When is active surveillance the right choice for intermediate-risk prostate cancer patients? In this episode of BackTable Urology, Dr. Claire de la Calle, Assistant Professor of Urology at the University of Washington, joins Dr. Ruchika Talwar to unpack how active surveillance has evolved beyond low-risk disease and why select Grade Group 2 patients may be appropriate candidates now with thoughtful patient selection.

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SYNPOSIS

The conversation explores emerging tools that can refine surveillance decisions, including PSA density, MRI findings, genomic classifiers, and the growing role of AI-assisted pathology. Dr. de la Calle emphasizes the importance of nuanced patient counseling, acknowledging anxiety and long-term risk while reinforcing that time on active surveillance can be a meaningful win when oncologic outcomes remain comparable to upfront treatment.

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TIMESTAMPS

00:00 - Introduction
02:58 - Current Evidence
05:03 - Patient Selection Criteria
12:11 - Importance of PSA Density and Monitoring Protocols
18:12 - Pathology and Genomic Testing
32:18 - Future Directions and Research
36:33 - Key Takeaways

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RESOURCES

ProtecT Trial: Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer
https://www.nejm.org/doi/full/10.1056/NEJMoa2214122

Canary PASS Study
https://canarypass.org/

Genomic Classifier Performance in Intermediate-Risk Prostate Cancer: Results From NRG Oncology/RTOG 0126 Randomized Phase 3 Trial
https://pubmed.ncbi.nlm.nih.gov/37137444

Is the era of cisplatin over, or are we simply becoming more precise about who benefits from it? As perioperative strategies in bladder cancer continue to evolve, emerging tools like circulating tumor DNA (ctDNA) are playing a bigger role in how clinicians assess recurrence risk and tailor treatment. In this episode of BackTable Tumor Board, host Alan Tan, medical oncologist at Vanderbilt-Ingram Cancer Center, is joined by bladder cancer experts Dr. Amanda Nizam and Dr. Brad McGregor to discuss recent advances in the diagnosis and treatment of urothelial carcinoma.

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SYNPOSIS

The doctors examine the evolving management of muscle-invasive bladder cancer (MIBC), including the role of neoadjuvant and adjuvant therapies, the integration of immunotherapy, and the recent approval of enfortumab vedotin plus pembrolizumab. The discussion explores the rapidly changing perioperative landscape, the prognostic utility of ctDNA, and how biomarkers such as HER2 and FGFR are influencing treatment selection across disease states. They also address bladder preservation strategies, management of treatment-related toxicities, and the importance of multidisciplinary coordination. The episode concludes with a forward-looking discussion on emerging therapies and the potential to improve cure rates in bladder cancer.

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TIMESTAMPS

00:00 - Introduction
01:44 - Overview of Bladder Cancer Treatment
04:54 - Patient Staging and Treatment Goals
10:12 - Bladder Preservation vs. Radical Cystectomy
16:39 - Emerging Trials and Future Directions
22:40 - ctDNA and Precision Medicine
33:50 - Metastatic Disease and Biomarker Strategies
42:16 - Managing Neuropathy in Metastatic Treatment
48:44 - HER2 and FGFR in Bladder Cancer
54:15 - Future Directions in Bladder Cancer Treatment

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RESOURCES

EV-302/303 Trial
https://newsroom.astellas.com/2023-12-15-PADCEV-R-enfortumab-vedotin-ejfv-with-KEYTRUDA-R-pembrolizumab-Approved-by-FDA-as-the-First-and-Only-ADC-Plus-PD-1-to-Treat-Advanced-Bladder-Cancer

NIAGARA Regimen
https://www.nejm.org/doi/full/10.1056/NEJMoa2408154

KEYNOTE-905 Study
https://www.annalsofoncology.org/article/S0923-7534(25)04894-X/fulltext

In reconstructive urology, preventing infection often means prolonged antibiotic exposure, raising important questions about stewardship and long-term harm. In this episode of BackTable Urology, Joshua Sterling of Yale University joins host George Koch to examine how antibiotic stewardship and emerging insights into the urinary microbiome are reshaping infection management in reconstructive practice.

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SYNPOSIS

The discussion centers on real-world clinical challenges, particularly in high-risk populations such as patients with neurogenic bladder, chronic catheterization, or prior reconstruction - groups in whom antibiotics are frequently used prophylactically or indefinitely. Drs. Sterling and Koch explore how well-intentioned prescribing patterns can contribute to resistance, dysbiosis, and recurrent infection, while often failing to address the underlying drivers of disease.

Rather than framing infection control solely around eradication, the conversation considers a shift toward modulation of the urinary microbiome, drawing on lessons from gastroenterology, infectious disease, and transplant medicine. The episode concludes by outlining how a more nuanced, multidisciplinary approach may better serve reconstructive urology patients in the long term.

