BackTable Urology

Often misunderstood as end-of-life care, palliative care is actually about improving quality of life at any stage of serious illness. In this episode of BackTable Urology, Dr. Ashwin Kotwal, a geriatrician and palliative care physician at UCSF, and Dr. Pauline Filippou, a urologic oncologist at Kaiser Permanente in Northern California join hosts Dr. Gina Badalato and Dr. Lindsay Hampson to discuss the importance of palliative care in the field of urology. --- SYNPOSIS The episode covers how palliative care can improve quality of life for patients with serious illnesses, the challenges and opportunities of integrating palliative care into urology practice, and specific training resources and frameworks for effective communication and symptom management. From addressing common misconceptions to providing practical advice on implementing palliative care, this episode is an essential guide for trainees and urology professionals looking to deepen their understanding of palliative care and enhance their practice. --- TIMESTAMPS 00:00 - Introduction03:04 - Understanding Palliative Care04:43 - Misconceptions and Communication Strategies07:45 - Integrating Palliative Care in Urology10:26 - Collaborative Approaches and Multidisciplinary Teams15:48 - Training and Education for Trainees20:25 - Effective Communication Techniques28:18 - Impact of Palliative Care34:33 - Final Thoughts and Takeaways --- RESOURCES Center to Advance Palliative Care website:https://www.capc.org/ AUA White Paper: https://www.auanet.org/documents/guidelines/white%20papers/postoperative.pdf VitalTalk:https://www.vitaltalk.org/ Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters: https://link.springer.com/article/10.1007/s11606-018-4540-5 Family Meetings on Behalf of Patients with Serious Illness: https://www.nejm.org/doi/full/10.1056/NEJMvcm1913056

Prostate biopsy is evolving rapidly, offering urologists more precision - but also more decisions. In this episode of BackTable Urology, Dr. Ricardo Sánchez-Ortiz, a pioneer in robotic surgery and neuro-urology in Puerto Rico, joins host Dr. Jose Silva to discuss the shifting landscape of prostate biopsy and emerging strategies that improve accuracy and personalize care. --- SYNPOSIS The conversation explores the transition from transrectal to transperineal prostate biopsy, emphasizing the role of PSA density and modern imaging in refining patient selection. Dr. Sánchez-Ortiz highlights the value of biomarkers in improving diagnostic accuracy and focal therapy as a promising, less invasive treatment option.Beyond clinical innovations, the doctors also discuss the importance of communication in urology practice. Dr. Sánchez-Ortiz shares how tools like WellPrept can enhance patient education and engagement, reinforcing the need for individualized care strategies in an increasingly complex diagnostic landscape. --- TIMESTAMPS 00:00 - Introduction 02:14 - Evolution of Prostate Biopsy Methods17:51 - Transperineal vs. Transrectal Approaches22:52 - Use of Sedation35:10 - PSA Screening41:48 - Rise in Metastatic Prostate Cancer50:44 - Potential of Focal Ablation55:58 - Use of WellPrept --- RESOURCES WellPrept:https://www.wellprept.com/

Is your patient’s sexual dysfunction an early indicator of serious cardiovascular disease? In this episode of BackTable Urology, Dr. Amy Pearlman teams up with preventative cardiologist Dr. Dapo Iluyomade to discuss the relationship between erectile dysfunction (ED) and cardiovascular disease, and the holistic approach needed to prevent both of these chronic conditions from worsening. --- SYNPOSIS Dr. Iluyomade shares his preventive cardiology workup, the significance of lipid panels, and advanced diagnostics. They also explore the effects of common cardiovascular medications like beta blockers on sexual health and address common concerns related to testosterone and hormone therapies in both men and women. The conversation underscores the importance of interdisciplinary collaboration between urology and cardiology for optimal outcomes in patients with sexual dysfunction. --- TIMESTAMPS 00:00 - Introduction01:52 - The Intersection of Cardiology and Urology03:43 - Understanding Preventive Cardiology07:56 - Patient Risk Stratification and Workup16:35 - Cardiovascular Health in Women20:07 - Testosterone Therapy and Cardiovascular Risk26:39 - Hormone Replacement Therapy in Men and Women36:09 - Beta Blockers and Sexual Dysfunction42:36 - Diuretics and Sexual Health48:57 - A Message to Urologists from a Cardiologist --- RESOURCESTRAVERSE Trial Results: https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today. --- SYNPOSIS Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence. --- TIMESTAMPS 00:00 - Introduction02:50 - Focus on Menopause and Hormone Replacement Therapy04:20 - The Women's Health Initiative (WHI) Study05:39 - Understanding Risks and Misconceptions12:43 - Reevaluation of the Women’s Health Initiative Study18:31 - Impact of Media and Physician Education19:58 - Current State of Hormone Therapy22:17 - Broader Implications and Future Directions27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments29:49 - The Impact of Hormone Therapy on Women's Health32:11 - Risks of Not Using Hormones35:44 - Hormones and Brain Health: Debunking Myths40:41 - The Timing Hypothesis and Long-Term Hormone Use46:32 - Advocacy and Education for Menopause Awareness48:04 - Conclusion and Upcoming Resources --- RESOURCES PBS: The M Factor: Shredding the Silence on Menopause:https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/ The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/ Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

