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.
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SYNPOSIS
Dr. 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guidance on prescribing estrogen, progesterone, testosterone, and DHEA, while highlighting her advocacy to remove outdated FDA black box warnings on vaginal estrogen.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.
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TIMESTAMPS
00:00 - Introduction
03:41 - Challenges in Menopause Medicine
07:21 - Misconceptions and Risks of HRT
15:35 - Understanding Bioidentical Hormones
18:48 - WHI Studies and Their Impact
23:21 - Practical Guide to Prescribing HRT
33:47 - Understanding Estrogen Levels and Risks
36:04 - Debating Gels vs. Patches
37:51 - Concerns with Compounded Products and Pellets
38:50 - Patient Education and Meeting Them Where They Are
42:12 - Progesterone Benefits and Sensitivities
46:38 - Testosterone Therapy for Women
51:36 - The Importance of Lab Tests
55:39 - DHEA and Vaginal Health
57:14 - Advocacy for Accurate Hormone Therapy Information
01:00:05 - Conclusion and Final Thoughts
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RESOURCES
The 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_BmWz2sWf4m
Dr. 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.
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SYNPOSIS
The 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.
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TIMESTAMPS
00:00 - Introduction
01:56 - Post-Residency Financial Realities
04:43 - Budgeting During Residency
07:23 - The 50-30-20 Rule
08:06 - Investing During Residency
15:29 - Financial Planning for Attending Physicians
24:42 - Understanding Insurance: Life and Disability
33:11 - Resources and Advice for Financial Success
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RESOURCES
The White Coat Investor (podcast and books):
https://www.whitecoatinvestor.com/
The Millionaire Next Door (book):
https://themillionairenextdoor.com/

Could ctDNA testing allow us to treat bladder cancer earlier, smarter, and more effectively? In this episode of BackTable Urology, Dr. Alberto Pieretti, a urologic oncologist at Cleveland Clinic Weston Hospital, joins host Dr. Jose Silva to explore the emerging role of ctDNA in bladder cancer management.

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This podcast is supported by:

Ferring Pharmaceuticals

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SYNPOSIS

Dr. Pieretti and Dr. Silva discuss how ctDNA can refine staging, identify patients at risk of recurrence, and guide decisions on when to intensify treatment. The conversation also examines its potential to detect actionable mutations, inform precision therapies, and shape the design of future clinical trials in urologic oncology.

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TIMESTAMPS

0:00 - Introduction
2:50 - Overview of Bladder Cancer
12:59 - Overview of ctDNA
20:34 - Current ctDNA Trials
27:21 - Clinical Implications of ctDNA
31:20 - Conclusion

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RESOURCES

Updated Overall Survival by Circulating Tumor DNA Status from the Phase 3 IMvigor010 Trial: Adjuvant Atezolizumab Versus Observation in Muscle-invasive Urothelial Carcinoma - PubMed
https://pubmed.ncbi.nlm.nih.gov/37500339/

Perioperative Durvalumab with Neoadjuvant Chemotherapy in Operable Bladder Cancer | New England Journal of Medicine
https://www.nejm.org/doi/abs/10.1056/NEJMoa2408154

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

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This podcast is supported by:

⁠Ferring Pharmaceuticals⁠

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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.

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TIMESTAMPS

00:00 - Introduction
02:29 - Defining Imposter Syndrome
04:24 - Personal Experiences with Imposter Syndrome
08:44 - Impact of Imposter Syndrome in Medicine
10:39 - Strategies to Overcome Imposter Syndrome
13:59 - The Role of Mentorship
16:28 - Gender and Mentorship in Medicine
27:24 - Peer Support and Building Community
32:13 - Final Thoughts and Takeaways

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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).
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SYNPOSIS
The 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.
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TIMESTAMPS
00:00 - Introduction
01:35 - Overview of the 2025 AUA/SUFU Guidelines
02:27 - Guideline Development Process
05:48 - Categories of Guidelines
07:03 - Understanding GSM: Symptoms and Diagnosis
10:28 - Patient Education and Shared Decision Making
15:22 - Hormonal Interventions and Safety Concerns
17:17 - Local Vaginal Estrogen: Recommendations and Usage
23:12 - Compounded Estrogens and Alternative Therapies
25:48 - Understanding Estrogen Dosage Forms
26:11 - Introduction to DHEA and Its Benefits
27:15 - Exploring Ospemifene as an Alternative
28:05 - Guidelines for Treating GSM Symptoms
30:11 - The Role of Vaginal Estrogen in UTI Prevention
33:01 - Non-Hormonal Interventions for GSM
35:39 - Laser Treatments for GSM
39:59 - Addressing Cancer Risks with Vaginal Estrogen
44:48 - Endometrial Surveillance and Follow-Up
49:14 - Advocating for Vaginal Estrogen Use
51:13 - Conclusion and Final Thoughts

How do you effectively treat your bladder cancer population with an insufficient supply of BCG? Dr. Amy Luckenbaugh, a urologic oncologist at Vanderbilt University Medical Center, joins host Dr. Ruchika Talwar to highlight challenges and solutions to managing bladder cancer amidst ongoing BCG shortages.

