BackTable Urology

In this crossover episode of BackTable OBGYN with Urology, Dr. Suzette Sutherland, Director of Female Urology at the University of Washington, and Dr. Anne Cameron, Professor of Urology at the University of Michigan, share their insights on the prevention and management of urinary tract infections (UTIs).

First, they emphasize the importance of dispelling misconceptions about recurrent UTIs being a result of poor hygiene or incorrect behaviors, explaining that they can stem from genetic or hormonal risk factors. Dr. Cameron describes her algorithm for managing UTIs in specific patient populations. She further discusses the impact of factors such as fluid intake, bowel habits, and vaginal health on the incidence of UTIs. Dr. Cameron also highlights the potential for UTIs in diabetic patients on certain medications and the importance of a collaborative approach with diabetic healthcare teams. Additionally, the doctors explore various treatment strategies, such as cranberry supplements and gentamicin bladder installations, cautioning against antibiotic overuse due to the risk of resistance.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2P5fzK

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SHOW NOTES

00:00 - Introduction

02:13 - Understanding UTIs: Definitions, Symptoms, and Prevalence

04:39 - Recurrent UTIs: Definitions, Causes, and Treatment Challenges

12:00 - Understanding Asymptomatic Bacteriuria

15:00 - Cystitis vs. Pyelonephritis vs. Urosepsis

20:57 - Antimicrobial Resistance and Antibiotic Stewardship

24:36 - Treatment Guidelines for UTIs

31:13 - Self-start Antibiotic Therapy for UTIs

34:37 - Preventing UTIs: Hydration, Lifestyle Factors, and Bowel Health

38:33 - The Connection Between Vaginal Health and UTIs

42:40 - The Role of Supplements in UTI Prevention: D-Mannose and Cranberry, and Methenamine Hippurate

57:18 - Identification and Treatment of UTIs in Patients with Indwelling Catheters

01:00:04 - The Role of Gentamicin Bladder Installations in UTI Prevention

01:04:27 - The Impact of Diabetes Medications on UTIs

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RESOURCES

AUA Guidelines for UTI Treatment:

https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

In this episode, host Dr. Jose Silva and Dr. Padraic O’Malley, a urologic oncologist from University of Florida Health, discuss how to diagnose and treat upper tract urothelial carcinoma.

Referencing official guidelines and personal experiences, the doctors discuss various treatments such as tumor ablation, JELMYTO, neoadjuvant chemotherapy, and nephroureterectomy. They also discuss the role of lymph node dissection and the significance of Lynch syndrome. Additionally, they touch upon the Thulium laser and updated staging guidelines. The episode concludes with discussions about follow-up care, and the doctors agree on the need for a standardized reporting system and risk stratification guidelines for improved patient management.

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SHOW NOTES

00:00 - Introduction

02:09 - Initial Presentation of Patients with Upper Tract Urothelial Carcinoma

10:54 - Discussion on Lynch Syndrome

14:27 - Risk Stratification in Patients

15:37 - Tumor Ablation and Intracavitary Therapies

26:47 - The Use of Thulium Laser in Treatment

28:50 - Discussion on High Volume Disease

32:39 - Discussion on High Grade Tumors

38:23 - The Role of Neoadjuvant Chemotherapy

43:02 - Post-Treatment Follow Up

45:18 - Standardized Reporting in Guidelines

In this episode of the Backtable Urology Podcast, Dr. Jose Silva invites Dr. Ali Kasraeian, urologic oncologist in Jacksonville, Florida, to discuss his experiences with the Aquablation technique for treating benign prostatic hyperplasia (BPH).

First, Dr. Kasraeian shares the process of learning Aquablation, the initial challenges he faced, and the benefits it offers patients. He explains that Aquablation is a procedure that democratizes the treatment of any size of the prostate by removing inconsistencies in management and offering a consistent, reproducible method. The doctors also discuss Aquablation outcomes and patient considerations, focusing on quality of life improvement and preserving ejaculatory function. Dr. Kasraeian also shares some insights on insurance coverage and billing for this procedure.

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SHOW NOTES

00:00 - Introduction

03:34 - Dr. Ali Kasraeian’s Journey with Aquablation

07:31 - The Evolution of Aquablation Technique

12:14 - Criteria for Aquablation Candidates

29:59 - Starting Out with Aquablation: Tips and Tricks

33:24 - Preserving Ejaculatory Function: Patient Discussions and Planning

35:08 - Post-Procedure Follow-ups and Revisions

49:42 - Billing and Insurance Considerations for Aquablation

54:36 - Final Thoughts on Aquablation and Urology Innovation

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RESOURCES

Kasraeian Urology

https://kasraeianurology.com/

Aquablation

https://aquablation.com/

In this episode, Dr. Aaron Fritts and Dr. Jose Silva invite interventional radiologist Dr. Jamil Muasher to highlight the potential that interventional radiologists possess in offering prostate biopsy work alongside Urology colleagues.

