BackTable Urology

This week on the BackTable Urology Podcast, Dr. Bagrodia talks with Dr. Daniel Spratt, professor and chairman of radiation oncology at Case Western University in Cleveland, about the workup and treatment of high risk prostate cancer.---CHECK OUT OUR SPONSORVeracytehttps://www.veracyte.com/decipher---SHOW NOTESFirst, Dr. Spratt defines high risk prostate cancer and discusses how to evaluate non-specific PSMA PET findings. He notes the importance of standardized systems to avoid over-calling such findings and discusses the role of CT scans and MRI scans when necessary. Finally, the doctors emphasize the importance of synthesizing PSMA PET findings into their decision-making. Next, the doctors discuss the use of germline and genomic testing, specifically Decipher testing, to characterize the tumor. Germline testing can determine eligibility for neoadjuvant PARP inhibitor trials, and biomarkers have the potential to improve radiation therapy outcomes. Although they quickly summarize the NCCN guidelines, they also emphasize the importance of patient counseling to determine the right treatment plan.Then, the doctors move on to discuss the different radiation treatments available for treating high-risk prostate cancer, such as conventional fractionation, brachytherapy, and ultrahypofractionated radiotherapy. They also explain the use of protons in treating high-risk prostate cancer, which is difficult because of the lack of high-level evidence and financial benefit when using protons compared to conventional radiation treatments.Finally, they wrap up the episode by explaining the correlation between early PSA responses and the success of radiation therapy. Surgery and radiation are often used together in treating most cancers, and how combining both can cut down the chances of PSA recurrence.---RESOURCESVeracyte Decipher:https://decipherbio.com/

Dr. David Albala, chief of urology at Crouse Hospital, discusses the benefits of biomarkers in prostate cancer diagnosis. They explore the history of PSA testing and the importance of considering clinical risk factors. The use of urine and blood biomarkers to determine the need for biopsy is also discussed. The integration of the ExoDx Prostate Test and MRI in diagnosis is explained, highlighting the benefits and limitations. The significance of early diagnosis, screening, and advancements in patient care are emphasized.

In this episode of BackTable Urology, Dr. Bagrodia, program director Dr. Steve Hudak (UTSW) and resident doctor Dr. Theresa Olmstead (UC San Diego) discuss the tangible advice for having successful urology away rotations and crafting an outstanding urology residency application.---SHOW NOTESFirst, the doctors discuss advice for first and second-year medical students interested in urology. Students in the early stages of their medical journey should be honest and transparent with themselves and mentors about their interests, abilities, and goals. The removal of STEP 1 scores and other metrics has allowed students to determine if a specialty is right for them without the fear of being turned away. Connections, research, and opportunities for first and second year medical students are important, but taking the time to find a mentor who resonates with them and committing to projects that will help them move forward is also essential.Then, the doctors discuss the process of applying for away rotations and Theresa shares her experience of doing three away rotations. Additionally, they explain the job interview-like process of away rotations and how to best prepare for the process, like taking the time to understand and orient oneself in the situation. Both Theresa and Steve agree that punctuality, being oneself, and assessing program fit are very important.Next, the doctors share tangible advice on how to ask for stellar letters of recommendation, such as having tangible examples to share with letter writers, taking the time to talk to faculty ahead of time, and providing their curriculum vitae and personal statement. They also discuss the pros and cons of the signaling process. Finally, they give interview tips, such as having unique stories to share, and being concise and succinct when answering questions.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Suzette Sutherland, director of Female Urology at the University of Washington, discuss new therapies for overactive bladder (OAB).---CHECK OUT OUR SPONSORWellprepthttps://wellprept.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/V7Flno---SHOW NOTESFirst, they describe the symptoms of OAB which include an increased frequency and urgency of urination, sometimes leading to urinary incontinence. Conservative measures include pelvic floor exercises, diet, and lifestyle changes. If patients fail conservative measures, urologists can prescribe anticholinergics. However,beta agonists are preferable because they do not cross the blood-brain barrier. Then. the doctors briefly chat about the use of these agents in Alzheimer disease patients as well, which may be dependent on insurance approval.Next, Dr. Sutherland summarizes surgical devices to treat OAB and the clinical trials supporting each of them. Sacral nerve neuromodulation is a device that has been on the market for years, but newer models that include fixed and rechargeable batteries are starting to become more available. Additionally, the Neuspera is a sacral nerve neuromodulation that operates wirelessly through Bluetooth. The doctors also compare the two existing models of sacral neuromodulation (Medtronic vs. Axonics).One newer surgical treatment is tibial nerve stimulation, and Dr. Sutherland summarizes her placement technique, voltage settings, intraoperative testing, and the importance of a healthy ankle evaluation prior to placing the device. promising results, in-office, sedation, healthy ankle evaluation. She also notes that repositioning the leads in sacral and tibial neuromodulation in a followup visit may be necessary. Finally, she shares about Fempulse, vaginal stimulator mimicking a pessary, that is still being tested in research trials.---RESOURCESWellprept​​https://wellprept.com/

