BackTable Urology

Not every pediatric GU injury fits neatly into the guidelines. In this episode of BackTable Urology, trauma reconstructive urologist Dr. Travis Pagliara (Hennepin County Medical Center) joins hosts Dr. Arthi Hannallah and Dr. Niccolo Passoni to walk through practical management of pediatric renal, bladder, urethral, and genital injuries. Through case-based discussion, they highlight diagnostic decision-making, when to observe versus intervene, and how to approach these patients in the acute setting.

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SYNPOSIS

The conversation also explores operative pearls, the role of technologies like the Optilume balloon, and why thoughtful short-term follow up is critical for both patient outcomes and clinician learning. Together, they emphasize a measured, conservative mindset whenever appropriate to minimize morbidity while delivering high-quality trauma care.

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TIMESTAMPS

00:00 - Introduction
03:07 - Kidney and Ureteric Trauma
19:16 - Urethral Trauma
34:42 - MRI vs Ultrasound
47:56 - Collaboration in Reconstructive Urology
52:26 - Testicular Trauma
57:29 - Epididymal Injury
01:02:35 - Follow-Ups Matter
01:05:14 - Foreign Body Stories
01:06:52 - Career Advice

What do the 2025 AUA guidelines change about how we evaluate and manage chronic male pelvic pain? In this episode of BackTable Urology, Dr. Susan MacDonald (Penn State) joins host Dr. George Koch (Ohio State University) to break down the new American Urological Association (AUA) guidelines on chronic male pelvic pain, including chronic prostatitis / chronic pelvic pain syndrome and chronic scrotal content pain.

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SYNPOSIS

They review a structured approach from initial evaluation and physical examination to pain management. The discussion outlines an evidence-informed, multimodal management framework incorporating medications, pelvic floor physical therapy, behavioral health interventions, neuromodulators, and selective procedural strategies, with an emphasis on realistic expectation setting in this complex patient population.

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TIMESTAMPS

00:00 - Introduction
01:41 - Path to Chronic Pelvic Pain Work
08:19 - Getting Involved with the AUA
13:02 - Developing Guidelines
19:56 - Initial Patient Evaluation
27:11 - Setting Expectations
32:05 - Making the Diagnosis
35:17 - Success Rates and Counseling Patients
39:51 - Central Sensitization
44:31 - Physical Exam Recommendations
49:26 - Non-Pharmacologic Options
54:38 - Follow Up Cadence
01:02:24 - Chronic Scrotal Pain vs CPPS
01:08:26 - Conclusion

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RESOURCES

Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline (2025)
https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

What do you do when metastatic urothelial cancer responds dramatically to systemic therapy? In this episode of BackTable Urology, Dr. Abhinav Khanna (Mayo Clinic) speaks with host Dr. Daniel Roberson about the growing question of consolidative surgery after enfortumab vedotin plus pembrolizumab. They discuss how EV-pembro has reshaped treatment expectations, why unexpected complete or near-complete responses are prompting tumor board debates about cystectomy, and how careful multidisciplinary decision-making guides which patients may be considered for surgery.

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SYNPOSIS

The conversation reviews early outcomes showing high rates of pathologic downstaging and the possibility that many patients may avoid additional systemic therapy after surgery, while emphasizing this approach is not yet standard of care. Dr. Khanna highlights coordination with medical oncology, radiology, and pathology, postoperative considerations, and the potential future role of biomarkers such as ctDNA. Ultimately, the episode underscores the need for clinical trials and thoughtful patient selection as clinicians navigate integrating surgery into an evolving systemic therapy landscape.

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TIMESTAMPS

00:00 - Introduction
02:19 - The Evolution of Urothelial Carcinoma Treatment
05:23 - Rationale for Consolidative Surgery
12:32 - Patient Selection Criteria
15:23 - Surgical Approach and Considerations
23:58 - Pathologic Findings
31:34 - The Role of Radiation
39:38 - Biomarkers
44:10 - Prospective Trials and Future Directions
53:06 - Guidance for Urologists

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RESOURCES

Consolidative Surgery for Advanced Urothelial Carcinoma Following Induction Enfortumab Vedotin and/or Immune Checkpoint Inhibitor Therapy: A Multicenter Analysis
https://pubmed.ncbi.nlm.nih.gov/40425390/

Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancer
https://www.nejm.org/doi/full/10.1056/NEJMoa2312117

Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer
https://www.nejm.org/doi/abs/10.1056/NEJMoa2401497

Is transecting urethroplasty still the default, or is reconstructive urology moving beyond it? In this episode of BackTable Urology, Dr. Ben Breyer (University of California San Francisco) joins host Dr. George Koch (Ohio State University) to discuss evolving approaches in reconstructive urology with an emphasis on complex stricture cases.

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SYNPOSIS

Throughout the conversation, Dr. Breyer reflects on his path into the subspecialty and breaks down the evolution of reconstructive practice, particularly the shift from anastomotic urethroplasty to non-transecting techniques. Dr. Breyer and Dr. Koch also discuss managing complex urethral strictures, including cases involving prior radiation and inflammatory conditions, while emphasizing thoughtful patient selection and surgical planning. Finally, they explore the current training landscape, challenges in patient access to subspecialty reconstructive care, and why patient-reported outcomes will play a central role in shaping future innovation in urethral reconstruction.

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TIMESTAMPS

00:00 - Introduction
05:40 - Evolution of Surgical Techniques
10:01 - Managing Complex Cases
14:19 - Education and Training in Reconstructive Urology
23:45 - The Future of Reconstructive Urology
28:45 - The Journey of a Reconstructive Urologist
30:45 - Challenges in Urology Training and Practice
35:35 - Addressing Urologist Shortages in Rural Areas
48:34 - Innovations and Research in Reconstructive Urology
57:25 - Final Thoughts

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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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

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