BackTable Urology

Dr. Claus Roehrborn discusses BPH surgical management options based on invasiveness, patient characteristics, and prostate size, recommending UroLift, Rezum, TURP, prostatectomies, Greenlight laser, and enucleation for different scenarios. He emphasizes using POCUS for prostate size evaluation and tailoring treatments for optimal outcomes, touching on ejaculatory function preservation and post-operative medication management.

Dr. Claus Roehrborn from UT Southwestern Urology department discusses BPH management with Dr. Aditya Bagrodia. They categorize LUTS, emphasize pre-treatment tests like flow rate and PVR, and highlight the importance of PSA as an indirect measure of prostate size.

Dr. Jose Silva talks with Urologist Dr. Yahir Santiago from UC San Diego Medical Center about the diagnosis and treatment of pelvic floor dysfunction in women.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/7YanKm---SHOW NOTESIn this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, director of Women's Pelvic Medicine and associate professor of medicine at UC San Diego, joins our host Dr. Jose Silva to discuss treatment and management of pelvic floor dysfunction.Dr. Santiago-Lastra starts by distinguishing between stress incontinence and urgency incontinence. She emphasizes the importance of getting to know a patient, understanding their priorities and expectations, and correctly diagnosing the predominant type of incontinence to offer appropriate treatment. She also talks about the utility of less invasive means of evaluation, such as detailed surveys and bladder diaries, over more invasive procedures like a cystoscopy or urodynamics study.The discussion then shifts to treatment options for stress incontinence, and Dr. Santiago-Lastra states the importance of letting the patient determine the course of treatment after learning all their options. The hosts discuss the importance of pelvic floor physical therapy, and point out the lack of access to this therapy in certain communities. They then do a deep dive into sling surgery, discussing TVTs, TOTs, and mini-slings. Dr Santiago-Lastra states her preference for retropubic slings, and warns against the severe groin pain that can be caused by TOTs. The docs also talk about contraindications for sling placement, post-op care guidelines, and considerations for younger patients.The episode ends with Dr. Santiago-Lastra restating the importance of listening to one’s patients, and counseling them about the wide variety of treatments available. She also points out language as a barrier to accessing care, and calls for more diversity in the field so patients can feel better understood.---RESOURCESAUA Guidelines: https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guidelineEAU Guidelines: https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guidelineSISTEr Trial: https://repository.niddk.nih.gov/studies/sister/

Dr. Jose Silva talks with Urologist Dr. Aditya Bagrodia from UT Southwestern Medical Center about the medical and surgical management of testicular cancer.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/Em4or1---SHOW NOTESIn this episode of BackTable Urology, urologic oncologist Dr. Aditya Bagrodia joins our host Dr. Jose Silva to discuss the diagnosis, treatment, and long-term management of testicular cancer.The episode begins with an algorithm for initial work up of a testicular mass – scrotal ultrasound and tumor markers – and reviews the pre-orchiectomy timing of additional imaging and when more advanced imaging modalities like MRI or contrast-enhanced CT might be clinically useful. Dr. Bagrodia then walks through his surgical technique, highlighting practical tips to avoid common frustrations and complications. The pair also discuss operative technique and optimal timing for placement of testicular prostheses, as well as the role for partial orchiectomy in patients prioritizing fertility preservation and androgen production.Dr. Bagrodia discusses indications for adjuvant chemotherapy and radiation, with a focus on avoiding over-treatment in these young patients and opting for observation when appropriate. He reviews surveillance protocols based on pathological stage, then walks through the management of recurrent and metastatic disease with an emphasis on the importance of multidisciplinary care.The episode ends with an overview of Dr. Bagrodia’s current research, microRNAs. He reviews the sensitivity and specificity of these unique microRNAs in testicular cancer, explaining their potential to truly individualize care by correctly diagnosing equivocal tumors and identifying residual or recurrent disease.---RESOURCESAUA Guidelines: https://www.auanet.org/guidelines/guidelines/testicular-cancer-guidelineEAU Guidelines: https://uroweb.org/guideline/testicular-cancer/NCCN Guidelines: https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf

Dr. Jose Silva talks with Urologist Dr. Aditya Bagrodia from UT Southwestern Medical Center about the medical and surgical management of bladder cancer.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/a1DEz5---SHOW NOTESIn this episode of BackTable Urology, UT Southwestern urologic oncologist Dr. Aditya Bagrodia joins our host Dr. Jose Silva to discuss the diagnosis, surgical treatment, and post-operative management of bladder cancer.The episode opens with a brief overview of the initial workup for a suspected bladder tumor with imaging and cystoscopy, then quickly moves into the OR for definitive treatment and establishment of a tissue diagnosis. Dr. Bagrodia walks us through his surgical approach for transurethral resection of a standard bladder tumor and explains some of his techniques for optimal visualization, resection in challenging locations, and minimizing cautery artifact in smaller tumors to provide the pathologist with enough tissue for a pathological diagnosis.The conversation then turns to more complex or unusual cases, starting with the approach to particularly large tumors that are likely to be muscle-invasive. Dr. Bagrodia emphasizes the importance of working closely with medical oncology in these cases requiring multimodal therapy, then discusses how he balances the risks and benefits of aggressive resection versus a “less is more” philosophy based on the overall clinical picture. When aggressive resection is appropriate, blue light cystoscopy is particularly helpful in resecting not just the visible tumor but also peritumoral dysplasia and carcinoma in situ. The pair also discuss when to place a stent or even a nephrostomy tube when resecting at the ureteral orifice, how to troubleshoot significant urethral stricture disease, and approach to hemostatic control in difficult cases.The episode ends with a discussion of bladder-sparing techniques for muscle-invasive bladder cancer, a guideline-directed option still largely regionalized in the United States. Dr. Bagrodia first reviews some of the relative contraindications to a bladder preserving approach, then emphasizes that it can be an efficacious option in appropriate, motivated patients so should be a treatment option included in the conversation with these select patients.---RESOURCESAUA Guidelines, Non-Muscle Invasive Bladder Cancer: https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-muscle-invasive-guidelineAUA Guidelines, Muscle-Invasive Bladder Cancer: https://www.auanet.org/guidelines/guidelines/bladder-cancer-non-metastatic-muscle-invasive-guideline

Anish Parikh interviews Urologist Dr. Jose (Oche) Silva about his experiences building a practice from scratch after training, and then a Category V hurricane forced him to start over again.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/xK1fKn---SHOW NOTESIn this inaugural episode of Backtable Urology, Dr. Jose Silva reflects on his journey to becoming a urologist with host Anish Parikh.Dr. Silva talks about his early years, growing up in a family of doctors and dentists, and knowing that medicine was a possible path for him. He talks about going back to Puerto Rico for medical school where he developed an interest in general surgery and orthopedic surgery before eventually finding his way to urology. He cites the duality of urology as a clinical and surgical specialty as a major factor in his decision to pursue the field.Dr. Silva then discusses his decision to stay in Puerto Rico after medical school, and talks about navigating a complex system of hospitals and insurance companies. He recounts anecdotes of networking with other physicians and hospital staff as he worked to start a fledgling practice, and Anish compares the experience to starting a new business.Finally, the two discuss the impact of Hurricane Maria, which led to Dr. Silva’s decision to move to the mainland. Dr. Silva recalls not being able to practice medicine due to power cuts while also worrying about his pregnant wife, and deciding to move in order to avoid repeating the experience. Today, he practices in Florida where he enjoys the support of a strong hospital system but misses his extended family in Puerto Rico.