In this episode of BackTable Urology, Dr. Bagrodia and urologic oncologist Dr. Piyush Agarwal (University of Chicago) discuss the impact of music to keep them focused and set the mood in the OR.---CHECK OUT OUR SPONSORWellprepthttps://wellprept.com/---SHOW NOTESFirst, the doctors explore different types of music that can be used in the OR to help set a certain tone or rhythm for a procedure. They discuss the use of Bollywood, classic rock, show tunes, EDM, R&B, lo-fi, as well as other music genres to help create a more enjoyable OR environment. They also touch on the importance of having the right crew to enjoy music in the OR, as well as the humorous associations that some surgeons have with certain music. Dr. Agarwal then explains why Apple Music and Spotify are his preferred platforms for streaming music in the OR. Additionally, they look at the power of sharing playlists on Spotify to create a community.Finally, they discuss the importance of engaging the team in the OR and encouraging other members to contribute to the music selection. They end the episode by exploring how nostalgic music can bring back fond memories of childhood and lift the spirits of everyone in the OR.

In this episode of BackTable Urology, Dr. Jose Silva, radiation oncologist Dr. Neil Mariados, and urologic oncologist Dr. Dan Welchons discuss techniques and benefits of rectal spacing for radiation therapy in prostate cancer patients.---CHECK OUT OUR SPONSORBarrigelhttps://barrigel.com/---SHOW NOTESFirst, Dr. Mariados explains the need for rectal spacing in order to minimize the toxicities of prostate radiation. He then discusses the national rectal spacing trials (SpaceOAR and Barrigel) that he and Dr. Welchons participated in. The doctors also mention that most patients are interested in rectal spacing in order to minimize toxicities, but having a tumor with extracapsular extension is a contraindication of the procedure.Then, the doctors compare two rectal spacing products, SpaceOAR and Barrigel, in the context of setup and product materials. They explain the Barrigel technique, which is performed through the transperineal approach. Preoperatively, their patients receive Valium and oxycodone. After the surgery, the spacer can be visualized through a CT scan. Dr. Welchon also reflects on his process of learning the Barrigel procedure and the satisfaction that comes with helping patients avoid toxicities.The stability of Barrigel is 1 year. Most patients feel little to no discomfort after the procedure, and the doctors do not prescribe any postoperative antibiotics. The most serious complication of rectal wall spacing is rectal wall invasion, which occurs after incorrect product placement. However, the doctors discuss ways to avoid this complication, like using tactile feedback. They also emphasize the similarities between rectal spacing technique and transperineal prostate biopsies. Finally, they emphasize the importance of publications and education to avoid misunderstanding and myths about rectal spacing.---RESOURCESBarrigel Rectal Spacerhttps://barrigel.com/

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with urological oncologist Dr. Ashley Ross from Northwestern University about risk factors of prostate cancer and the importance of genome expression tests to predict tumor characteristics.---CHECK OUT OUR SPONSORVeracytehttps://www.veracyte.com/decipher---SHOW NOTESFirst, the doctors summarize how to determine stage and risk of prostate cancer by assessing local and regional staging with MRI and PET-PSMA scans. They discuss the significant role of Gleason grade groups and genetic variants and genetic predisposition for prostate cancer. They underscore the importance of evaluation beyond the microscopic cellular structure of the cancer and using tools like MRI to reduce unnecessary biopsies.Next, they explain the factors involved in the decision to treat or observe prostate cancer. Dr. Ross shares insights into the three possible lines of progression that prostate cancer can take and how to identify them in a patient. He illuminates the differences between germline and genomic testing, the impact of genomics on treatment decisions, and the crucial role of shared decision making. The doctors also consider the cost of genomics and the patient's expectation of what will happen before making a decision. Although there is a lack of standardization in the qualification and execution of prostate cancer surveillance, national trials are being done nationally that could influence guidelines around the use of genomics and active surveillance.---RESOURCESDecipher Prostate Genomic Classifier by Veracytehttps://www.veracyte.com/diagnostics/prostate-cancer

