BackTable Urology

Male factor infertility accounts for nearly half of all infertility cases, yet male evaluation is often delayed or overlooked. In this episode of BackTable Urology, Dr. Robert Brannigan joins guest host Dr. Catherine Nam to unpack the 2024 AUA/ASRM Male Infertility Guideline update and discuss how the field is evolving beyond basic semen analysis.

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Timestamps

00:00 - Introduction
04:12 - Rationale Behind the Updates
09:37 - Concurrent Couple Evaluation
15:01 - Diagnosis, Assessment and Evaluation
20:33 - Y Chromosome Microdeletion Testing
23:54 - Workup for Recurrent Pregnancy Loss
33:57 - Pelvic MRI for EDO
36:46 - MicroTESE
40:15 - Future Research Directions
44:09 - Closing Takeaways

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More about this episode

They review updated definitions of infertility, challenges with WHO semen reference ranges, and the need for comprehensive male assessment. The discussion also covers sperm DNA fragmentation, recurrent pregnancy loss, the role of pelvic MRI for ejaculatory duct obstruction, micro-TESE for nonobstructive azoospermia, and the latest directions in male infertility research.

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Resources

Increased risk of incident chronic medical conditions in infertile men: analysis of United States claims data:
https://pubmed.ncbi.nlm.nih.gov/26674559/

Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline
https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

Sixth edition of the World Health Organization laboratory manual of semen analysis: Updates and essential take away for busy clinicians
https://pmc.ncbi.nlm.nih.gov/articles/PMC10929669/

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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

Are biomarkers the missing link in personalized prostate cancer care? What is the practical role of biomarkers across the prostate cancer treatment continuum? In this episode of BackTable Urology, Dr. Udit Singhal (University of Michigan) joins Dr. Ruchika Talwar (Vanderbilt University) to explore the evolving role of genomic classifiers and biomarkers in prostate cancer care.

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This podcast is supported by
Veracyte
https://www.veracyte.com/decipher-prostate

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Timestamps

00:00 - Introduction
04:58 - Current State
10:07 - Interpreting High Risk Scores
13:25 - Intermediate Risk Decisions
16:18 - Imaging vs. Genomics
18:26 - Advanced Disease Evidence
22:02 - AI and Clinical Trials
29:52 - Conclusions

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More about this episode

They review commonly used assays, including Prolaris, Oncotype Dx, Decipher, and ConfirmMDx and emphasize how these tools complement traditional clinical and pathologic risk factors. The discussion highlights practical applications across the disease continuum from initial diagnosis and active surveillance to intermediate-risk management and post-prostatectomy salvage decisions. They also explore emerging AI-driven tools and ongoing trials, highlighting the importance of contextualizing biomarker data within the broader clinical picture and using it to inform, rather than dictate, patient-centered care.

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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

When Renal Cell Carcinoma (RCC) invades the veins, the stakes and the surgical challenges rise. Are you prepared? In this episode, Dr. Vidit Sharma (Mayo Clinic) joins guest host Dr. Daniel Roberson to review Renal Cell Carcinoma (RCC) with Venous Tumor Thrombus (VTT), seen in 4 to 10% of cases. They review Mayo level classification and how CT and MRI venography guide surgical planning by defining thrombus extent and IVC involvement.

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Timestamps

00:00 - Introduction
03:03 - What is a Venous Tumor Thrombus?
12:32 - Presentation and Workup
31:49 - Preoperative Considerations
40:26 - Building the Dream Team
46:06 - Preop Counseling and Risks
51:24 - The Operation
01:31:01 - Outcomes and Adjuvant Immunotherapy
01:36:40 - Future Neoadjuvant Shrinkage
01:39:40 - Final Takeaways

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More about this episode

They also cover key management decisions, including when anticoagulation is appropriate and why embolic urgency is often overestimated. Dr. Sharma highlights the importance of experienced multidisciplinary teams, reviews surgical considerations across thrombus levels, and discusses outcomes, including risk stratification with the TeNNiS model and evolving roles for systemic therapy.

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Resources

Outcomes for patients with renal tumors and venous tumor thrombus
https://www.mayoclinic.org/medical-professionals/urology/news/outcomes-for-patients-with-renal-tumors-and-venous-tumor-thrombus/mac-20570379

TeNNiS Score
https://www.goldjournal.net/article/S0090-4295(26)00078-6/fulltext

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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

When does urodynamics actually change management and when is it unnecessary? In BackTable Urology’s latest collaboration with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), Dr. Howard Goldman and Dr. David Ginsberg join Dr. Giulia Ippolito to discuss the evidence-based use of urodynamics across a range of clinical scenarios.

