BackTable Urology

What is the role of the American Medical Association (AMA) in 2025 and how does it affect your practice? Join Dr. Ruchika Talwar in this insightful episode of the BackTable Urology podcast as she converses with Dr. Willie Underwood, a urologic oncologist and president-elect of the American Medical Association.---SYNPOSISDr. Underwood shares his journey into medical advocacy, the pivotal role of the AMA in advancing healthcare, and the importance of physician engagement in legislative processes. The discussion highlights key issues such as Medicare and Medicaid reforms, physician burnout, and the implementation of technology in healthcare. This episode is a must-listen for anyone in the medical field who wants to understand the significance of collective efforts in improving patient care and the future of healthcare. Stay tuned to learn how you can make a difference in organized medicine.---TIMESTAMPS00:00 - Introduction04:01 - The Role of the AMA08:33 - AMA's Legislative Actions14:40 - Engaging with the AMA17:57 - Balancing Diverse Physician Values30:38 - Importance of Physician Participation and PACs40:13 - Final Thoughts and Call to Action

Kids with kidney stones–how do you treat them, prevent recurrence, and provide effective longitudinal care? In this episode of BackTable Urology, Dr. Nicholas Kavoussi and Dr. Scott Sparks join co-hosts Dr. Arthi Hannallah and Dr. Niccolo Passoni for a high-yield discussion on pediatric and adolescent stone disease.---SYNPOSISTogether, they explore best practices for managing complex kidney stones in children, surgical techniques like supine PCNL, and the use of novel technologies such as thulium lasers and suction sheaths. The doctors also address strategies to reduce procedural trauma, manage pain, and minimize infection risk. Beyond the OR, they emphasize the psychological toll of recurrent interventions and the importance of thoughtful counseling, patient education, and a multidisciplinary approach to help patients successfully transition into adult care.---TIMESTAMPS00:00 - Introduction03:06 - Managing Complex Cases Without PCNL10:25 - Approach to Supine PCNL18:21 - Balancing Surgical Risks24:21 - Shared Decision-Making and Setting Expectations33:16 - Minimizing Postoperative Pain37:47 - Innovations in Technology55:55 - Transitioning from Pediatric to Adult Urology

What does it take to build a successful reconstructive urology practice while balancing the worlds of academia and private practice? In this episode of BackTable Urology, reconstructive urologist Dr. Lucas Wiegand joins host Dr. Jose Silva to explore his career journey from training at the University of South Florida and fellowship at Washington University, to establishing his practice at Orlando Health.---SYNPOSISDr. Wiegand shares insights on the evolution of robotic surgery, from laparoscopic to single-port systems, and how these advances have improved patient recovery and expanded the possibilities for outpatient care.The conversation also dives into the shifting boundaries between academic and private practice, the growing demand for reconstructive urology, and practical advice for residents considering fellowship training. Dr. Wiegand emphasizes the enduring value of subspecialty education, the increasing recognition (and even financial premium) placed on fellowship training, and the importance of continuous learning, collaboration, and patient-centered care.---TIMESTAMPS00:00 - Introduction03:12 - Robotic Surgery in Urology04:08 - Choosing a Fellowship07:18 - Single Port Robotics11:36 - Open vs. Robotic Surgery24:33 - The Growing Demand for Urologic Care in Florida27:53 - Building a Reconstructive Urology Practice32:48 - The Role of Fellowship in Reconstructive Urology36:46 - Staying Current and Engaged Post-Residency42:19 - Final Thoughts and Contact Information