In this episode of BackTable Urology, Dr. Aditya Bagrodia speaks with PGY4 urologist Dr. Chloe Peters (University of Washington) and OB/GYN Dr. Beverly Gray (Duke University) about their work in women's health and advocacy, and how the Dobbs ruling has impacted their respective medical fields.---SHOW NOTESFirst, the doctors explore the implications of state abortion laws on the OB/GYN and urology workforces and how they may directly impact where people choose to live and work. Dr. Peters and Dr. Gray explain the complexities of state abortion policies, as well as the differences between restrictive and nonrestrictive states. The Dobbs ruling in June 2022 gave individual states the power to regulate any aspect of abortion not protected by federal law, thus overturning Roe v. Wade. Both doctors emphasize that this ruling affects all urologists and OB/GYNs in private and academic settings, because they provide unsafe environments for patients who need them.Recent studies and surveys show how restrictive abortion laws are impacting the urology rank lists and applications. One in five applicants to the urology match took programs off their list because they are located in states with illegal abortion laws, and almost 60% said they would worry about their health and safety if they matched in a state with restrictive laws. In summary, all three doctors agreed that restrictive laws can have a direct impact on residency and urology recruitment efforts.Finally, they observe that the increasing diversity in the field of urology has encouraged younger, female members to advocate for better access to healthcare. They remain optimistic that the current generation can use their voices to create change and provide better access to care for all.---RESOURCESAmerican Urologic Association (AUA) Position Statement on the Supreme Court’s Decision to Overturn Roe v. Wadehttps://www.auanet.org/about-us/aua-statement-on-overturning-roe-v-wadeAmerican College of Obstetricians and Gynecologist (ACOG) Abortion Policyhttps://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/abortion-policyRyan Residency Training Programhttps://ryanprogram.org/

In this episode of BackTable Urology, urologists Dr. Jay Shah (Stanford University) and Dr. Brantley Thrasher (University of Kansas) discuss the importance of self-improvement and listening in leadership, a skill that has to be learned and honed over time.---SHOW NOTESDr. Brantley Thrasher reflects on a piece of advice he received several years ago when considering a leadership role he wasn't ready for. He emphasizes the importance of mentors, the power of honest conversation, and listening to show your team that they can trust you and be willing to follow your lead. He notes that when looking for a leadership role, it's important to know your skillset and to be honest with yourself and those around you. It is also important to recognize when someone is not the right fit for a particular leadership role and to be willing to be open and honest with them about it. He shares his experience of having to tell a friend that they don't have the skill set for the job, and how he has seen people treating their team in a disrespectful way.Finally, he also discusses his past experience as the chair of Urology at Kansas and president of the AUA and Society of Urological Oncology, as well as his current role as the chair of the Society of Academic Urology and the executive director of the American Board of Urology. Finally, he offers advice to those looking for a leadership role on how to assess if they have the skills for the job. He recommends books such as The Servant, Grit, The Road to Character, and The War of Art.---RESOURCESThe Servant: A Simple Story About the True Essence of Leadership by James C. Hunterhttps://www.amazon.com/Servant-Simple-Story-Essence-Leadership/dp/0761513698Grit: The Power of Passion and Perseverance by Angela Duckworthhttps://www.amazon.com/Grit-Passion-Perseverance-Angela-Duckworth/dp/1501111108The Road to Character by David Brookshttps://www.amazon.com/Road-Character-David-Brooks/dp/0812983416The War of Art by Steven Pressfieldhttps://www.amazon.com/War-Art-Winning-Creative-Battle-audio-cd/dp/1501260626

In this episode of BackTable Urology, urologist Dr. Manoj Monga (UC San Diego) and clinical nutritionist Dr. Kristina Penniston (UW Madison) discuss the role of diet in kidney stone prevention and how urologists can partner with dietitians to create integrated stone clinics.---SHOW NOTESFirst, the doctors explore how to adjust fluid intake based on the patient's body size and consistency of bowel movements. They also cover ways to be creative with fluids, including incorporating low sugar, low calorie, and low alcohol beverages into the diet, as well as scheduling and flavoring options. They review the importance of mineral content in hard and soft water, and the potential benefits of alkaline water. Finally, they discuss the recommended sodium intake per day.Next, Dr. Penniston explains that oxalate, a common component of kidney stones, is found in many plant foods, such as spinach, potatoes, sweet potatoes, beans, rhubarb, beets, nuts, and grains. She discusses how oxalate bioavailability can be reduced by the simultaneous consumption of foods and beverages containing calcium. Finally, she outlines the many non-dairy alternatives for calcium that are available.Lastly, the doctors discuss how certain diets can increase and decrease the acidity of the urine. They debate the effects of intermittent fasting on stone risk, as well as the healthiest diet to lose weight without increasing stone risk. They end by emphasizing the importance of lifestyle changes and how a balanced and varied diet is key to successful weight loss.