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Timestamps

00:00 - Introduction
05:04 - Case: Male Urinary Retention
12:38 - Case: Failed Sling
18:44 - Case: Parkinson’s OAB
21:50 - Case: Post-Prostatectomy
26:48 - Prolapse Without Urodynamics
32:29 - Obstruction Workup
36:16 - Refractory OAB
42:49 - Interstitial Cystitis
45:18 - Recurrent UTI Evaluation
50:16 - Conclusions

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More about this episode

They review guideline-driven indications and limitations of urodynamic testing, emphasizing that many common conditions do not routinely require testing. Through case-based discussion, they highlight situations where urodynamics can meaningfully inform care, such as complex neurogenic patients and cases requiring differentiation between obstruction and detrusor underactivity. The conversation highlights the importance of clinical judgment, targeted use of adjuncts such as uroflow, and aligning testing with decision-making to optimize patient outcomes.
This podcast is supported by the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

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Resources

Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study)
https://pubmed.ncbi.nlm.nih.gov/34702331/

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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

Is your “yes” advancing your career or just adding to your workload? In collaboration with the Society of Women in Urology (SWIU), this episode of BackTable Urology features timely professional advice from Dr. Anne Cameron (University of Michigan, former SWIU president) and Dr. Helen Bernie (Indiana University) on how to approach yes and no decisions with intention across different stages of your medical career.

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Timestamps

00:00 - Introduction
02:43 - How Yes Changes Over Time
11:34 - Power Dynamics For Trainees
16:11 - Housekeeping Work
18:46 - Kind Versus Nice
22:52 - Delegating And Mentoring
28:07 - Decision-Making Framework
36:21 - FOMO Versus Opportunity
40:30 - Mentorship
45:02 - Final Takeaways

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More about this episode

Early in training, saying yes is often driven by power dynamics, while later in a career, it’s competing priorities that make those decisions harder. According to Dr. Cameron, a clear, timely “no” is not only acceptable but often more professional than a delayed response, and leaders play a key role in reinforcing this by giving trainees the space to decline opportunities. This episode also highlights the disproportionate share of “housekeeping” work taken on by women and junior faculty, adding another layer to these decisions. To navigate these challenges, Dr. Cameron offers a practical framework that considers time, role expectations, energy, personal fulfillment, CV value, and long-term goals, while emphasizing the role of mentors and trusted colleagues in providing perspective.

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Resources

Society of Women in Urology (SWIU)
https://swiu.org/home.aspx

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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 role does prostate artery embolization (PAE) play in modern prostate cancer care? In this episode of BackTable Urology, Dr. Nainesh Parikh (Interventional Radiology at Moffitt Cancer Center) and Dr. Kosj Yamoah (Radiation Oncology at Moffitt Cancer Center) join Dr. Ruchika Talwar (Vanderbilt University) to discuss how PAE could become a key adjunct in optimizing radiation therapy outcomes.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
01:44 - Why Use PAE in Cancer
04:08 - Neoadjuvant and Salvage Use
07:26 - Radiation Planning Benefits
12:51 - PAE vs. Surgery
18:36 - SBRT Access
20:48 - Current Evidence and Trials
25:29 - Patient Selection
32:18 - PAE After Radiation
36:56 - When to Avoid PAE
40:29 - Long-Term Implications
44:28 - Conclusions

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More about this episode

They review how PAE can improve lower urinary tract symptoms and reduce prostate volume, potentially optimizing patients for radiation therapy, including stereotactic body radiotherapy (SBRT) and brachytherapy. The discussion highlights early clinical data and patient selection considerations such as gland size and symptom burden. Finally, they examine post-radiation applications, technical challenges, and current limitations, emphasizing the need for larger, multicenter trials to better define PAE’s role in prostate cancer treatment pathways.

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Resources

Prostate Artery Embolization in the Setting of Prostate Cancer: Review and Opinion
https://pmc.ncbi.nlm.nih.gov/articles/PMC11775958/

What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making.

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Timestamps

00:00 - Introduction
03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline
07:32 - Patient Experience with OAB
11:59 - Beta-3 Agonists vs Anticholinergics
15:15 - Botox Counseling and Dosing
18:11 - Tibial Nerve Stimulation
25:47 - Sacral Neuromodulation
32:09 - Cost Burden of OAB
39:38 - Evolution of OAB Care
41:39 - Future Research Directions

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More about this episode

The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently.