Given the advancement in MRI guidance, the discussion addresses the opportunity for radiologists to step in and provide crucial expertise to optimize patient outcomes. Dr. Muasher talks about his approach of using an MR imaging to guide the biopsy procedure. He further expresses importance in understanding the grading, reading, interpreting systems like Prostate Imaging-Reporting and Data System (PI-RADS) and significant experience needed for accurate results. The doctors also explain various biopsy procedures, details about post-procedure care and follow-ups, and observations about billing for the services.

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CHECK OUT OUR SPONSOR

Veracyte

https://www.veracyte.com/decipher

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SHOW NOTES

00:00 - Introduction

07:29 - Learning to Read Prostate MRI

09:43 - The Role of Radiologists and Grading Systems in Prostate Biopsies

24:00 - Techniques in Prostate Biopsy

31:16 - The Role of Antibiotics in Biopsy

32:34 - The Debate Between Transperineal and Transrectal Biopsy

40:36 - Post-Procedure Care and Follow-Up

45:49 - The Future of Biopsy

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RESOURCES

Decipher Prostate Genomic Classifier by Veracyte:

https://decipherbio.com/

In this episode of the Backtable Urology Podcast, host Dr. Suzette Sutherland (University of Washington) and Dr. Tamsin Greenwell (University College London Hospitals) discuss surgical treatments for incontinence and their comparative efficacies.

They focus mainly on midurethral slings and a new urethral bulking agent called Bulkamid. They further analyze how conditions like product expectations, surgeon expertise, data availability, patient preferences, and financial costs influence the choice of procedure. Additionally, they discuss the impact of mesh-related complications and how they affected the usage of synthetic slings in the UK. Finally, they touch on the role of shared decision making in choosing treatment strategies.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/p4RNfi

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SHOW NOTES

00:00 - Introduction

03:48 - Discussion on Midurethral Slings

11:05 - The Mesh Controversy and Its Impact

22:21 - Shared Decision Making in Treatment Options

26:47 - The Role of Urethral Bulking Agents

32:51 - Comparative Trial and EAU Guidelines

42:12 - Conclusion and Closing Remarks

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RESOURCES

Bulkamid Injections

https://bulkamid.com/en-US

In this week’s BackTable Podcast, guests Dr. Sarah Psutka and Dr. Rachel Rubin join host Dr. Aditya Bagrodia to discuss the importance of considering women’s sexual health in urologic oncology surgeries.

The doctors go on to discuss how to ensure proper patient education and setting realistic expectations about post-surgery recovery. Additionally, they highlight the need for open conversation about sexual health and the use of hormone therapies to improve menopause symptoms. Finally, they touch on the need for more research in women’s sexual health and the use of pelvic floor physical therapy.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/uYv0Hm

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SHOW NOTES

02:30 - The Importance of Open Conversations about Sexual Health

03:55 - Addressing Sexual Health in Cancer Patients

11:47 - The Role of Hormones in Women’s Health

25:05 - The Renewed Interest in Gynecologic Organ Sparing

29:39 - Importance of Risks and Oncologic Outcomes in Bladder Cancer Treatment

35:56 - The Role of Pelvic Floor Physical Therapy in Bladder Cancer Recovery

44:24 - The Role of Hormone Therapy in Bladder Cancer Recovery

53:59 - Conclusion: The Future of Bladder Cancer Treatment

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RESOURCES

Mark Cuban's Cost Plus Drug Company:

https://costplusdrugs.com/

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Bilal Chughtai discuss their workup for benign prostate hyperplasia (BPH) and how they use Greenlight Laser therapy and pharmacologic interventions to treat this common condition.

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CHECK OUT OUR SPONSOR

Boston Scientific GreenLight Laser Therapy

https://www.bostonscientific.com/greenlight

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SHOW NOTES

First, the doctors discuss workup of BPH. Questionnaires, like the International Prostate Symptom Score (IPSS) are helpful when in the first clinic evaluation. They also discuss differential diagnoses of urinary obstructive symptoms.