Global medical missions bring unique challenges and powerful rewards—something Dr. Spencer Hiller and Dr. Kenneth Peters know firsthand. In this episode of BackTable Urology, they join host Dr. Jose Silva to reflect on their work in global health, focusing on their surgical missions to Zambia to treat complex urologic conditions, including vesicovaginal fistula, and a variety of general urologic cases. --- SYNPOSIS The discussion covers the origins and evolution of their missions, the preparation required for high-volume surgical trips, and the clinical impact on both patients and participating healthcare providers. Dr. Peters and Dr. Hiller detail the logistical and financial hurdles involved, the emphasis on sustainable care models, and their strategies for fundraising. They also emphasize the value of cultural immersion and the long-term goal of establishing educational and medical infrastructure within the communities they serve. --- TIMESTAMPS 00:00 - Introduction 01:23 - The Mission to Africa: How It All Began02:32 - Challenges and Logistics of Medical Missions06:02 - Resident Involvement and Impact09:10 - Preparation and Experiences in Africa11:38 - Overcoming Obstacles: Supplies and Customs19:18 - Types of Procedures and Medical Work in Africa21:45 - Upgrading Equipment and Training Local Staff28:28 - Daily Operations and Patient Management31:00 - Post-Trip Activities and Community Engagement34:26 - Funding and Sustainability Efforts40:31 - Personal Reflections and Future Plans

This week, we present an inspiring episode for anyone interested in the history, present, and future of prostate cancer care. In this Legends in Urology installment of the BackTable Urology Podcast, Dr. Gerald Andriole joins guest host Dr. Niraj Badhiwala to reflect on a career that has left a lasting impact on the field. --- SYNPOSIS Dr. Andriole shares personal stories from his upbringing in Northeastern Pennsylvania and his journey into medicine. He reflects on his expedited education through Penn State and Jefferson Medical College and his path to urology. He discusses his pivotal work in prostate cancer screening, including the influence of major trials like The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, and traces the evolution of surgical and diagnostic techniques. The conversation also touches on current innovations and the future of prostate cancer management, offering valuable advice for the next generation of urologists. --- TIMESTAMPS 00:00 - Introduction01:59 - From Childhood to Medical School06:48 - Discovering Urology16:52 - Pioneering Prostate Cancer Screening24:07 - The PLCO Study: Design and Challenges28:57 - Controversies and Criticisms in Prostate Cancer Screening33:29 - Evolving Practices in Prostate Cancer Management44:19 - Future of Prostate Cancer Treatment

How do the experts balance organ preservation, oncologic control, and emerging therapies in both localized and metastatic cases of penile cancer? This episode of BackTable Tumor Board focuses on penile cancer diagnosis and treatment, featuring urologic oncologist Dr. Charles Peyton (UAB), radiation oncologist Dr. Juanita Crook (UBC), and medical oncologist Dr. Andrea Apolo (NCI). --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS This session covers case studies ranging from localized to advanced penile cancer, diagnostic practices, imaging preferences (MRI vs. CT), and treatment options, including surgery, brachytherapy, chemoradiation, and neoadjuvant chemotherapy. The multidisciplinary team highlights the complexities of treating this rare cancer, underscores the importance of physical exams, and stresses the necessity of personalized treatment plans. They also delve into the challenges of managing metastatic stages, potential salvage therapies, and the importance of clinical trials in enhancing treatment efficacy. The doctors also emphasize the potential of immunotherapy and chemotherapy combinations for metastatic disease. --- TIMESTAMPS 00:00 - Introduction02:23 - Imaging Preferences03:29 - Biopsy vs Immediate Surgery06:04 - Lymph Node Dissection vs Radiation13:48 - Brachytherapy Techniques and Case Study23:21 - Challenges in Advanced Penile Cancer27:03 - Chemotherapy and Chemoradiation30:15 - InPACT Trial37:12 - Salvage Therapies and Exploring New Treatment Frontiers44:25 - Support and Awareness for Penile Cancer51:29 - Final Thoughts --- RESOURCES Society of Urologic Oncologyhttps://suonet.org/home.aspx

