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.

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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.

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TIMESTAMPS

00:00 - Introduction
02:14 - Evolution of Prostate Biopsy Methods
17:51 - Transperineal vs. Transrectal Approaches
22:52 - Use of Sedation
35:10 - PSA Screening
41:48 - Rise in Metastatic Prostate Cancer
50:44 - Potential of Focal Ablation
55:58 - Use of WellPrept

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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.

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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.

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TIMESTAMPS

00:00 - Introduction
01:52 - The Intersection of Cardiology and Urology
03:43 - Understanding Preventive Cardiology
07:56 - Patient Risk Stratification and Workup
16:35 - Cardiovascular Health in Women
20:07 - Testosterone Therapy and Cardiovascular Risk
26:39 - Hormone Replacement Therapy in Men and Women
36:09 - Beta Blockers and Sexual Dysfunction
42:36 - Diuretics and Sexual Health
48:57 - A Message to Urologists from a Cardiologist

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RESOURCES
TRAVERSE 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.

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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.

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TIMESTAMPS

00:00 - Introduction
02:50 - Focus on Menopause and Hormone Replacement Therapy
04:20 - The Women's Health Initiative (WHI) Study
05:39 - Understanding Risks and Misconceptions
12:43 - Reevaluation of the Women’s Health Initiative Study
18:31 - Impact of Media and Physician Education
19:58 - Current State of Hormone Therapy
22:17 - Broader Implications and Future Directions
27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments
29:49 - The Impact of Hormone Therapy on Women's Health
32:11 - Risks of Not Using Hormones
35:44 - Hormones and Brain Health: Debunking Myths
40:41 - The Timing Hypothesis and Long-Term Hormone Use
46:32 - Advocacy and Education for Menopause Awareness
48:04 - Conclusion and Upcoming Resources

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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/

With BCG in short supply and recurrence rates still high, the race is on for better intravesical options. In this episode of BackTable Tumor Board, Dr. Lindsey Herrel, urologic oncologist at the University of Michigan, joins Dr. Ruchika Talwar to explore the evolving landscape of intravesical therapy for intermediate risk bladder cancer.

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This podcast is supported by an educational grant from UroGen Pharma.

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SYNPOSIS

The doctors break down the nuances of defining this risk category and the clinical gray zones that complicate treatment decisions. Dr. Herrell shares her patient-centered approach to surveillance and therapy, and introduces promising new agents, including Anktiva, UGN-102, and the gemcitabine-releasing TAR-200 "pretzel" device. The discussion also highlights how advances in molecular profiling are reshaping care strategies.
This episode underscores the urgent need for clearer guidelines and continued innovation to improve outcomes and quality of life for patients with this nuanced disease subtype.

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TIMESTAMPS

00:00 - Introduction
02:03 - Defining Intermediate Risk Bladder Cancer
06:12 - Intravesical Therapy Options
08:47 - Quality of Life and Patient Counseling
10:18 - New Treatments on the Horizon
12:56 - Practical Tips for TURBT Recovery
17:03 - In-Office Procedure Management
21:38 - Managing Symptoms and Quality of Life
31:50 - A Note on Smoking Cessation
33:37 - Conclusion and Future Directions

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.

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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.

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TIMESTAMPS

00:00 - Introduction
01:23 - The Mission to Africa: How It All Began
02:32 - Challenges and Logistics of Medical Missions
06:02 - Resident Involvement and Impact
09:10 - Preparation and Experiences in Africa
11:38 - Overcoming Obstacles: Supplies and Customs
19:18 - Types of Procedures and Medical Work in Africa
21:45 - Upgrading Equipment and Training Local Staff
28:28 - Daily Operations and Patient Management
31:00 - Post-Trip Activities and Community Engagement
34:26 - Funding and Sustainability Efforts
40:31 - Personal Reflections and Future Plans

Counseling patients with intermediate-risk non-muscle invasive bladder cancer can be complex, with a wide range of treatment options and care pathways. In this episode of BackTable Urology, urologic oncologists Dr. Ruchika Talwar and Dr. Kelly Bree explore how to approach this challenge with clarity and compassion.

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This podcast is supported by an educational grant from UroGen Pharma.

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SYNPOSIS

They emphasize a shift toward patient-centered, less aggressive treatment strategies, highlighting the importance of quality of life in clinical decision-making. The discussion includes risk stratification, the use of intravesical gemcitabine, and ongoing clinical trials. Dr. Bree also offers actionable tips for optimizing patient preparation and recovery. This episode underscores the growing importance of listening to patient voices to shape future standards of care.

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TIMESTAMPS

00:00 - Introduction and Overview
02:09 - Risk Stratification and Treatment Approaches
06:12 - Intravesical Therapy Options
08:47 - Quality of Life and Patient Counseling
12:56 - Practical Tips for TURBT Recovery
17:03 - In-Office Procedures and Patient Management
21:23 - Resources and Support for Patients
24:13 - Future Directions and Final Thoughts

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RESOURCES

Society of Urologic Oncology
https://suonet.org/home.aspx

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.

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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.

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TIMESTAMPS

00:00 - Introduction
01:59 - From Childhood to Medical School
06:48 - Discovering Urology
16:52 - Pioneering Prostate Cancer Screening
24:07 - The PLCO Study: Design and Challenges
28:57 - Controversies and Criticisms in Prostate Cancer Screening
33:29 - Evolving Practices in Prostate Cancer Management
44:19 - 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).

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This podcast is supported by:
Ferring Pharmaceuticals

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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.

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TIMESTAMPS

00:00 - Introduction
02:23 - Imaging Preferences
03:29 - Biopsy vs Immediate Surgery
06:04 - Lymph Node Dissection vs Radiation
13:48 - Brachytherapy Techniques and Case Study
23:21 - Challenges in Advanced Penile Cancer
27:03 - Chemotherapy and Chemoradiation
30:15 - InPACT Trial
37:12 - Salvage Therapies and Exploring New Treatment Frontiers
44:25 - Support and Awareness for Penile Cancer
51:29 - Final Thoughts

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RESOURCES

Society of Urologic Oncology
https://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.

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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.

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TIMESTAMPS

00:00 - Introduction
02:13 - Erectile Dysfunction and Testosterone
08:05 - Young Men's Health and Early Detection
10:20 - Semen Analysis for Overall Health
12:50 - Daily Tadalafil and Its Benefits
16:40 - Proactive Sexual Health Management
21:28 - Female Sexual Health
25:16 - Treating Delayed Ejaculation
28:53 - Psychogenic Erectile Dysfunction
31:16 - Technology in Sexual Health
35:54 - Lifestyle Modifications for Better Sexual Health
41:55 - Resources and Referrals for Patients
44:30 - 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).

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This podcast is supported by:
Ferring Pharmaceuticals

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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.

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TIMESTAMPS

00:00 - Introduction
02:49 - Case Study 1: 66-Year-Old Male with UTUC
11:19 - Case Study 2: 73-Year-Old Male with High-Grade Urothelial Carcinoma
28:11 - Intravesical Chemotherapy Protocols
30:44 - Case Study 3: 57-Year-Old Male with Recurrent Urothelial Cancer
41:25 Clinical Trials and Emerging Treatments
45:40 Case Study: 55-Year-Old Female with Bulky Lymphadenopathy
56:45 Concluding Remarks and Future Directions

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RESOURCES

Society of Urologic Oncology
https://suonet.org/home.aspx