BackTable Urology

In this episode, Dr. Edward Schaeffer, chair of urology at Feinberg School of Medicine, discusses precision medicine in prostate cancer with Dr. Aditya Bagrodia.First, Dr. Schaeffer introduces the importance of using a defined screening strategy for prostate cancer that includes analyzing a patient’s genomic and germline risk. Then, he summarizes existing and new diagnostic tools for prostate cancer. Additionally, Dr. Schaeffer discusses genomic testing and PSMA testing and explains how he applies them to individual patient cases depending on their cancer stage and grade. Finally, the doctors highlight the ability of future tools, like PET PSMA scans, to advance precision medicine.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/3XO8iL---SHOW NOTES00:00 - Introduction10:32 - Precision Medicine and Prostate Cancer16:17 - Screening and Diagnosis of Prostate Cancer29:41 - Personalizing Surveillance and Disease Management33:11 - The Role of Genomic Testing in Prostate Cancer45:00 - The Use of PET PSMA Scans in Prostate Cancer Staging48:08 - The Future of Precision Medicine in Prostate Cancer

This week on BackTable Urology, Dr. Ben Chew, professor and clinical researcher with the University of British Columbia, provides valuable insights on laser treatments for kidney stones.First, Dr. Chew provides a comprehensive overview of the current landscape of laser treatment for kidney stones. Dr. Silva and Dr. Chew then discuss the unique characteristics of different laser types, such as the Holmium and the Thulium lasers. Dr. Chew also covers critical safety considerations, like maintaining low intravenous pressure, using cold irrigation, and taking breaks during sustained laser treatment. Additionally, they delve into emerging technology, such as the use of electromagnetic guidance, for more accurate laser application.---SHOW NOTES00:00 - Introduction06:49 - Choosing the Right Laser12:11 - Energy Settings for Lasers18:49 - Upper Tract Tumors and Lasers23:54 - Preventing Thermal Injuries During Laser Treatment27:03 - Dusting vs Fragmentation with Lasers34:27 - The Impact of New Technologies on Kidney Stone Treatment41:30 - Final Thoughts and Safety Recommendations

Dr. Stacy Loeb, Professor of Urology at NYU Grossman School of Medicine, joins Dr. Aditya Bagrodia to discuss lifestyle medicine in prostate cancer prevention. They cover topics including the negative impacts of red and processed meat consumption, the importance of regular physical activity and healthy sleep, managing substance abuse, and the significance of maintaining social connections and managing stress effectively for preventative health.

Dr. C.J. Stimson and Dr. Ruchika Talwar from Vanderbilt University discuss the transformation in healthcare with corporations like Amazon and Walmart entering the industry. They highlight the shift from doctor-centric to consumer-centric care, innovations such as value-based arrangements, and the role of employers in healthcare. They also emphasize the importance of preserving the doctor-patient relationship amidst the changing landscape.

This week on BackTable Urology, urologic oncologist Dr. Bogdana Schmidt (University of Utah) hosts a discussion with medical oncology experts Dr. Rana McKay (UC San Diego) and Dr. Neeraj Agarwal (University of Utah) on recent clinical trials from bladder, kidney, and prostate cancer research presented at the 2023 European Society for Medical Oncology (ESMO) Meeting.First, they discuss impactful data regarding bladder cancers, specifically the CheckMate 901 and the EV-302 trials which show improvement in overall survival and promise for urothelial carcinoma patients’ quality of life. The conversation moves onto kidney-specific trials such as the LITESPARK-005, which offers improved progression-free survival for patients through the use of belzutifan. The panel rounds off by discussing the progress made in prostate-specific trials with emphasis on the EMBARK and SPLASH trials involving Lutetium therapy. Finally, the doctors discuss the trend towards personalized treatment plans based on the unique goals and health requirements of the patients.---SHOW NOTES00:00 - Discussion on Urothelial Carcinoma: CheckMate 901 and EV-30211:22 - Discussion on Kidney Cancer: LITESPARK-00523:53 - Discussion on Prostate Cancer: EMBARK31:41 - Discussion on Prostate Cancer: SPLASH vs PSMA36:39 - Future Directions for Lutetium Therapy for Prostate Cancer37:50 - Closing Remarks and Future Expectations---RESOURCESCheckMate 901 Trial Investigators. Nivolumab plus Gemcitabine-Cisplatin in Advanced Urothelial Carcinoma.https://www.nejm.org/doi/full/10.1056/NEJMoa2309863LBA6 EV-302/KEYNOTE-A39: Open-label, randomized phase III study of enfortumab vedotin in combination with pembrolizumab (EV+P) vs chemotherapy (Chemo) in previously untreated locally advanced metastatic urothelial carcinoma (la/mUC).https://www.sciencedirect.com/science/article/pii/S0923753423042709LBA88 Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): Randomized open-label phase III LITESPARK-005 study.https://www.sciencedirect.com/science/article/pii/S0923753423042345LBA02-09 EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-risk Biochemically Recurrent Prostate Cancer.https://pubmed.ncbi.nlm.nih.gov/37119051/177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy.https://pubmed.ncbi.nlm.nih.gov/26795286/

