 - Effective Communication Techniques28:18 - Impact of Palliative Care34:33 - Final Thoughts and Takeaways --- RESOURCES Center to Advance Palliative Care website:https://www.capc.org/ AUA White Paper: https://www.auanet.org/documents/guidelines/white%20papers/postoperative.pdf VitalTalk:https://www.vitaltalk.org/ Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters: https://link.springer.com/article/10.1007/s11606-018-4540-5 Family Meetings on Behalf of Patients with Serious Illness: https://www.nejm.org/doi/full/10.1056/NEJMvcm1913056

Prostate biopsy is evolving rapidly, offering urologists more precision - but also more decisions. In this episode of BackTable Urology, Dr. Ricardo Sánchez-Ortiz, a pioneer in robotic surgery and neuro-urology in Puerto Rico, joins host Dr. Jose Silva to discuss the shifting landscape of prostate biopsy and emerging strategies that improve accuracy and personalize care. --- SYNPOSIS The conversation explores the transition from transrectal to transperineal prostate biopsy, emphasizing the role of PSA density and modern imaging in refining patient selection. Dr. Sánchez-Ortiz highlights the value of biomarkers in improving diagnostic accuracy and focal therapy as a promising, less invasive treatment option.Beyond clinical innovations, the doctors also discuss the importance of communication in urology practice. Dr. Sánchez-Ortiz shares how tools like WellPrept can enhance patient education and engagement, reinforcing the need for individualized care strategies in an increasingly complex diagnostic landscape. --- TIMESTAMPS 00:00 - Introduction 02:14 - Evolution of Prostate Biopsy Methods17:51 - Transperineal vs. Transrectal Approaches22:52 - Use of Sedation35:10 - PSA Screening41:48 - Rise in Metastatic Prostate Cancer50:44 - Potential of Focal Ablation55:58 - Use of WellPrept --- RESOURCES WellPrept:https://www.wellprept.com/

Is your patient’s sexual dysfunction an early indicator of serious cardiovascular disease? In this episode of BackTable Urology, Dr. Amy Pearlman teams up with preventative cardiologist Dr. Dapo Iluyomade to discuss the relationship between erectile dysfunction (ED) and cardiovascular disease, and the holistic approach needed to prevent both of these chronic conditions from worsening. --- SYNPOSIS Dr. Iluyomade shares his preventive cardiology workup, the significance of lipid panels, and advanced diagnostics. They also explore the effects of common cardiovascular medications like beta blockers on sexual health and address common concerns related to testosterone and hormone therapies in both men and women. The conversation underscores the importance of interdisciplinary collaboration between urology and cardiology for optimal outcomes in patients with sexual dysfunction. --- TIMESTAMPS 00:00 - Introduction01:52 - The Intersection of Cardiology and Urology03:43 - Understanding Preventive Cardiology07:56 - Patient Risk Stratification and Workup16:35 - Cardiovascular Health in Women20:07 - Testosterone Therapy and Cardiovascular Risk26:39 - Hormone Replacement Therapy in Men and Women36:09 - Beta Blockers and Sexual Dysfunction42:36 - Diuretics and Sexual Health48:57 - A Message to Urologists from a Cardiologist --- RESOURCESTRAVERSE Trial Results: https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

With BCG in short supply and recurrence rates still high, the race is on for better intravesical options. In this episode of BackTable Tumor Board, Dr. Lindsey Herrel, urologic oncologist at the University of Michigan, joins Dr. Ruchika Talwar to explore the evolving landscape of intravesical therapy for intermediate risk bladder cancer. --- This podcast is supported by an educational grant from UroGen Pharma. UGN-102 was approved by the FDA on June 12, 2025. --- SYNPOSIS The doctors break down the nuances of defining this risk category and the clinical gray zones that complicate treatment decisions. Dr. Herrell shares her patient-centered approach to surveillance and therapy, and introduces promising new agents, including Anktiva, UGN-102, and the gemcitabine-releasing TAR-200 "pretzel" device. The discussion also highlights how advances in molecular profiling are reshaping care strategies.This episode underscores the urgent need for clearer guidelines and continued innovation to improve outcomes and quality of life for patients with this nuanced disease subtype. --- TIMESTAMPS 00:00 - Introduction02:03 - Defining Intermediate Risk Bladder Cancer06:12 - Intravesical Therapy Options08:47 - Quality of Life and Patient Counseling10:18 - New Treatments on the Horizon12:56 - Practical Tips for TURBT Recovery17:03 - In-Office Procedure Management21:38 - Managing Symptoms and Quality of Life31:50 - A Note on Smoking Cessation33:37 - Conclusion and Future Directions