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Resources

The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)
https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

Anticholinergic Drug Exposure and the Risk of Dementia
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial

https://pubmed.ncbi.nlm.nih.gov/20171677/

Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registry
https://www.auajournals.org/doi/10.1097/UPJ.0000000000000916

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?
https://pubmed.ncbi.nlm.nih.gov/33197059/

What are the key decision points in managing renal, bladder, and urethral trauma? In this episode of BackTable Urology, Dr. Niels Johnson (Vanderbilt University Medical Center) joins host Dr. George Koch (Ohio State University) to discuss the 2025 American College of Surgeons (ACS) best practice guidelines for genitourinary trauma.

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Timestamps

00:00 - Introduction
05:09 - Who Manages GU Trauma?
13:53 - Purpose of ACS Guidelines
16:13 - Development of ACS Guidelines
20:01 - Foley Catheter Debate
23:26 - Renal Trauma
26:40 - Imaging Protocols and Delays
29:30 - Bladder Trauma and Special Populations
33:15 - Urethral Injuries
38:02 - Genital Wounds and Antibiotics
39:42 - Transfer Criteria and Resources
41:26 - Conclusions

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More about this episode

Dr. Johnson and Dr. Koch review the rationale for developing multidisciplinary guidelines and the variability in genitourinary trauma care across institutions. The discussion highlights key management principles, including non-operative strategies for renal trauma, decision-making in bladder and urethral injuries, and how urinary diversion impacts orthopedic and trauma surgical planning. The episode also addresses considerations for special populations, long-term functional outcomes, and practical implementation tools, such as the ACS gap analysis checklist, designed to improve coordination and quality of care across trauma systems.

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Resources

ACS Best Practices Guidelines: Management of Genitourinary Injuries (August 2025)
https://www.facs.org/media/ya5hcu0s/genitourinary_guidelines.pdf

What are the key practice changes introduced in the new American Urological Association (AUA) vasectomy guidelines? In this episode of BackTable Urology, Dr. Akanksha Mehta (Emory University), Vice Chair of the AUA Vasectomy Guidelines Committee, joins Dr. Catherine Nam (University of Michigan) to discuss the latest updates to vasectomy practice.

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SYNPOSIS

Dr. Mehta and Dr. Nam review the key changes in vasectomy guidelines. They address common misconceptions about sexual function and long-term health risks, as well as the role of telemedicine consultation and day-of-procedure examination. Their discussion also covers recommended surgical techniques and updated guidance on post-vasectomy semen analysis, including mail-in testing options. Finally, Dr. Mehta outlines fertility considerations after vasectomy, including cryopreservation, reversal, and sperm retrieval with IVF, and how clinicians can counsel patients about expectations and referral pathways.

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TIMESTAMPS
00:00 - Introduction
02:07 - Why Update the Guidelines
05:38 - Key Guideline Changes
11:02 - Sexual Function Concerns
17:19 - Health Risks Debunked
21:28 - Periprocedural Best Practices
28:25 - Semen Analysis Follow Up
37:12 - Future of Male Contraception
39:11 - Conclusions

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RESOURCES

Vasectomy: AUA Guideline (2026)
https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline

When a male patient presents with lower urinary tract symptoms, should you blame the bladder or bust the prostate? In this SUFU-sponsored episode of BackTable Urology, Dr. Benjamin Brucker (NYU) and Dr. Craig Comiter (Stanford) join host Dr. Chris Tenggardjaja (Kaiser Permanente) for a discussion on evaluating and treating male LUTS using a bladder-and-outlet framework.

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This podcast was developed in collaboration with:

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)
https://sufuorg.com/home.aspx

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SYNPOSIS

Through a case-based approach, they review initial evaluation strategies including symptom history, validated questionnaires, uroflowmetry, post-void residual measurement, and when tools like voiding diaries can help clarify the diagnosis. The conversation then moves to management, outlining a stepwise approach from behavioral interventions and medications to surgical options when symptoms persist. The doctors discuss how prostate anatomy, side effect profiles, and patient priorities guide treatment selection, when urodynamics may add diagnostic clarity, and why addressing outlet obstruction early may help prevent more difficult-to-treat bladder dysfunction over time.

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TIMESTAMPS

00:00 - Introduction
06:31 - Workup for Frequency and Nocturia
11:41 - When to Use a Voiding Diary
19:18 - Behavioral Therapy
26:40 - Post-Finasteride Syndrome
30:03 - Surgical Options
44:41 - Nocturia Counseling
47:32 - Botox With Outlet Surgery
49:47 - When to Order Urodynamics
54:14 - Bladder or Prostate?

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RESOURCES

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)
https://sufuorg.com/home