BackTable Urology

On this episode of BackTable Urology, Dr. Aditya Bagrodia and Dr. Rana McKay, a medical oncologist at UC San Diego, discuss guidelines and advances in prostate cancer treatment.---CHECK OUT OUR SPONSORVeracytehttps://www.veracyte.com/decipher---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/B9kR7B---SHOW NOTESFirst, they define three types of prostate cancer. Metastatic castration-sensitive disease refers to patients with metastatic cancer who have low testosterone levels because of androgen deprivation therapy (ADT). Nonmetastatic castration-resistant disease is nonmetastatic cancer with testosterone levels unresponsive to ADT. This category is harder to define as the classification varies based on imaging modality. Finally, metastatic castration-resistant disease is the most lethal type of prostate cancer, as there is an unmet need in developing therapeutics for these patients. Traditionally, the castrate level is defined as a testosterone level <50 ng/dL.Then, the doctors discuss different types of ADT, which include GnRH agonists, GnRH antagonists, and anti-androgen receptor medications. When explaining ADT to her patients, Dr. McKay always identifies the class of the agent and common side effects (i.e.- bone composition changes, metabolic changes, and mood and libido changes). Dr. McKay notes that she has observed many patients who have had success with ADT and shares lifestyle tips that she recommends to mitigate the side effects of ADT.Next, the doctors summarize treatment options for different types of prostate cancer patients, including those with de novo metastatic prostate cancer, metastatic hormone sensitive disease, biochemically recurrent disease, and chemotherapy naive patients. In addition, they reflect on past landmark trials and current prospective trials about different combinations of therapies. They end the episode by discussing lutetium-177 as a new therapy for prostate cancer.---RESOURCESVeracyte Decipher Prostate Genomic Classifierhttps://www.veracyte.com/diagnostics/prostate-cancerProstate Cancer Foundationhttps://www.pcf.org/Zero Prostate Cancerhttps://zerocancer.org/

In this episode of BackTable, Dr. Bagrodia interviews Dr. Sia Daneshmand, chief of urologic oncology at the University of Southern California, about the research trials and treatment of stage II seminomas.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/oOcODJ---SHOW NOTESFIrst, Dr. Daneshmand defines stage II seminomas, which are seminomas that have spread outside of the testicles to the retroperitoneal lymph nodes. Stage II seminomas are further subclassified into IIa, b, or c depending on size and number of affected lymph nodes. This disease stage can present on Initial seminoma diagnosis or occur after a relapse of a stage I seminoma. There are 3 options for standard treatment for stage II seminomas: radiation therapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Dr. Daneshmand recommends a monotherapy option to minimize toxicities and explains which treatment modalities are best for each subtype of stage II seminomas. Then, the doctors discuss common side effects of each modality. Radiation may cause cardiotoxicity, fatigue, enteritis, and secondary malignancy. Chemotherapy may cause neurotoxicity, nephrotoxicity, infertility, and tinnitus or hearing loss.The doctors also discuss RPLND as a therapeutic option. Dr. Daneshmand explains that some patients may be hesitant at first to choose this option, as this has been a large open surgery with lengthy hospitalizations in the past. However, his technique involves only making a small midline incision and using an extraperitoneal approach. His RPLND patients usually only stay in the hospital for one day and fully recover by 2 to 3 weeks. He also discusses prospective RPLND trials on stage II seminomas, including his own research project. Both doctors agree that patients should be involved in shared decision making in order to weigh the cure rate against the comorbidity rate of each therapy.Finally, Dr. Daneshmand speculates on the future of seminoma treatment, which he believes lies in advancements of individualized treatment based on biomarker data.