In this episode, Dr. Wayne Kuang (MD for Men LLC in Albuquerque, NM) discusses his initiative to redefine the benign prostatic hyperplasia (BPH) care pathway for patients, doctors, and the healthcare industry.One of his main focuses is to prioritize bladder health and end the polypharmacy approach to BPH. Dr. Kuang also introduces the 5 Stages of Bladder Health, emphasizing the risks if BPH is not treated effectively and earlier. He underlines the importance of strategic treatment planning based on detailed data collection of the patient’s prostate and bladder health. Dr. Kuang also examines different surgical and medical treatments for BPH. He ends the episode by explaining the Man vs. Prostate initiative and the significant global impact of his advocacy.---SHOW NOTES00:00 - Introduction02:01 - The Impact of BPH on Patients05:57 - The Importance of Bladder Health10:38 - The Five Stages of Bladder Health23:00 - The Role of Primary Care Physicians in BPH Treatment26:03 - The Role of Medications in Treating BPH34:06 - The Role of Urologists in BPH Treatment39:07 - The Importance of Personalized Therapy in BPH Treatment44:17 - The Man vs. Prostate Initiative---RESOURCESDr. Wayne Kuang on LinkedInhttps://www.linkedin.com/in/wayne-kuang-md/Man vs. Prostatehttps://www.manvsprostate.com/

In this episode, host Dr. Suzette Sutherland is joined by Dr. Kelly Casperson, a urologist who specializes in women’s sexual health, to discuss the importance of education, therapy, and hormone replacement in female sexual health.They explore topics such as the role of estrogen and testosterone in women’s sexual desire, FDA-approved medications for hypoactive sexual desire disorder, and the importance of sex education and communication within relationships. They also highlight the topic of gender inequality in sexual health care delivery and the lack of clinical resources specifically tailored to women’s needs. In sum, they aim to provide a deeper understanding of female sexual health and offer strategies for practitioners to provide more effective care.---SHOW NOTES00:00 - Introduction05:53 - The Role of Urologists in Women’s Sexual Health07:18 - The Importance of Communication in Addressing Sexual Dysfunction10:23 - The Role of the Clitoris in Female Orgasm19:52 - Understanding the Hormones Behind Female Sexual Desire25:32 - The Misconceptions and Gender Bias Surrounding Hormones26:04 - The Role of Testosterone in Menopause and Sexual Desire30:02 - The Challenges of Commercially Available Testosterone Products32:52 - Non-Hormonal Treatments for Low Libido42:41 - The Importance of Referring to Sex Therapists and Other Resources---RESOURCESDr. Kelly Casperson’s Websitehttps://kellycaspersonmd.com/You Are Not Broken Podcasthttps://kellycaspersonmd.com/you-are-not-broken-podcast/“You Are Not Broken” by Kelly Caspersonhttps://kellycaspersonmd.com/you-are-not-broken-book/“Magnificent Sex” by Peggy Kleinplatzhttps://www.amazon.com/Magnificent-Sex-Lessons-Extraordinary-Lovers/dp/0367181371American Association of Sexuality Educators, Counselors, and Therapistshttps://www.aasect.org/