Then, they discuss who is and isn’t a candidate for a GreenLight laser therapy. They also touch on the topic of pre-operative antibiotics. Dr. Chughtai then describes in detail the steps of the procedure to ensure an open channel and removal of the correct prostate lobes. Next, he discusses the possible risks and benefits of doing an ejaculatory hood sparing procedure. Additionally, they explore the hood technique and how it's used to preserve mucosa at the apex of the prostate.

They also consider the importance of having a discussion about ejaculation with patients before the GreenLight procedure. Additional technology or adjunctive medications, such as alpha blockers and PDE5 inhibitors may be necessary as well. Finally, Dr. Chughtai explains his post-operative medications and the decision to discharge or admit for overnight observation.

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RESOURCES

GreenLight Laser Therapy:

https://www.bostonscientific.com/en-EU/health-conditions/enlarged-prostate/our-treatments/greenLight-laser-therapy.html

In this episode, host Dr. Jose Silva speaks with Dr. Duke Herrell, CEO and CMO of Virtuoso Surgical, a robotic surgery tool known for its exceptional dexterity and precision.

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SHOW NOTES

Dr. Duke Herrell is a minimally invasive urologic surgeon and professor at Vanderbilt University. Dr. Herrell came to Vanderbilt for his surgical fellowship, where he met Bob Webster, a mechanical engineer who had developed concentric tube robots made out of an elastic metal. Together, they worked to form the metal into curves that could create a tentacle-like motion for clinical applications. Over the next 15 years, Dr. Herrell and three co-founders started their company, Virtuoso Surgical, and received grant funding to move forward with their startup.

The surgical device features two 1-millimeter dextrous tools inserted through a rigid scope that is capable of carrying a versatile array of instruments. The device is currently intended for the urologic procedures including removal and enucleation of prostate tissue, bladder lesion removal and sampling, and transurethral resection of bladder tumors (TURBT). Notably, the device addresses a critical issue in tumor staging by improving the accuracy of margin determination, which is a game-changer for the 50% of TURBT procedures that yield specimens lacking muscle or clear margin information. Beyond urology, the device has the potential to improve other surgical procedures that utilize a rigid scope in a constrained environment including pulmonology, neurosurgery, and ENT interventions.

Dr. Herrell and his team are also developing EndoTheia, a micromachine instrument that functions as a steerable catheter, specifically designed for flexible ureteroscopy. This device is currently in the verification and validation phase.

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RESOURCES

Virtuoso Surgical:

https://virtuososurgical.net/

This week on BackTable Urology, Dr. Kristen Scarpato (Vanderbilt University), Dr. Todd Morgan (University of Michigan), and Dr. Philip Kim (Kaiser Permanente) discuss their urologic oncology fellowship experiences, the importance of mentorship, and work-life balance as urologists.

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SHOW NOTES

First the doctors discuss the changing landscape of urologic oncology fellowships and the favorable job market for those graduating from residency. They also share how their experiences in residency and mentorship from esteemed urology professionals shaped their paths towards urologic oncology. Additionally, they discuss the Society of Urologic Oncology (SUO) Clinical Trials Consortium and its role in providing education and resources to fellows. Benefits of joining an SUO fellowship program include the ability to participate in clinical trials and gain mentorship opportunities.

Finally, the doctors examine the reality of balancing early career work and family responsibilities. They analyze the effect of burnout on our work-life balance and the different stages of career and family life. They conclude the episode by emphasizing the importance of intentionality in both aspects of their lives.

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RESOURCES

SUO Clinical Trials Consortium

https://suoctc.org/home.aspx

This week on BackTable Urology, Dr. Aditya Bagrodia (UC San Diego), Dr. Clint Cary (Indiana University), and Dr. Gagan Prakash (Tata Memorial Hospital) discuss the diagnosis and management of metastatic testicular cancer.

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SHOW NOTES

First, the doctors discuss when orchiectomy and retroperitoneal lymph node dissection (RPLND) are necessary. They also summarize the relevant tumor markers and laboratory values to obtain and discuss the possibility of teratomas. Then, they examine the role of chemotherapy in the treatment of metastatic testicular cancer.

The doctors then transition to explaining how to manage patient expectations before orchiectomy and RPLND. They discuss the various complications of the procedure as well as the potential benefits of using 3D models and animations to explain the surgery to patients. They also cover the complications of chemotherapy as well and emphasize the importance of preparing the patient for the side effects of all treatment combinations. Then, they delve into specific surgical techniques that can prevent surgical complications when resecting testicular cancers.

Finally, the doctors discuss the importance of gaining experience with observing RPLND and training at a high volume urology center to gain more insight into the complexities of the operation. Finally, they emphasize the importance of having an experienced team to handle the operation.