Can we do more than prescribe pills to address men’s sexual health complaints? In this episode of the BackTable Urology Podcast, men’s health expert Dr. Mohit Khera from Baylor College of Medicine joins guest host Dr. Amy Pearlman for a deep dive into testosterone management and the full spectrum of erectile dysfunction therapies. --- SYNPOSIS The conversation covers daily tadalafil use, lifestyle optimization, and the nuanced role of off-label medications. Dr. Khera also highlights emerging technologies like the Tech Ring and radiofrequency treatments, alongside practical insights into semen analysis and hormonal health markers. Throughout, he emphasizes a holistic, patient-centered approach to sexual health—blending medical therapy with meaningful lifestyle change. This is a must-listen for general urologists, men’s health specialists, and trainees looking to expand their toolkit in this evolving field. --- TIMESTAMPS 00:00 - Introduction02:13 - Erectile Dysfunction and Testosterone08:05 - Young Men's Health and Early Detection10:20 - Semen Analysis for Overall Health12:50 - Daily Tadalafil and Its Benefits16:40 - Proactive Sexual Health Management21:28 - Female Sexual Health25:16 - Treating Delayed Ejaculation28:53 - Psychogenic Erectile Dysfunction31:16 - Technology in Sexual Health35:54 - Lifestyle Modifications for Better Sexual Health41:55 - Resources and Referrals for Patients44:30 - Final Thoughts

With so many treatment modalities for upper tract urothelial carcinoma, how does new evidence inform optimal care? In this episode of BackTable Tumor Board, urologic oncologist Dr. Nirmish Singla (Johns Hopkins), medical oncologist Dr. Jeannie Hoffman-Censits (Johns Hopkins), and urologic oncologist Dr. Bogdana Schmidt discuss treatment and diagnosis of upper tract urothelial carcinoma (UTUC). --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The discussion covers real-world UTUC cases, highlighting diagnostic challenges, treatment options, and evidence-based management strategies. They address scenarios ranging from localized to advanced UTUC, the role of systemic therapies, perioperative treatments, and the potential for novel approaches with immune checkpoint inhibitors. The episode underscores the evolving landscape of UTUC treatment and the importance of clinical trials and emerging biomarkers in improving patient outcomes. --- TIMESTAMPS 00:00 - Introduction 02:49 - Case Study 1: 66-Year-Old Male with UTUC11:19 - Case Study 2: 73-Year-Old Male with High-Grade Urothelial Carcinoma28:11 - Intravesical Chemotherapy Protocols30:44 - Case Study 3: 57-Year-Old Male with Recurrent Urothelial Cancer41:25 Clinical Trials and Emerging Treatments45:40 Case Study: 55-Year-Old Female with Bulky Lymphadenopathy 56:45 Concluding Remarks and Future Directions --- RESOURCES Society of Urologic Oncologyhttps://suonet.org/home.aspx

With fewer incisions and faster recovery, single port robotic surgery is changing the game—hear from the urologic surgeons leading the charge. This episode of BackTable Urology features an insightful discussion of the transformative impact of single port robotic surgery with Dr. Richard Link, Dr. Michael Stifelman and guest host Dr. Mihir Shah. --- SYNPOSIS This episode explores the benefits of single port (SP) robotic surgery, highlighting improved access, greater efficiency, and shorter patient recovery times. The doctors discuss the evolution of single port technology and the challenges that remain. They also share practical tips around case selection, building community support, and tracking outcomes to enhance efficacy. Whether you're new to SP or a seasoned surgeon, this episode offers valuable insights on how to refine your surgical practice. --- TIMESTAMPS 00:00 - Introduction04:18 - Early Adoption06:50 - Commitment and Learning Curve15:45 - Innovations and Best Practices19:10 - The Magic of Single Port Access29:29 - Practical Tips and Instrumentation32:14 - Instrument Spread and Force Bipolar34:25 - Benefits of Single-Port Surgery35:57 - Challenges and Cognitive Load in SP Surgery42:55 - Adoption and Resistance to SP Technology50:52 - Final Thoughts