In this episode, Dr. Suzette Sutherland and Dr. Alana Desai from the University of Washington discuss the management of urinary tract stones in pregnant patients, considerations for ureteroscopy, and consequences of radiation exposure in the fetus.First, the doctors underscore the importance of ultrasound as the first line imaging modality to minimize fetal exposure to radiation. Dr. Sutherland and Dr. Desai also delve into nausea and pain management options, recommended diets for prevention of stone formation during pregnancy, and the necessity of involving a multidisciplinary team in such cases. The episode concludes with a remarkable case study from Dr. Desai’s experience.---SHOW NOTES00:00 - Introduction02:06 - Incidence and Risk Factors of Kidney Stones in Pregnancy03:29 - Physiological Changes and Stone Formation in Pregnancy07:04 - Diagnosing Kidney Stones in Pregnancy13:08 - Expectant Management vs. Intervention14:41 - Managing Pain and Nausea in Pregnant Patients with Kidney Stones17:13 - Decompression Methods for Kidney Stones in Pregnancy23:13 - Ureteroscopy as a Preferred Intervention26:05 - Case Description from Dr. Desai30:04 - Considerations for Ureteroscopy in Pregnant Patients31:14 - Preventing Kidney Stones in Pregnancy---RESOURCESLyon, M., Sun, A., Shah, A., Llarena, N., Dempster, C., Sivalingam, S., Calle, J., Gadani, S., Zampini, A., & De, S. (2023). Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology, 182, 61–66. https://doi.org/10.1016/j.urology.2023.09.023Thongprayoon, C., Vaughan, L. E., Chewcharat, A., Kattah, A. G., Enders, F. T., Kumar, R., Lieske, J. C., Pais, V. M., Garovic, V. D., & Rule, A. D. (2021). Risk of Symptomatic Kidney Stones During and After Pregnancy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 78(3), 409–417. https://doi.org/10.1053/j.ajkd.2021.01.008

In this episode, Dr. Aditya Bagrodia (UC San Diego), Dr. Lindsay Hampson (UC San Francisco) and Dr. Gina Badalato (Columbia University) discuss the impact of the COVID-19 pandemic on urology education.They discuss the conception and impact of virtual lecture series like EMPIRE and Urology COVID on residents’ education. They also underline how being adaptive and open to change can help residents shape the future of their own learning. The doctors also explain how resident-led and resident-focused educational resources came into existence, and what more is envisioned for education in urology. The episode ends with a discussion about unmet needs in education and the significance of diverse perspectives in teaching surgical procedures.---SHOW NOTES00:00 - Introduction01:15 - Reflections on Urology Education and Early Career Experiences04:08 - The Evolution of Learning and Engagement in Medical Training07:55 - Transitioning from Medical School to Residency08:34 - The Creation of the Intern Academy for the American Urological Association14:24 - The Impact of COVID-19 on Virtual Learning16:12 - The Role of Residents in Virtual Learning19:24 - The Future of Virtual Learning and Education20:00 - The Role of Innovation and Adaptability in Education23:07 - The Role of Residents in Shaping Their Own Learning42:28 - The Future of Education in Urology---RESOURCESAUA Intern Academyhttps://auau.auanet.org/content/intern-academy-2023AUA EMPIRE Lecture Serieshttps://nyaua.com/empire/UCSF Urology Collaborative Online Virtual Didactics (COViD) Lecture Serieshttps://urologycovid.ucsf.edu/

In this crossover episode of BackTable OBGYN with Urology, Dr. Suzette Sutherland, Director of Female Urology at the University of Washington, and Dr. Anne Cameron, Professor of Urology at the University of Michigan, share their insights on the prevention and management of urinary tract infections (UTIs).First, they emphasize the importance of dispelling misconceptions about recurrent UTIs being a result of poor hygiene or incorrect behaviors, explaining that they can stem from genetic or hormonal risk factors. Dr. Cameron describes her algorithm for managing UTIs in specific patient populations. She further discusses the impact of factors such as fluid intake, bowel habits, and vaginal health on the incidence of UTIs. Dr. Cameron also highlights the potential for UTIs in diabetic patients on certain medications and the importance of a collaborative approach with diabetic healthcare teams. Additionally, the doctors explore various treatment strategies, such as cranberry supplements and gentamicin bladder installations, cautioning against antibiotic overuse due to the risk of resistance.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2P5fzK---SHOW NOTES00:00 - Introduction02:13 - Understanding UTIs: Definitions, Symptoms, and Prevalence04:39 - Recurrent UTIs: Definitions, Causes, and Treatment Challenges12:00 - Understanding Asymptomatic Bacteriuria15:00 - Cystitis vs. Pyelonephritis vs. Urosepsis20:57 - Antimicrobial Resistance and Antibiotic Stewardship24:36 - Treatment Guidelines for UTIs31:13 - Self-start Antibiotic Therapy for UTIs34:37 - Preventing UTIs: Hydration, Lifestyle Factors, and Bowel Health38:33 - The Connection Between Vaginal Health and UTIs42:40 - The Role of Supplements in UTI Prevention: D-Mannose and Cranberry, and Methenamine Hippurate57:18 - Identification and Treatment of UTIs in Patients with Indwelling Catheters01:00:04 - The Role of Gentamicin Bladder Installations in UTI Prevention01:04:27 - The Impact of Diabetes Medications on UTIs---RESOURCESAUA Guidelines for UTI Treatment:https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti