BackTable 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/

Dr. Alberto Pieretti, a urologic oncologist at Cleveland Clinic Weston Hospital, speaks with Dr. Jose Silva about the groundbreaking potential of circulating tumor DNA (ctDNA) in bladder cancer. They discuss how ctDNA can refine treatment decisions, identify patients at risk of recurrence, and even detect actionable mutations for precision therapies. The conversation highlights the implications for early detection and personalization of care, as well as ongoing trials that aim to integrate ctDNA into clinical practice, shaping the future of urologic oncology.

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

Physical performance, recovery, longevity–are these outcomes part of your urology practice? In this episode of BackTable Urology, Dr. Vonda Wright, a renowned orthopedic surgeon and expert in aging and longevity, joins Dr. Amy Pearlman to discuss the intersection of surgical practice, longevity medicine, and patient-centered healthcare in urology. --- SYNPOSIS The discussion covers the significance of whole-person care in surgery and the critical role of empathy in surgical practice. Dr. Wright shares her experiences from her extensive career and research, including her innovative work in hip arthroscopy and advocacy for performance-based care for middle-aged patients. The surgeons also explore the impact of hormonal health on physical performance and quality of life, the value of tailored exercise and nutrition plans, and practical strategies for optimizing long-term vitality in both men and women. Dr. Wright emphasizes the need for healthcare professionals to lead by example in prioritizing their own well-being while staying informed on emerging science that supports longevity and quality of life. --- TIMESTAMPS 00:00 - Introduction13:50 - Urology Applications in Orthopedics24:18 - Optimizing Longevity and Lifestyle29:08 - Musculoskeletal Syndrome of Menopause42:12 - Approach to Protein Intake and Supplements50:48 - Practicing Longevity Medicine53:26 - Final Thoughts --- RESOURCES Unbreakable: A Woman’s Guide to Aging with Power by Dr. Vonda Wright:https://www.drvondawright.com/resources/books/unbreakable

Is one outdated warning label standing between millions of women and safe, effective care? In this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, a urologist specializing in female pelvic medicine and reconstructive surgery at UC San Diego, joins host Dr. Suzette Sutherland to discuss the black box warning on vaginal estrogen, its historical context, and the ongoing advocacy efforts to update outdated FDA guidelines. --- SYNPOSIS The conversation covers the importance of low-dose vaginal estrogen in treating genitourinary syndrome of menopause (GSM), the fear surrounding hormone therapy due to misinterpreted data from the Women's Health Initiative (WHI) study, and the inequities faced in women's health, particularly in the context of hormone replacement therapies. They discuss the legislative and advocacy strategies needed to enact change, emphasizing the role of professional societies, legislative efforts, patient advocacy, and industry support in overcoming the barriers to updating the black box warning. --- TIMESTAMPS 00:00 - Introduction03:43 - History Behind the Estradiol Black Box Warning13:44 - The FDA Citizen Petition18:18 - Gender Inequity in Medicine24:05 - The Role of Organizational Guidelines in Patient Advocacy28:51 - Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM)32:57 - Medicare Spending and Legislative Advocacy44:56 - Recap and Future Directions --- RESOURCES (TRAVERSE Trial) Cardiovascular Safety of Testosterone-Replacement Therapyhttps://www.nejm.org/doi/full/10.1056/NEJMoa2215025 Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Studyhttps://doi.org/10.1093/jnci/djac112 (ASCO Study) Use of local estrogen therapy among breast cancer patients in SEER-MHOS databasehttps://doi.org/10.1200/JCO.2025.43.16_suppl.578 Vaginal estrogen use in breast cancer survivors: a systematic review and meta-analysis of recurrence and mortality riskshttps://doi.org/10.1016/j.ajog.2024.10.054

Have we been wrong about testosterone and prostate cancer all along? In this episode of BackTable Urology, Dr. Abraham Morgentaler, who pioneered the modern use of testosterone therapy, joins Dr. Amy Pearlman to discuss the evolving understanding of testosterone therapy in clinical practice and its implications on patient care. --- SYNPOSIS Dr. Morgentaler shares insights from his decades-long career, including his pivotal research that refuted the presumed harms of testosterone therapy and belief that it contributes to the development of prostate cancer. The conversation explores the evolution of testosterone therapy, its misunderstood role in prostate cancer, and the need for broader clinical recognition of testosterone deficiency. The discussion also explores potential future applications of testosterone therapy, including its role in perioperative optimization and the growing need for nuanced, evidence-based guidelines in men’s health care. --- TIMESTAMPS 00:00 - Introduction08:45 - The Evolution of Testosterone Therapy20:10 - Challenging Conventional Wisdom on Testosterone34:04 - Reevaluating Testosterone and Prostate Cancer51:20 - Testosterone and Prostate Cancer Recurrence55:44 - Managing Testosterone Therapy in Prostate Cancer Patients01:12:45 - Final Thoughts --- RESOURCES The Sex Doctors:https://www.amazon.com/The-Sex-Doctors/dp/B0DCJQ5B5Q