In this episode of BackTable, Dr. Bagrodia interviews Dr. William Flanary, a physician-comedian popularly known as Dr. Glaucomflecken, about lessons he has learned as a two-time testicular cancer survivor and the importance of humor in medicine.---CHECK OUT OUR SPONSORVeracytehttps://www.veracyte.com/decipher---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/VJvXZx---SHOW NOTESFirst, Dr. Glaucomflecken shares about his first diagnosis of testicular cancer. During his third year of medical school he felt a lump in his testicle, which led to a quick workup, diagnosis, and a full orchiectomy. The diagnosis was emotionally difficult, as he was in his mid-twenties and healthy. He returned to comedy, a skill he had developed in high school and college, to cope with his diagnosis. This time, however, he started to practice medical-based comedy with his new experiences as a medical student. He recounts other discussions he had about his cancer, such as fertility, the possibility of chemotherapy, and active surveillance.Four years after his first orchiectomy, he received his second diagnosis of testicular cancer during his last year of residency. He recounts feeling distraught and overwhelmed, as questions about fertility, hormone replacement, medical expenses, and postponing residency became more serious. He decided to have a full orchiectomy and testosterone replacement therapy, which solved his issues with fatigue and irritability. Additionally, his wife got him involved in testicular cancer support groups and foundations, including one called First Descents, an organization that encourages young adults with cancer to explore the outdoors. He notes that young patients are often overlooked in cancer support groups and encourages cancer patients to find their support networks outside of friends and family as well.Then, Dr. Flanary discusses his experience with suffering from cardiac arrest in 2020, which led to his wife doing ten minutes of chest compressions to keep him alive. He reflects on this event and concludes that it taught him how to be a better physician to his patients by making sure he involves patients’ families and encouraging him to address medical insurance issues directly.Finally, Dr. Flanary discusses how he uses humor to advocate and educate patients on social media. He notes that comedy can stimulate conversation and debate and encourages physicians to have social media presence.---RESOURCESKnock Knock Hi Podcasthttps://podcasts.apple.com/us/podcast/knock-knock-hi-with-the-glaucomfleckens/id1659572053First Descentshttps://firstdescents.org/

En este episodio de BackTable Urology, Dr. Jose Silva entrevista a Dr. Jose Saavedra, un especialista de salud sexual en Puerto Rico, sobre tratamientos mínimamente invasivos y cirugía para Peyronie's disease.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/BVuIxP---SHOW NOTESPrimero, Dr. Saavedra reflexiona sobre su trayectoria médica antes de establecer su práctica privada, Puerto Rico Sexual Wellness Clinic. Después de la formación en cirugía general durante 3 años, escogió la urología como su especialidad por la habilidad de mejorar la calidad de vida de pacientes.Después, él habla sobre su evaluación para curvatura del pene. Usualmente sus pacientes desarrollan la curvatura y sufren 3-6 meses de síntomas antes de buscar su ayuda. Síntomas importantes incluyen dolor general durante la penetración y dolor referido en testículos. Es importante preguntar sobre su historial sexual y la posibilidad de un trauma escondido. Para él, la habilidad de obtener y mantener una erección es la medida más importante para evaluar la función del pene. Explica también en cuáles pacientes recomienda el vacuum erection device, los NSAIDs, y gabapentin también. Adicionalmente, habla sobre la onda de choque (shockwave therapy), que solamente recomienda para el manejo de dolor porque no resuelve el plaque.Próximo, explica los detalles de cómo realiza sus inyecciones en la clínica y las ventajas del vacuum erection device. Además, la satisfacción, la ansiedad, y el “body dysmorphic syndrome” son sus indicaciones para la cirugía. Finalmente, describe sus técnicas quirúrgicas y consejos para pacientes para la recuperación.

In this episode of BackTable Urology, Dr. Ranjith Ramasamy interviews Dr. Marc Goldstein about the history of microsurgery in the field of male fertility and the lessons he has learned as a renowned urological microsurgeon.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/eXilEv---SHOW NOTESFirst, Dr. Goldstein gives an overview of the history of medicine. It was developed by ENT doctors and used by ophthalmologists and gynecologists before Sherman Silber and Earl Owen, performed the first urologic microsurgery procedures in the 1970s. Then, Dr. Goldstein recounts his journey to performing microsurgery. Inspired by a paper he read about transplanting testicles in twins, he was able to shadow Dr. Silber in Saint Louis. Because there were no fellowships in male fertility microsurgery at the time, he practiced microsurgery by transplanting testicles in rats to practice microsurgery. He reflects on mentors who helped him develop more microsurgery skills and went on to establish his own fellowship program in 1984 at Cornell. Additionally, he briefly explains some microsurgical techniques he was able to develop in his career.Finally, he speaks about achievements and challenges of microsurgery as well as his general advice for young and soon-to-be urologists. He emphasizes the importance of doctors unionizing and engaging in wellness activities.

En este episodio de BackTable Urology, Dr. Jose Silva entrevista a Dr. Ramon Virasoro sobre los tratamientos diferentes para estrecheces uretrales.---SHOW NOTESPrimero, Dr. Virasoro habla sobre su camino a ser urólogo reconstructivo en los Estados Unidos. Empezó su educación en Buenos Aires pero obtuvo un fellowship de reconstrucción urológica en Eastern Virginia Medical School debajo de la tutela de Dr. Gerald Jordan. Dr. Virasoro refleja en su decisión de escoger esta especialidad y también los obstáculos de ser un graduado médico internacional. Decidió quedarse en la medicina académica después de terminar su entrenamiento.Próximo, Dr. Virasoro habla sobre su práctica de reconstrucción, incluso sus estudios primeros y procedimientos más comunes para pacientes con estrecheces ureterales. Aunque los síntomas son importantes, cree que la información radiológica es clave. Los doctores también están de acuerdos de que la selección de pacientes es importante también; es importante comprender la causa, la locación, y el tamaño de la estrechez porque hay técnicas mejores para cada tipo del estrechez.Entonces, discuten sobre los tratamientos diferentes para esta condición. Para estrecheces cortos sin tratamiento previo, una dilatación con globo tiene un alto nivel de éxito. Sin embargo, si la paciente con un estrecho largo o uno que ya tenía muchos procedimientos, el globo tiene un bajo nivel de éxito. En estos casos, una reconstrucción con injerto puede ser mejor. Los doctores evalúan diferentes tipos de injertos, incluso desde la lengua y desde la mejilla. También hablan de complicaciones después de la cirugía, como la pérdida de sensación, neuropraxia, y rabdomiolisis. Adicionalmente, Dr. Virasoro aboga por la preservación de vasos sanguíneos en sus casos de reconstrucción. En casos difíciles, él siempre involucra al paciente en la discusión para escuchar sus goles y preferencias. Hará una lista de los pros y contras de cada tratamiento y dará al paciente la capacidad de elegir el tratamiento. Los doctores hablan sobre la reparación concurrente de las fístulas y el desarrollo del globo con paclitaxel también (Optilume).Finalmente, Dr. Virasoro habla de sus experiencias internacionales de voluntariado con las organizaciones de Physicians for Peace y Safe Surgery and Anesthesia for Everyone.---RESOURCESSafe Surgery and Anesthesia for Everyone (SAFE)https://www.safesurgery4all.org/Physicians for Peacehttps://www.physiciansforpeace.org/

In this episode of BackTable, Dr. Jose Silva interviews Dr. Aaron Schneider, a pharmacist, and Dr. Jordan Grant, a urologist, about compounding pharmacies and their uses in providing medications to treat urological conditions.---CHECK OUT OUR SPONSORReviveRXhttps://reviverx.com/urology/---SHOW NOTESFirst, the doctors define compounding, which is the process of creating special treatments for unique populations of patients. Compounding a medication can involve a multitude of actions, such as removing an allergen, eliminating a preservative, changing typical route of administration, and more. Dr. Grant and Dr. Schneider explain how in 2016, ReviveRX, their compounding pharmacy, realized the need for compounding urologic medications, especially to treat infertility, erectile dysfunction, and low testosterone. Additionally, the doctors explained how ReviveRX provides a unique type of intracavernosal injection that is freeze dried to help increase the shelf life and distribution efficiency of the product. Although insurance companies may not cover the cost of compounded medications, some patients with allergies to medications have seen great improvement in side effects with medication compounded to their unique needs.Next, Dr. Grant discusses his testosterone replacement therapy regimen for patients with low free testosterone levels. He explains how he integrates hCG and FSH into the treatment plan if patients have concerns about declining fertility. Then, Dr. Schneider provides an overview of the history of hCG use and regulations in commercial and compounding pharmacies.Finally, the doctors wrap up by explaining how other doctors can order from ReviveRX and steps they can take to ensure the quality of products from compounding pharmacies.---RESOURCESReviveRXhttps://reviverx.com/

In this episode of BackTable, Dr. Jose Silva and Dr. Justin Dubin chat about the benefits and pitfalls of using social media to network with colleagues and to educate patients about urological conditions.---CHECK OUT OUR SPONSORReviveRXhttps://reviverx.com/urology/---SHOW NOTESFirst, Dr. Dubin explains why he created his own social media presence, which was to control his own narrative online. However, he realized that he could also form valuable connections with other doctors through social media, which motivated him to develop his social media from a professional standpoint. For instance, he was able to connect with other researchers virtually and publish papers. He encourages other urologists to create professional social media accounts but to also portray themselves authentically.Next, he explains his job search after fellowship. He had to consider his own priorities, most important of which was to have a clinic focused on men’s health, not just general urology. Additionally, he only refers patients to primary care physicians he would go to himself. Next, he and Dr. Silva discuss the workup for patients with low testosterone. According to guidelines, treatment is warranted if the patient has a low testosterone level and is symptomatic. Dr. Dubin emphasizes the importance of explaining to young patients that testosterone replacement therapy can cause infertility through azoospermia or anejaculation. Dr. Silva debunks the myth that testosterone replacement causes prostate cancer. Then, the doctors discuss the benefits of the expanding field of telemedicine. Dr. Dubin explains that telemedicine mitigates the stigma of erectile dysfunction and increases the convenience and accessibility of urologic care.Finally, Dr. Silva and Dr. Dubin comment on the increasing incidence of misinformation from social media about urologic conditions. Dr. Dubin summarizes a paper he published about harmful myths propagated by non-medical personnel on TikTok and Instagram. Both of the doctors agree that podcasts, such Dr. Dubin’s Man Up Podcast, can provide accurate information to patients. Dr. Silva notes the importance of outreach to younger patients, who utilize social media more and are more prone to misinformation.---RESOURCESReviveRxhttps://reviverx.com/Man Up Podcast“The broad reach and inaccuracy of men’s health information on social media: analysis of TikTok and Instagram” (Dubin, 2022)https://www.nature.com/articles/s41443-022-00645-6“Never Eat Alone: And Other Secrets to Success, One Relationship at a Time” by Keith Ferrazzihttps://www.penguinrandomhouse.com/books/227558/never-eat-alone-expanded-and-updated-by-keith-ferrazzi-and-tahl-raz/

