BackTable Urology

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: VeracyteVeracyte.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 Pharmaceuticalshttps://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1 --- 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 Pharmaceuticalshttps://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1 --- 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

With the right protocols (and the right team!), urology clinics can proactively manage the side effects of intravesical therapy. This in-studio episode from the 2025 NMIBC Creator Weekend™ series features unique perspectives from Vanderbilt nurse practitioner Meredith Donahue and surgical neuro-oncology nurse Brynn Moore, both with focuses in urologic oncology. Hosted by Dr. Ruchika Talwar, we cover the practical and logistical considerations in intravesical therapy administration. --- This podcast is supported by: Ferring Pharmaceuticalshttps://www.ferring.com/home-classic/people-and-families/uro-uro-oncology/bladder-cancer/ --- SYNPOSIS Donahue and Moore share their experiences with intravesical therapy, discussing practical issues such as patient management, scheduling, and handling side effects. They emphasize the importance of creating a supportive environment in clinics, proactive treatment plans, and ensuring effective communication among the multidisciplinary team. They also share resources and tips for nurses and nurse practitioners new to urologic oncology. --- TIMESTAMPS 00:00 - Introduction07:09 - Multidisciplinary Team Dynamics11:34 - Resources for Patients18:55 - Transvaginal Estrogen Cream26:56 - Optimizing Intravesical Therapy Clinics35:57 - The Importance of Multidisciplinary Collaboration36:27 - Conclusion

What does it take to save both life and function in a rapidly progressing infection? In this episode of BackTable Urology, Dr. Judith Hagedorn (University of Washington) joins Dr. George Koch (Ohio State University) to unpack the complexities of Fournier’s gangrene management. --- SYNPOSIS They discuss advances in surgical techniques like skin-sparing debridement and the value of high-volume centers for patient outcomes. They also explore the use of wound vacuums, the challenges related to testicular management, and the future of Fournier’s gangrene treatment, including early detection and better patient scoring systems. --- TIMESTAMPS 0:00 - Introduction3:04 - Evolution of Fournier’s Management7:50 - Management at High-Volume vs. Community Centers20:39 - Use of Wound Vacs27:03 - Testicular Management43:56 - Future Directions

As new genetic and AI-powered tools emerge for bladder cancer screening, are we getting closer to reducing the need for invasive cystoscopies? In part five of the 2025 BackTable NMIBC Creator Weekend™ series, host Dr. Vignesh Packiam engages in an insightful discussion with Dr. Sarah Psutka from the University of Washington and Dr. Katie Murray from NYU about the complexities and potential benefits of using biomarkers in non-muscle invasive bladder cancer (NMIBC). --- This podcast is supported by: Ferring Pharmaceuticals https://www.ferring.com/home-classic/people-and-families/uro-uro-oncology/bladder-cancer/ --- SYNPOSIS The conversation covers the current challenges of interpreting positive biomarkers without clinical correlates, the gold standard of biopsies, and the potential of various biomarkers such as urine cytology, FISH, and newer genomic tests like the Decipher Bladder Genomic Classifier. They also touch upon the role of AI in pathology, the cost implications of biomarkers, and how these tools might influence future clinical practices and patient decisions. The episode emphasizes the need for precision medicine, careful patient counseling, and the impact of false positives and negatives on both patients and healthcare providers. --- TIMESTAMPS 00:00 - Introduction05:25 - Challenges with Current Biomarkers08:10 - New Biomarkers and Genomic Classifiers21:10 - AI and Pathology in Bladder Cancer35:13 - Screening and Future Directions41:20 - Challenges and Future Directions in Bladder Cancer Surveillance57:51 - Conclusion --- RESOURCES DaBlaCa-15 Trialhttps://pubmed.ncbi.nlm.nih.gov/40280776/ Sam Chang CHAI Studyhttps://pubmed.ncbi.nlm.nih.gov/40514253/