Could ongoing trials redefine the management of oligometastatic and advanced prostate cancer? In this installment of BackTable Tumor Board, leading prostate cancer experts Dr. Neeraj Agarwal, a medical oncologist from the University of Utah, and Dr. Tyler Seibert, a radiation oncologist from UC San Diego, join host Dr. Parth Modi to share their insights on the latest clinical trials and persistent challenges in managing prostate cancer. --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The multidisciplinary discussion addresses clinical decision-making in active surveillance versus early intervention, the role of PSMA PET imaging in detection and treatment planning, and evolving strategies for metastatic and castration-resistant disease. They also evaluate the therapeutic potential of alpha emitters and radioligand therapies, consider the evidence behind treatment intensification and de-intensification, and explore how these approaches can be individualized to optimize patient outcomes. --- TIMESTAMPS 0:00 - Introduction1:48 - Active Surveillance in Low-Risk Prostate Cancer7:08 - Molecular Testing and Risk Stratification8:28 - Radiation Therapy Approaches20:16 - PSA Recurrence and PSMA PET Scans32:40 - The Role of ADT37:15 - PSMA PET Scans40:58 - Genetic Testing in High-Risk and Metastatic Prostate Cancer46:54 - Treatment Intensification vs. De-Intensification Trials55:59 - Castration-Resistant Prostate Cancer

When it comes to menopause care, the facts are better than the fears. In this Urology/OBGYN crossover episode of the BackTable Podcast, host Dr. Suzette Sutherland welcomes renowned urologist Dr. Rachel Rubin to explore various aspects of sexual health and hormone replacement therapy (HRT), particularly for menopausal women. ---SYNPOSISDr. Rachel Rubin shares her career journey, expertise in sexual health, and the critical role of hormone replacement therapy (HRT) in managing menopause. She addresses common challenges and misconceptions, particularly around estrogen use, by demystifying the Women’s Health Initiative studies and emphasizing the proven safety and benefits of systemic and vaginal HRT. Dr. Rubin offers practical guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen. Through personal anecdotes and professional insights, she empowers practitioners with evidence-based strategies and underscores the importance of education and research in advancing women’s health.---TIMESTAMPS00:00 - Introduction03:41 - Challenges in Menopause Medicine07:21 - Misconceptions and Risks of HRT15:35 - Understanding Bioidentical Hormones18:48 - WHI Studies and Their Impact23:21 - Practical Guide to Prescribing HRT33:47 - Understanding Estrogen Levels and Risks36:04 - Debating Gels vs. Patches37:51 - Concerns with Compounded Products and Pellets38:50 - Patient Education and Meeting Them Where They Are42:12 - Progesterone Benefits and Sensitivities46:38 - Testosterone Therapy for Women51:36 - The Importance of Lab Tests55:39 - DHEA and Vaginal Health57:14 - Advocacy for Accurate Hormone Therapy Information01:00:05 - Conclusion and Final Thoughts---RESOURCESThe Peter Attia Drive episode with Dr. Rachel Rubin:https://peterattiamd.com/rachelrubin/ FDA Expert Panel on Menopause and Hormone Replacement Therapy for Women:https://www.youtube.com/live/_2ZRlOivC5M?si=-Xynb_BmWz2sWf4mDr. Rachel Rubin’s Hormone Therapy for Early Adopters Course:https://rachelrubinmd.thinkific.com/courses/MHTCME

Residency teaches you how to save lives, but does it teach you how to save money? In this episode of BackTable Urology, Dr. Sammy Elsamra joins host Dr. Gina Badalato to unpack the essentials of financial planning during and after urology residency. From budgeting and managing loans to covering living expenses, Dr. Elsamra emphasizes the importance of building an emergency fund, addressing high-interest debt, and following the 50-30-20 rule to maintain stability.---SYNPOSISThe conversation also dives into long-term strategies like Roth IRAs, tax-advantaged accounts, and the role of disability and life insurance in protecting your future. With recommendations such as The White Coat Investor and foundational financial books, Dr. Elsamra equips trainees with the knowledge and resources they need to set themselves up for lasting success. This episode is a must-listen for residents aiming to take control of both their careers and their financial futures.---TIMESTAMPS00:00 - Introduction01:56 - Post-Residency Financial Realities04:43 - Budgeting During Residency07:23 - The 50-30-20 Rule08:06 - Investing During Residency15:29 - Financial Planning for Attending Physicians24:42 - Understanding Insurance: Life and Disability33:11 - Resources and Advice for Financial Success---RESOURCESThe White Coat Investor (podcast and books):https://www.whitecoatinvestor.com/The Millionaire Next Door (book):https://themillionairenextdoor.com/