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This podcast is supported by an educational grant from UroGen Pharma. UGN-102 was approved by the FDA on June 12, 2025.

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SYNPOSIS

Dr. Luckenbaugh and Dr. Talwar delve into the history and significance of BCG in bladder cancer treatment, exploring the reasons behind the shortages and discussing various coping strategies, including split dosing and alternative intravesical therapies like gemcitabine, docetaxel, and the new mitomycin hydrogel. The conversation also covers emerging treatments for high-risk patients, the role of radical cystectomy, and the importance of standardization and innovation in dealing with medication shortages. Dr. Luckenbaugh highlights the importance of patient quality of life, cost considerations, and the need for resilient pharmaceutical supply chains.

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TIMESTAMPS

00:00 - Introduction
01:56 - History and Importance of BCG in Bladder Cancer
03:21 - Challenges and Shortages of BCG
06:36 - Managing BCG Shortages in Clinical Practice
12:33 - New Alternatives and Treatments for Bladder Cancer
23:28 - The Role of Cystectomy in Bladder Cancer Treatment
26:12 - Future Directions and Final Thoughts

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RESOURCES

BCG Shortage AUA Recommendations:
https://www.auanet.org/about-us/bcg-shortage-info

Reduced-dose bacillus Calmette-Guérin (BCG) in an era of BCG shortage: real-world experience from a tertiary cancer centre: https://pmc.ncbi.nlm.nih.gov/articles/PMC11951178/

Bladder Cancer Advocacy Network (BCAN):
https://bcan.org/

Primary Chemoablation of Recurrent Low-Grade Intermediate-Risk Nonmuscle-Invasive Bladder Cancer With UGN-102: A Single-Arm, Open-Label, Phase 3 Trial (ENVISION)
https://pubmed.ncbi.nlm.nih.gov/39446087/b

FDA Approves Intravesical Mitomycin in Non–Muscle-Invasive Bladder Cancer:
https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-mitomycin-intravesical-solution-recurrent-low-grade-intermediate-risk-non-muscle

TAR-200 - SunRISe-3 Study:
https://www.jnjmedicalconnect.com/products/tar-200/medical-content/tar-200-sunrise-3-study

First results from TAR-200 - SunRISe-1 Study:
https://www.jnj.com/media-center/press-releases/johnson-johnsons-tar-200-monotherapy-achieves-high-disease-free-survival-of-more-than-80-percent-in-bcg-unresponsive-high-risk-papillary-nmibc
N-803 Plus BCG Treatment for BCG-Naïve or -Unresponsive Non-Muscle

Invasive Bladder Cancer: A Plain Language Review:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11524197/

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.

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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.

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TIMESTAMPS

00:00 - Introduction
13:50 - Urology Applications in Orthopedics
24:18 - Optimizing Longevity and Lifestyle
29:08 - Musculoskeletal Syndrome of Menopause
42:12 - Approach to Protein Intake and Supplements
50:48 - Practicing Longevity Medicine
53:26 - Final Thoughts

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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.

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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.

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TIMESTAMPS

00:00 - Introduction
03:43 - History Behind the Estradiol Black Box Warning
13:44 - The FDA Citizen Petition
18:18 - Gender Inequity in Medicine
24:05 - The Role of Organizational Guidelines in Patient Advocacy
28:51 - Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM)
32:57 - Medicare Spending and Legislative Advocacy
44:56 - Recap and Future Directions

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RESOURCES

(TRAVERSE Trial) Cardiovascular Safety of Testosterone-Replacement Therapy
https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
https://doi.org/10.1093/jnci/djac112

(ASCO Study) Use of local estrogen therapy among breast cancer patients in SEER-MHOS database
https://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 risks
https://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.

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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.

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TIMESTAMPS

00:00 - Introduction
08:45 - The Evolution of Testosterone Therapy
20:10 - Challenging Conventional Wisdom on Testosterone
34:04 - Reevaluating Testosterone and Prostate Cancer
51:20 - Testosterone and Prostate Cancer Recurrence
55:44 - Managing Testosterone Therapy in Prostate Cancer Patients
01:12:45 - Final Thoughts

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RESOURCES

The Sex Doctors:
https://www.amazon.com/The-Sex-Doctors/dp/B0DCJQ5B5Q

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.

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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.

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TIMESTAMPS

00:00 - Introduction
03:04 - Understanding Palliative Care
04:43 - Misconceptions and Communication Strategies
07:45 - Integrating Palliative Care in Urology
10:26 - Collaborative Approaches and Multidisciplinary Teams
15:48 - Training and Education for Trainees
20:25 - Effective Communication Techniques
28:18 - Impact of Palliative Care
34:33 - Final Thoughts and Takeaways

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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