BackTable Urology

How many prostate medications and procedures should a man try before anyone checks his bladder? Dr. Bilal Chughtai has met men who worked through an alpha blocker, add-on medications, a minimally invasive prostate procedure, and even resective surgery before anyone named overactive bladder as part of the problem. On this episode of BackTable Urology, Dr. Anjali Kapur, urogynecologist at Hackensack Meridian Health, welcomes Dr. Chughtai, chief of urology at Northwell Health's Plainview and Syosset hospitals, to rethink how urologists separate overactive bladder (OAB) from benign prostatic hyperplasia (BPH) in men. Dr. Chughtai explains how he reads the storage and voiding items of the International Prostate Symptom Score (IPSS), why he usually starts with a beta-3 agonist rather than an anticholinergic, how he trims polypharmacy one medication holiday at a time, and when urodynamics helps decide whether to treat the prostate, the bladder, or both. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Sumitomo Pharma America, Inc.https://www.us.sumitomo-pharma.com/ --- Timestamps 00:00 - Introduction02:37 - Initial Evaluation and First-Line Therapy06:11 - Combination Therapy and Medication Holidays09:37 - Reassessing Symptoms After an Outlet Procedure11:59 - Botox and Neuromodulation in Men15:14 - Persistent Symptoms After Prior BPH Treatment18:44 - The COURAGE Trial and Urge Incontinence23:22 - Combining Therapies and Setting Goals25:48 - Questionnaires, Bladder Diaries, and Underreporting29:05 - OAB Awareness in Primary Care31:14 - Nocturia and Sleep Apnea33:23 - Timing of Intervention and Bladder Health38:04 - Final Takeaways and Closing Remarks --- More about this episode The two then turn to third-line therapy in men, including intradetrusor botulinum toxin, sacral neuromodulation, and tibial nerve stimulation, and to men whose storage symptoms persist or appear after an outlet procedure. Dr. Chughtai shares what the COURAGE trial of a beta-3 agonist added to BPH therapy taught him about asking men directly about urge incontinence, along with his goal of a 50% improvement in symptoms, the limits of questionnaires and bladder diaries, his research on OAB awareness in primary care, and the link between nocturia and sleep apnea. They close on the open question of when to treat the bladder before it changes, and why counseling should inform men without threatening them. --- Resources Efficacy and Safety of Vibegron for Persistent Symptoms of Overactive Bladder in Men Being Pharmacologically Treated for Benign Prostatic Hyperplasia: Results From the Phase 3 Randomized Controlled COURAGE Trial. J Urol. 2024https://pubmed.ncbi.nlm.nih.gov/38708869/ Vibegron for overactive bladder in men with benign prostatic hyperplasia/obstruction: insights from the COURAGE trial. Transl Androl Urol. 2025https://pubmed.ncbi.nlm.nih.gov/40376518/ Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate. Curr Urol Rep. 2018https://pubmed.ncbi.nlm.nih.gov/30128964/ 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998https://pubmed.ncbi.nlm.nih.gov/9628595/ The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladderhttps://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder BackTable Urology Episode 138: Hood-Sparing & Greenlight Laser Therapy in BPH Managementhttps://www.backtable.com/shows/urology/podcasts/138/hood-sparing-greenlight-laser-therapy-in-bph-management Dr. Bilal Chughtai, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-bilal-chughtai Dr. Anjali Kapur, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-anjali-kapur --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

By one estimate, half or more of all non-muscle invasive bladder cancer (NMIBC) is intermediate risk, yet the major guidelines still do not define it the same way, which leaves urologists sorting a large, mixed group of patients without a shared playbook for when to resect again, treat in the office, or start intravesical therapy. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Wesley Yip, urologic oncologist at City of Hope, to rethink what she calls the forgotten stepchild of bladder cancer: intermediate-risk non-muscle invasive bladder cancer (NMIBC). Dr. Yip explains why he sees the category as a catch-all rather than a single biological entity, by his estimate covering 50 to 60 percent of NMIBC, why he now relies on the International Bladder Cancer Group (IBCG) definition, and why tumor grade comes first, ahead of multiplicity, size, and recurrence timing. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction02:24 - Defining Intermediate-Risk NMIBC07:53 - Case Presentation and the Initial TURBT10:42 - Evaluating the First Recurrence13:09 - High-Grade Cytology and Blue Light Cystoscopy15:01 - The Burden of Repeat TURBT16:57 - Office Fulguration and Chemoablation20:23 - Chemoablation Tolerability and Patient Selection24:24 - Intravesical Chemotherapy and Treatment Barriers28:08 - New Formulations and Upcoming Trials33:12 - Recurrence After Chemoablation and De-escalation38:00 - Future Directions and Patient-Centered Endpoints42:39 - Closing Remarks --- More about this episode Working through the case of a healthy 67-year-old man with recurrent low-grade Ta disease, the two discuss what to document at the first resection, how to counsel patients, when to return to the operating room, and when office fulguration, intravesical chemoablation, or intravesical chemotherapy with gemcitabine and docetaxel makes more sense. They cover the cumulative burden of repeat transurethral resection, practical lessons from bringing chemoablation into the clinic, how to read new trial data, and when to de-escalate surveillance. Dr. Yip closes with his hopes for the next five years: a biology-based definition and trials that measure fewer recurrences, fewer procedures, and better quality of life. --- Resources Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35718695/ Intermediate-risk Non-muscle-invasive Bladder Cancer: Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group. Eur Urol Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/41076366/ All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors. J Urol. 2022https://pubmed.ncbi.nlm.nih.gov/35770498/ Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline EAU Guidelines on Non-muscle-invasive Bladder Cancerhttps://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer Bladder Cancer Advocacy Network (BCAN)https://bcan.org Dr. Wesley Yip, City of Hope physician profilehttps://www.cancercenter.com/physician-directory/wesley-yip Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

By his own estimate, an AI scribe gives one urologist about two hours of his day back, and an evidence tool built into it has taught him something new in the clinic almost every day. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes back Dr. David Canes, urologist at Lahey Hospital & Medical Center and founder of WellPrept, to talk about how urologists can practically put AI to work. Dr. Canes explains why he sees this moment as a renaissance for physicians, how an AI scribe turned him from author into proofreader, by his estimate saving about two hours a day, and why evidence tools running alongside the scribe now answer questions in the exam room, including a question about post-prostatectomy dysorgasmia, a complaint that rarely comes up in clinic. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:32 - Getting Started With AI in Practice07:24 - AI Scribes and Cognitive Load14:18 - AI Evidence Tools at the Point of Care18:41 - Context, Pre-Charting, and Evidence in the Exam Room24:52 - AI for Email and Personal Workflow29:09 - Building a Permanent AI Memory34:20 - AI Skepticism, Privacy, and Intellectual Honesty40:47 - Will AI Replace Physicians?46:39 - Pre-Charting, Patient Education, and Care Journeys49:27 - Reducing the In-Basket Burden53:04 - Where to Start With AI55:27 - Closing Remarks --- More about this episode The conversation then moves beyond the clinic. Dr. Canes describes an AI layer on email that flags what cannot wait, and a permanent AI memory built from plain text files that keeps research, licenses, talks, and family life organized, with a firm rule that no protected health information goes anywhere without a business associate agreement. He and Dr. Talwar discuss what work is worth delegating to AI, push back on a recent JAMA perspective arguing that autonomous AI may outperform physicians, and run through tools for pre-charting, patient education, postoperative care journeys, and front-desk calls. Dr. Canes closes with simple advice for exhausted physicians: ask the AI you already use to build you a 90-day plan. --- Resources Will Autonomous AI Exceed AI-Aided Physicians as the Best Medical Care? JAMA. 2026https://jamanetwork.com/journals/jama/fullarticle/2852952 The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis. Eur Urol. 2005https://pubmed.ncbi.nlm.nih.gov/15716202/ WellPrepthttps://www.wellprept.com BackTable Urology Episode 55: Patient Preparation Made Easy: The WellPrept Storyhttps://www.backtable.com/shows/urology/podcasts/55/patient-preparation-made-easy-the-wellprept-story Dr. David Canes, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-david-canes Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Every prostate cancer biomarker returns a number, but the real question is whether that number changes what you do next for the patient. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Amir Lebastchi, urologic oncologist at Keck Medicine of USC, to discuss how biomarkers are moving prostate cancer care from numbers to meaningful clinical decisions. They define what makes a biomarker clinically useful, organize the growing list of blood, urine, and tissue tests into pre-biopsy, post-negative-biopsy, and post-diagnosis settings, and talk through where these tests fit alongside MRI after an elevated PSA. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Cleveland Diagnosticshttps://www.isopsa.com/ --- Timestamps 00:00 - Introduction02:59 - Clinical Utility and a Framework for Biomarkers08:43 - Workup of an Elevated PSA11:42 - Pre-Biopsy Blood and Urine Tests13:29 - Equivocal MRI, Outside Imaging, and Community Practice20:26 - Patient Factors and Practical Considerations24:44 - Case: Elevated PSA and a Negative MRI30:11 - Case: Biopsy Approach and Discordant Results34:41 - Counseling on PSA Limitations and Overdiagnosis37:05 - Biomarkers in Active Surveillance and Renaming Grade Group 140:56 - AI and the Future of Biomarkers44:38 - Take-Home Points and Closing Remarks --- More about this episode The discussion covers equivocal MRI findings, patient counseling, and the practical impact of age, family history, and race when interpreting PSA levels. Through real cases, Dr. Lebastchi explains when he repeats a PSA, how he performs a templated transperineal biopsy, and why a negative MRI plus a negative biomarker can give him the confidence to forgo a biopsy. They also touch on active surveillance, the debate over renaming grade group 1 prostate cancer, and how AI may help future tests guide treatment intensity rather than just risk category. Dr. Lebastchi closes with the clinician’s obligation to know all available tests and use those that truly inform management. --- Resources Early Detection of Prostate Cancer: AUA/SUO Guideline (2023)https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines Clinical validation of IsoPSA, a single parameter, structure-focused assay for improved detection of prostate cancer: A prospective, multicenter study. Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35840465/ Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients With Elevated PSA. Urology. 2023https://pubmed.ncbi.nlm.nih.gov/36965817/ Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. J Clin Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35436144/ The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer. J Natl Cancer Inst. 2023https://pubmed.ncbi.nlm.nih.gov/37285311/ Dr. Amir Lebastchi, Keck Medicine of USC physician profilehttps://keckmedicine.org/provider/amir-h-lebastchi Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How is suction technology changing what it means to be “stone-free” after ureteroscopy? On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Karen Stern, endourologist at Mayo Clinic Arizona, for a practical discussion of how ureteroscopy is evolving in the era of suction. They discuss how thin-slice CT has revealed just how much stone typically remains after surgery, why dusting versus fragmenting is now a patient-dependent choice, and what to consider when selecting between suction sheaths, aspiration scopes, and traditional access. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Dornierhttps://www.dornier.com/backtable --- Timestamps 00:00 - Introduction02:16 - Residual Stone and Defining Success04:59 - Dusting, Fragmentation and Suction Devices07:15 - Patient Selection, OR Setup and Laser Settings11:39 - Evidence, Stone Clearance and Infection Risk15:39 - Community Adoption and Technique Pearls20:05 - Integrated Systems and Artificial Intelligence22:29 - Take-Home Points and Closing Remarks --- More about this episode The doctors discuss patient selection, OR setup, stenting, and why stones over a centimeter benefit most from a suction approach. Dr. Stern shares her tips for suction device setup, irrigation and suction settings, and how even a short learning curve can make these techniques routine. They review infection risks, evidence on residual stone volume, pearls for community adoption, and look ahead to integrated laser-suction platforms and AI tools that may one day help define when a case is truly finished. Dr. Karen Stern closes with advice for urologists on the fence: every technology works, but the best choice is the one that fits your practice. --- Resources Are We Overreporting Post-Op Sepsis? The Difference Between Reported and Verified Rates of Post-Ureteroscopy Sepsis Using the Sepsis 3 Criteria at a Single Institution. J Endourol. 2026https://doi.org/10.1177/08927790251394736 Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath Versus Mini-Percutaneous Nephrolithotomy for Treatment of 2-3 cm Renal Stones: An International, Multicenter, Randomized, Noninferiority Trial. Eur Urol. 2026https://doi.org/10.1016/j.eururo.2025.06.001 Dr. Karen Stern, Mayo Clinic physician profilehttps://www.mayoclinic.org/biographies/stern-karen-l-m-d/bio-20464490 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Same risk group, very different benefit. Can biomarkers help identify who needs treatment intensification in prostate cancer? On this episode of BackTable Urology, Dr. Ruchika Talwar and Dr. Angela Jia, a radiation oncologist at University Hospitals Cleveland Medical Center, break down the difference between prognostic and predictive biomarkers and how genomic testing is informing the way clinicians counsel patients. They review trial data suggesting that men with a low genomic score may gain little from adding hormone therapy, along with early prospective evidence that the luminal B subtype may help identify who benefits most from intensification. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Verasytehttps://www.veracyte.com/ --- Timestamps 00:00 - Introduction02:08 - Prognostic vs. Predictive Biomarkers06:34 - The NRG/RTOG 0815 Biomarker Cohort10:15 - Applying a Low Genomic Score in Clinic15:16 - Genomic Classifiers After Prostatectomy18:52 - RTOG 9601, SPPORT and the Salvage Evidence24:39 - Stage Migration and the Case for an ARPI28:13 - Ordering and Reading the Genomic Report34:31 - Common Mistakes in Interpretation37:31 - Where Genomics Could Go Next41:03 - Reflex Testing, EMR Integration and AI44:44 - Closing Remarks --- More about this episode The conversation covers practical application of test results, counseling with absolute risk numbers, and the pitfalls of stretching predictive claims beyond their evidence. Dr. Jia explains the limits of biopsy sampling, how stage migration with advanced imaging may shift baseline risk, and why a large portion of the genomic score remains unexplained by standard variables. The episode closes with a look at reflex testing, the potential role of AI, and the longer-term goal of giving patients clear, individualized benefit estimates for each treatment option. --- Resources NRG/RTOG 0815: A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT00936390 NRG-GU006 (BALANCE): A Phase II Randomized Trial of Salvage Radiotherapy With or Without Apalutamide in Recurrent Prostate Cancer (trial record)https://clinicaltrials.gov/study/NCT03371719 Feng FY, et al. Validation of a 22-Gene Genomic Classifier in Patients With Recurrent Prostate Cancer: An Ancillary Study of the NRG/RTOG 9601 Randomized Clinical Trial. JAMA Oncol. 2021https://pubmed.ncbi.nlm.nih.gov/33570548/ Pollack A, et al. The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT). Lancet. 2022https://pubmed.ncbi.nlm.nih.gov/35569466/ Zhao SG, et al. Associations of Luminal and Basal Subtyping of Prostate Cancer With Prognosis and Response to Androgen Deprivation Therapy. JAMA Oncol. 2017https://pubmed.ncbi.nlm.nih.gov/28494073/ Patel KR, Nguyen PL, et al. Biopsy-based Basal-luminal Subtyping Classifier in High-risk Prostate Cancer: A Combined Analysis of the NRG Oncology/RTOG 9202, 9413 and 9902 Phase 3 Trials. Eur Urol Oncol. 2026https://pubmed.ncbi.nlm.nih.gov/39542826/ Grist E, et al. Tumor transcriptome-wide expression classifiers predict treatment sensitivity in advanced prostate cancers (STAMPEDE). Cell. 2025https://pubmed.ncbi.nlm.nih.gov/40865526/ Jia AY, et al. Cross-Comparison Individual Patient-Level Analysis of Three Gene Expression Signatures in Localized Prostate Cancer in Over 50,000 Men. JCO Precis Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/40479622/ Dr. Angela Jia, University Hospitals physician profilehttps://www.uhhospitals.org/doctors/Jia-Angela-1902338718 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

How do you decide if a neurogenic bladder is a safety problem or a quality of life problem for each patient, and how do you move from guideline risk categories to a real surveillance plan? On this episode of BackTable Urology, Dr. Anjali Kapur interviews Dr. Benjamin Brucker, professor of urology and director of neuro-urology at NYU Langone Health, about navigating neurogenic lower urinary tract dysfunction. They start with the AUA and SUFU guideline framework, covering history, physical exam, mobility, cognition, voiding diaries, and risk stratification to sort patients into low, unknown, or high risk. Dr. Brucker outlines the findings that move a patient between categories and the workup needed, from renal ultrasound and urodynamics to identifying unsafe storage pressures and elevated post-void residual. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byMedtronic --- Timestamps 00:00 - Introduction03:20 - Initial Evaluation Under the AUA and SUFU Guidelines05:39 - Risk Stratification and Surveillance13:08 - Role of Fluoroscopy in Urodynamics14:55 - Spinal Cord Injury and Detrusor Sphincter Dyssynergia17:35 - Multiple Sclerosis, Parkinson Disease, and Stroke23:13 - Cognitive and Functional Status in Therapy Selection25:16 - Neuromodulation in the Neurogenic Population29:07 - Catheter Management and Sphincterotomy35:49 - Medical Therapy, Chemodenervation, and Surgical Escalation42:50 - Asymptomatic Bacteriuria and Antibiotic Stewardship46:04 - Gaps in Practice and Research on the Horizon50:48 - Closing Remarks --- More about this episode The conversation dives into the nuances of managing neurogenic bladder by underlying disease, from detrusor sphincter dyssynergia after spinal cord injury to the variable patterns in multiple sclerosis, Parkinson disease, and stroke. Dr. Brucker explains the role of videourodynamics, the importance of matching therapy to cognition and mobility, and how to counsel patients on medical therapy, neuromodulation, catheterization, and surgery. They discuss antibiotic stewardship for asymptomatic bacteriuria, gaps between guidelines and real-world care, and what new devices and bladder transplant might mean for the future. The episode closes with a reminder that management is about treating the whole person, not just the diagnosis. --- Resources Neurogenic Lower Urinary Tract Dysfunction: AUA/SUFU Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/adult-neurogenic-lower-urinary-tract-dysfunction Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. J Urol. 2021https://doi.org/10.1097/JU.0000000000002235 Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up. J Urol. 2021https://doi.org/10.1097/JU.0000000000002239 Vurture G, Peyronnet B, Palma JA, et al. Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J. 2019.https://doi.org/10.5213/inj.1938086.043 Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). https://sufuorg.com/ American Urological Association (AUA)https://www.auanet.org/ First human bladder transplant, UCLA Health, 2025.https://www.uclahealth.org/news/release/first-human-bladder-transplant-performed-ucla Dr. Benjamin Brucker, NYU Langone Health physician profilehttps://nyulangone.org/doctors/1235295619/benjamin-m-brucker Dr. Benjamin Brucker, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-benjamin-brucker Dr. Anjali Kapur, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-anjali-kapur --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What is the difference between mentorship, sponsorship, and coaching in a physician’s career, and how can coaching influence your professional development? On this episode of BackTable Urology, Dr. Helen Bernie interviews Dr. Emilie Johnson and Dr. Angie Smith about the transformative impact of career coaching for urologists. They break down how coaching differs from mentorship and sponsorship, who stands to benefit most, and the real value of having a conversation focused entirely on your goals and growth. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast was developed in collaboration withSociety of Women in Urologyhttps://swiu.org/home.aspx --- Timestamps 00:00 - Introduction03:21 - Mentorship, Sponsorship, and Coaching06:23 - Paths Into Physician Coaching11:39 - Who Should Seek a Coach15:56 - What a Coach Does Differently22:57 - Anatomy of a Coaching Session28:21 - Coaching Frameworks and Tools35:14 - Uncovering Unrecognized Goals42:12 - Coaching Beyond the Workplace47:16 - Advice for the Undecided Urologist52:08 - Closing Remarks --- More about this episode The discussion explores what a coaching session looks like, from low-stakes one-offs to multi-month programs, and the frameworks and tools that stick, like strengths-based assessments, DiSC, and the career portfolio exercise. Dr. Smith shares insights from her credentialed coaching program, while Dr. Johnson explains how coaching changes everything from listening at home to decision-making in the OR. The episode closes with advice on finding the right coach, recognizing when you are ready, and why coaching is about unlocking what you already know. --- Resources Society of Women in Urology (SWIU)https://www.swiu.org/ Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial (Dyrbye et al., JAMA Internal Medicine, 2019)https://doi.org/10.1001/jamainternmed.2019.2425 International Coaching Federation, credentialing and coach education requirements (ACC, PCC, MCC)https://coachingfederation.org/credentialing/prepare-for-icf-credential-application/education-training-requirements/ UNC School of Medicine coaching programs, Office of Faculty Affairs and Leadership Developmenthttps://www.med.unc.edu/facultyaffairs/coaching-culture/ VIA Character Strengths Survey, the free strengths assessment Dr. Smith recommendshttps://www.viacharacter.org/ CliftonStrengths (Gallup)https://www.gallup.com/cliftonstrengths/en/home.aspx --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Adrenal lesions now turn up on four to ten percent of cross-sectional scans, and every urologist needs a reliable way to sort out the harmless ones from the dangerous ones. On this episode of BackTable Urology, co-hosts Dr. Gina Badalato and Dr. Chris Anderson speak with Dr. Ben Ristau to share a practical, case-based framework for evaluating adrenal lesions. They walk through imaging criteria, the essential hormonal workup, size thresholds for surgery, the rare but crucial role of biopsy, and the operative planning that separates a smooth adrenalectomy from a crisis. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast was developed in collaboration with Society of Academic Urologistshttps://sauweb.org/ --- Timestamps 00:00 - Introduction03:42 - Imaging Criteria for Adrenal Adenoma08:15 - Framework for Hormonal Workup12:48 - Mild Autonomous Cortisol Secretion16:20 - Adrenal Venous Sampling21:12 - Genetic Syndromes and Pheochromocytoma25:40 - Suspected Pheochromocytoma Case31:19 - Alpha Blockade Before Surgery35:36 - Intraoperative Hemodynamic Swings40:50 - Adrenocortical Carcinoma Case45:00 - Managing Adrenal Vein Avulsion48:00 - Closing Remarks --- More about this episode The discussion opens with a 3.4 centimeter lipid-rich adenoma and the two questions that drive every evaluation, whether the lesion is malignant and whether it is functional. Dr. Ristau walks through the overnight 1 mg dexamethasone suppression test, the aldosterone to renin ratio, plasma free metanephrines and adrenal venous sampling, then explains why mild autonomous cortisol secretion is the most commonly missed diagnosis. Later cases cover preoperative alpha blockade for pheochromocytoma, the blood pressure swing that follows adrenal vein ligation, and open resection for suspected adrenocortical carcinoma. They close with pearls on surgical judgment, resident teaching, and the importance of systematic protocols in adrenal mass evaluation. --- Resources CUA guideline: Diagnosis, management, and follow-up of the incidentally discovered adrenal mass (endorsed by the AUA, Rowe et al., CUAJ 2023)https://cuaj.ca/index.php/journal/article/view/8248 European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, with ENSAT (Fassnacht et al., Eur J Endocrinol 2023)https://doi.org/10.1093/ejendo/lvad066 AACE / AAES Medical Guidelines for the Management of Adrenal Incidentalomashttps://pro.aace.com/disease-state-resources/pituitary-and-neuroendocrine/clinical-practice-guidelines/american Discrepancies in the Recommended Management of Adrenal Incidentalomas by Various Guidelines (Journal of Urology)https://www.auajournals.org/doi/10.1097/JU.0000000000001342 Society of Academic Urologistshttps://sauweb.org/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

What does a urologist actually need to know to confidently manage advanced prostate cancer in the clinic? On this episode of BackTable Urology, host Dr. Ruchika Talwar interviews Dr. Kristen Scarpato, director of the advanced prostate cancer clinic at Vanderbilt University Medical Center, and Dr. Jason Hafron, chief medical officer of the Michigan Institute of Urology. They break down how the landscape has shifted, why more patients stay in urology for treatment, and how to select and monitor therapy based on disease state, comorbidities, and patient goals. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by Bayer https://www.bayer.com --- Timestamps 00:00 - Introduction02:41 - Shift to Urology-Led Advanced Prostate Management07:07 - Sorting Therapies by Disease State10:33 - Treatment Intensification and Doublet Therapy17:54 - ARPI Selection and the Four Ps Framework25:46 - Managing Financial Toxicity29:30 - Monitoring, Labs, and Imaging34:11 - Red Flags and Comanagement36:49 - When to Refer to Medical Oncology41:11 - Future Directions and Practice Economics46:33 - Closing Remarks --- More about this episode The discussion covers sorting therapies by disease state rather than drug class, doublet and triplet intensification, the nuances of choosing between abiraterone, enzalutamide, apalutamide, and darolutamide, and Dr. Hafron’s “four Ps” framework for drug selection. Dr. Scarpato addresses financial toxicity, surveillance protocols, and red flag symptoms. Both guests share their referral triggers for medical oncology, approaches for oligometastatic disease and metastasis-directed therapy, and practical tips for running an advanced prostate cancer clinic. --- Resources Advanced Prostate Cancer: AUA/SUO Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/advanced-prostate-cancer Trial Design and Objectives for Patients With Prostate Cancer: Recommendations From the Prostate Cancer Working Group 4 (JCO)https://ascopubs.org/doi/10.1200/JCO-25-02834 ARACOG (AFT-47): Darolutamide vs Enzalutamide and Cognitive Function, ClinicalTrials.gov NCT04335682https://clinicaltrials.gov/study/NCT04335682 ARASENS: Darolutamide and Survival in Metastatic, Hormone-Sensitive Prostate Cancer (NEJM)https://www.nejm.org/doi/full/10.1056/NEJMoa2119115 PSMAddition: 177Lu-PSMA-617 Plus Standard of Care in mHSPC, ClinicalTrials.gov NCT04720157https://clinicaltrials.gov/study/NCT04720157 Medicare Plan Finder, referenced on air for comparing Part D out-of-pocket drug costshttps://www.medicare.gov/plan-compare/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app