Could ctDNA testing allow us to treat bladder cancer earlier, smarter, and more effectively? In this episode of BackTable Urology, Dr. Alberto Pieretti, a urologic oncologist at Cleveland Clinic Weston Hospital, joins host Dr. Jose Silva to explore the emerging role of ctDNA in bladder cancer management. --- This podcast is supported by: Ferring Pharmaceuticals --- SYNPOSIS Dr. Pieretti and Dr. Silva discuss how ctDNA can refine staging, identify patients at risk of recurrence, and guide decisions on when to intensify treatment. The conversation also examines its potential to detect actionable mutations, inform precision therapies, and shape the design of future clinical trials in urologic oncology. --- TIMESTAMPS 0:00 - Introduction2:50 - Overview of Bladder Cancer12:59 - Overview of ctDNA20:34 - Current ctDNA Trials27:21 - Clinical Implications of ctDNA31:20 - Conclusion --- RESOURCES Updated Overall Survival by Circulating Tumor DNA Status from the Phase 3 IMvigor010 Trial: Adjuvant Atezolizumab Versus Observation in Muscle-invasive Urothelial Carcinoma - PubMedhttps://pubmed.ncbi.nlm.nih.gov/37500339/ Perioperative Durvalumab with Neoadjuvant Chemotherapy in Operable Bladder Cancer | New England Journal of Medicinehttps://www.nejm.org/doi/abs/10.1056/NEJMoa2408154

In medicine, the hardest critic you’ll face is often yourself. In this episode of BackTable Urology, Dr. Michelle Van Kuiken joins host Dr. Lindsay Hampson to unpack the realities of imposter syndrome in urology practice and discuss its impact on trainees and professionals --- This podcast is supported by: ⁠Ferring Pharmaceuticals⁠ --- SYNPOSIS Dr. Van Kuiken and Dr. Hampson explain the basics of imposter syndrome, its prevalence, and the many ways it can show up in medical training and practice. They also share candid personal experiences and practical strategies for overcoming self-doubt, from reframing negative thoughts to embracing feedback as a tool for growth. The doctors highlight the value of mentorship, peer support, and celebrating achievements, as well as the importance of creating a culture where vulnerability and open conversations are encouraged. --- TIMESTAMPS 00:00 - Introduction02:29 - Defining Imposter Syndrome04:24 - Personal Experiences with Imposter Syndrome08:44 - Impact of Imposter Syndrome in Medicine10:39 - Strategies to Overcome Imposter Syndrome13:59 - The Role of Mentorship16:28 - Gender and Mentorship in Medicine27:24 - Peer Support and Building Community32:13 - Final Thoughts and Takeaways --- RESOURCES Medical Trainees and the Dunning–Kruger Effect: When They Don't Know What They Don't Know:https://doi.org/10.4300/JGME-D-20-00134.1 Imposter Syndrome in Surgical Trainees: Clance Imposter Phenomenon Scale Assessment in General Surgery Residents:https://doi.org/10.1016/j.jamcollsurg.2021.07.681 Defining the Incidence of the Impostor Phenomenon in Academic Plastic Surgery: A Multi-Institutional Survey Study:https://doi.org/10.1097/prs.0000000000010821 Academic Urology Endowments and Leadership Roles are Disproportionately Held by Male Urologists:https://doi.org/10.1016/j.urology.2025.04.038 Implementation of a “Best Self” Exercise to Decrease Imposter Phenomenon in Residents:https://doi.org/10.4300/JGME-D-23-00873.1 Keep-Stop-Start Framework:https://meded.ucsf.edu/sites/meded.ucsf.edu/files/2024-06/TipSheet-Feedback.pdf Lean In: https://leanin.org/ W. Brad Johnson, PhD: https://www.wbradjohnson.com/

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/