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TIMESTAMPS

00:00 - Introduction
02:22 - Antibiotic Stewardship in Urology
06:34 - Current Landscape of Antibiotic Use
13:44 - Protocols and Practices in Reconstruction
18:24 - Antibiotic Overuse and Misuse
21:02 - Shifting the Microbiome
25:12 - Chlorhexidine Irrigations
32:38 - Future Directions
38:27 - Implementing Antibiotic Protocols
40:48 - Conclusions

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RESOURCES

STOP-IT Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1411162

Vaginal rejuvenation is often misunderstood, misrepresented, and overdue for honest conversations in medicine. In this crossover episode between BackTable Urology and BackTable OBGYN, Dr. Nirit Rosenblum, a urology and OBGYN professor at NYU Langone Medical Center, is joined by Dr. Karyn Eilber, Chair of the Cedars-Sinai Medical Group Department of Surgery, and Dr. Ariana Smith, Chief of Urology at Pennsylvania Hospital. Together, they bring a multidisciplinary lens to one of the most misunderstood areas of women’s health.

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SYNPOSIS

The discussion revolves around the broad definition of vaginal rejuvenation, distinguishing between medical and cosmetic interventions. They address common misconceptions, the roles of different health professionals, and emphasize the importance of pelvic floor physical therapy and the appropriate use of systemic and vaginal estrogen therapy. The conversation also highlights critical gaps in research surrounding laser and radiofrequency interventions, underscoring the need for stronger evidence, clearer patient education, and continued advocacy around menopause care and sexual function.

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TIMESTAMPS

00:00 - Introduction
02:07 - Defining Vaginal Rejuvenation
04:31 - Common Procedures and Misconceptions
10:00 - Insurance and Coverage of Procedures
12:00 - Laser and Radiofrequency Therapies
18:06 - Vaginal Estrogen and Lift of Black Box Warning
19:55 - The Role of Systemic Hormone Therapy
26:52 - Vaginal Rejuvenation Misconceptions
32:17 - Pelvic Floor Physical Therapy and Timing of Procedures
34:20 - Regional Variations in Therapeutic Availability
38:36 - Gender Inequity in Healthcare
40:12 - Final Thoughts

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RESOURCES

Joint Report on Terminology for Cosmetic Gynecology
https://journals.lww.com/fpmrs/abstract/2022/06000/joint_report_on_terminology_for_cosmetic.2.aspx

Gender affirming surgery is becoming a more visible part of urologic practice, raising practical questions about surgical training, case volume, and multidisciplinary support. In this episode of BackTable Urology, Dr. Eric Walton of The Ohio State University joins Dr. George Koch to examine how gender affirming surgery is being integrated into contemporary urology. Dr. Walton discusses his path into reconstructive urology, structural barriers that limit patient access, and why expanding surgical training pathways is central to closing gaps in care.

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SYNPOSIS

The conversation explores fellowship models, academic versus private practice settings, and the role of multidisciplinary teams in supporting surgical programs. Practical considerations around patient screening, care coordination, and insurance are addressed, reframing gender affirming surgery as a core component of modern urologic care rather than a subspecialty outlier.

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TIMESTAMPS

00:00 - Introduction
00:52 - Journey to Gender Affirming Surgery
03:29 - Specialized Training in Gender Surgery
09:34 - Building a Gender Surgery Program
27:54 - Providing Competent and Affirming Care
32:54 - Future of Gender Affirming Surgery in Urology
39:58 - Final Thoughts and Advice

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RESOURCES

World Professional Association for Transgender Health (WPATH) Standards of Care:
https://wpath.org/publications/soc8/

What determines success in the early years of urology practice? In this BackTable Urology episode, produced in collaboration with the Society of Women in Urology (SWIU), this episode of the BackTable Urology Podcast brings on Dr. Raveen Syan, Dr. Helen Hougen, and host Dr. Michelle Van Kuiken to discuss the transition to early career practice in urology.

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SYNPOSIS

Together, the doctors explore the realities that new attendings face, from building efficient clinical systems to managing complications and building support networks. Drawing from personal experience, the guests offer practical guidance on mentorship, recognizing when a role or environment may no longer be the right fit, and building a sustainable, fulfilling professional life.

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TIMESTAMPS

00:00 - Introduction
02:54 - Early Challenges
06:13 - Finding Support and Building Systems
11:49 - Balancing Work and Personal Life
15:52 - The Importance of Saying Yes Early On
18:16 - Mentorship and Finding Allies
22:29 - Decision Making and Cognitive Biases
24:36 - Managing Complications
27:31 - Prioritizing Clinical Goals
38:45 - Knowing When to Leave
42:09 - Final Reflections

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RESOURCES

Annie Duke
https://www.annieduke.com/

Aristotle’s 10 Rules for a Good Life
https://www.theatlantic.com/ideas/archive/2023/08/aristotle-10-rules-happy-life/674905/

Personal Productivity: How to work effectively and calmly in the midst of chaos
https://www.cvdtraining.pitt.edu/wp-content/uploads/2023/01/Johnson2009_Essays.pdf

Understanding Academic Medical Centers: Simone’s Maxims
https://aacrjournals.org/clincancerres/article/5/9/2281/287826/Understanding-Academic-Medical-Centers-Simone-s

The microhematuria guideline just changed. Here’s what clinicians need to know. In this episode of BackTable Urology, Dr. Daniel Barocas (Vanderbilt University) joins host Dr. Ruchika Talwar to break down the 2025 updates to the American Urological Association (AUA) Microhematuria Guideline and why these changes matter in everyday practice.

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SYNPOSIS

They walk through the evidence driving the updates, including revised risk stratification and the expanding role of urinary biomarkers. The conversation highlights how these recommendations affect patient evaluation, imaging decisions, and shared decision-making, with an emphasis on balancing cancer detection, patient burden, and responsible use of healthcare resources.

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TIMESTAMPS

00:00 - Introduction
01:33 - What Prompted the Guidelines Update?
02:59 - Challenges of a Negative Microhematuria Evaluation
06:21 - Initial Evaluation Guidelines
07:58 - Risk Stratification
18:11 - Imaging in Hematuria Workups
21:16 - Use of Urinary Biomarkers
33:25 - Potential Future Guideline Updates
37:17 - Takeaways for Urologists

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RESOURCES

AUA/SUFU Microhematuria Guideline
https://www.auanet.org/guidelines-and-quality/guidelines/microhematuria

How are local and international teams working together to offer reconstructive urology in resource-constrained settings? This week on BackTable Urology, Dr. Jane Kurtzman (University of Utah) joins Dr. George Koch (Ohio State University) to discuss the realities, challenges, and opportunities of international surgical work.

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SYNPOSIS

They break down how global urology programs differ in structure, why cultural understanding is foundational, and what sustainable models look like in practice. The conversation highlights unmet reconstructive needs in low- and middle-income countries, evolving models for subspecialty development, and the growing role of long-term partnerships in shaping the future of global urology.

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TIMESTAMPS

0:00 - Introduction
4:46 - Understanding Healthcare Systems Abroad
8:12 - Need for Global Urology
13:39 - Role of Reconstructive Urology Abroad
21:57 - Current Programs
27:20 - GU Impacts
39:35 - Building Capacity through Training
49:00 - Past Successes
58:38 - Future Directions
1:14:12 - Getting Involved

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RESOURCES

GU Impacts
https://medicine.utah.edu/surgery/urology/gu-impacts

IVUMed
https://www.ivumed.org/

Urology Care Foundation
https://www.urologyhealth.org/humanitarianism

Can genomic classifiers close the gap between what we see and what a tumor will do? In this episode of BackTable Urology, Dr. Carissa Chu (UCSF) joins Dr. Ruchika Talwar (Vanderbilt) to explore how genomic classifiers are reshaping the way clinicians diagnose and manage bladder cancer.

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This podcast is supported by:

Veracyte
https://www.veracyte.com/decipher-bladder

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SYNPOSIS

They discuss the limitations of traditional staging systems and how molecular subtyping is providing deeper insight into tumor biology, treatment response, and prognosis. Dr. Chu highlights where these classifiers can be integrated into real-world clinical decision-making today, where the evidence is still emerging, and which ongoing trials may define the next era of precision medicine in urologic oncology.

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TIMESTAMPS

0:00 - Introduction
3:01 - Overview of Genomic Classifiers
9:34 - Risk Stratification
15:22 - Current Evidence for Genomic Classifiers
22:07 - Clinical Implications of Biomarkers
27:23 - Ordering Genomic Classifiers
33:46 - Future Directions
37:57 - Final Takeaways

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RESOURCES

Alignment of molecular subtypes across multiple bladder cancer subtyping classifiers
https://pubmed.ncbi.nlm.nih.gov/38480079/

GUSTO Trial
https://fundingawards.nihr.ac.uk/award/NIHR128103

If you’re navigating pregnancy, postpartum, or return-to-work stress, you are not alone. In this BackTable Urology × SWIU collaboration, Dr. Danielle Velez (Rutgers Health) joins host Dr. Helen Bernie (Indiana University Health) for a candid conversation on navigating parental leave, lactation, and the emotional turbulence of stepping back into clinical practice. Together, they unpack boundary-setting, finding a support system, protecting partnership time, and giving yourself grace through each stage of early parenthood.

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SYNPOSIS

The discussion highlights the power of mentorship, community, and transparency, especially for physicians balancing patient care and family life. From combo-feeding and night nannies to sleep deprivation, identity shifts, and the six-month reevaluation rule, both guests share wisdom they hope future trainees and new parents won't have to learn alone. This episode is a reminder that things get easier with time, that asking for help is strength, not weakness, and that paying it forward makes the path smoother for the next generation.

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TIMESTAMPS

00:00 - Introduction
03:07 - Support Systems, Mentorship and Maternity Leave
09:03 - Navigating Lactation and Pumping
19:21 - Lactation Resources
25:58 - Finding Your Village and Outsourcing Tasks
34:31 - Balancing Parenthood and Career
42:26 - Sleep Deprivation and Protecting Your Schedule
55:14 - Maintaining Spousal Relationships
59:20 - Rebuilding Your Practice Post-Maternity Leave
01:03:56 - Final Thoughts and Advice for New Parents

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RESOURCES

Dr. MILK (Mothers Interested in Lactation Knowledge) Support Group
https://www.drmilk.org/