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Ali Kasraeian, a private practice urologic oncologist in Jacksonville, about different techniques and research on prostate cancer screenings.---CHECK OUT OUR SPONSORExosomeDXhttps://www.exosomedx.com/---SHOW NOTESFirst, Dr. Kasraeian explains his interest in prostate cancer care. His father was a urologic oncologist who started a private practice, which he subsequently joined after completing his surgical training. He currently serves as a member of the Florida Prostate Cancer Advisory Council (FPCAC), a governor-elected board that raises public awareness for prostate cancer and brings practitioners and patient advocates together to advocate for this illness.Next, the doctors discuss the optimal time to screen for prostate cancer. Dr. Kasraeian notes that the national guidelines can be confusing for primary care providers and patients because they are constantly changing. Additionally, different organizations have different guidelines. In his practice, he recommends obtaining PSA levels at 45 years of age if the patient has not had any risk factors or family history of prostate cancer. Dr. Kasraeian notes that he looks at PSA velocity instead of single elevated PSA value to make decisions about subsequent steps.Then, he employs other screening methods, such as MRI scans and urine based biomarkers, if this is the case. He notes that biomarkers are useful because they can predict the risk of aggressive prostate cancer developing. Then, he will move onto obtaining a prostate biopsy if needed. The order of screening method will depend on the patient and their preferences. He emphasizes the importance of educating patients on the reasoning behind each screening test to allow them to become advocates of their own preventative cancer care.He then speaks about his personal experience spending a year in Paris and learning how to incorporate MRI as a screening test in his own private practice. He ends the episode by discussing the future directions of prostate cancer screenings and care by making comparisons between the trajectory of prostate cancer and that of breast cancer, and commenting on the use of biopsy alongside the increasing capabilities of MRI scans.

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Jason Wynberg, director of endourology at NYU Langone Health in Brooklyn, about his percutaneous nephrolithotomy (PCNL) technique and innovations.---CHECK OUT OUR SPONSORReviveRXhttps://reviverx.com/urology/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/LmSqn0---SHOW NOTESFirst, Dr. Wynberg explains his workup for a potential PCNL patient. He considers stone size, stone density, preexisting comorbidities, and patient preferences. He uses CT scans, retrograde pyelograms, and flexible ureteroscopy to study the anatomy of the patient. Next, he explains how he gets his own access through retrograde access while the patient is in the supine position.Then, he discusses the trademark patent he currently holds for a PCNL kit, which includes a puncture wire, sheath, and coaxial microintroducer. The kit allows urologists to put a retrograde puncture wire through a flexible ureteroscope. He notes that this kit decreases renal trauma and allows the papillary puncture to be aligned with the infundibulum. He also reflects on the challenges of developing his kit and finding industry partners to support development. Although he had to wait 7 years to commercialize his technology, he saw the prolonged time as a benefit because he was able to improve its design before commercial release.Finally, he explains his technique for using the PCNL kit and offers advice for different difficult scenarios during PCNL. He emphasizes that, in the end, skilled surgeons ensure the success of PCNLs, not just the equipment they use.---RESOURCESReviveRXhttps://reviverx.com/---The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen on BackTable.com/Urology or on the streaming platform of your choice.Get notified when new episodes drop! Subscribe to the BackTable Urology Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates.Apple ► https://podcasts.apple.com/us/podcast/backtable-urology/id1563577139Spotify ► https://open.spotify.com/show/32LoLeG0gYyJcNyloN8CviYouTube ► https://www.youtube.com/channel/UCCV3si2GQV6kWzig93ymEWg?sub_confirmation=1LinkedIn ► https://www.linkedin.com/company/backtable-urology/Twitter ► https://twitter.com/_backtableuroInstagram ► https://www.instagram.com/_backtableuro/Newsletter ► https://www.backtable.com/shows/urology/subscribe