BackTable Urology

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/

When it comes to GU cancers, fear and uncertainty often shape a patient’s treatment decisions well before the clinical data does. Dr. Hung-Jui (Ray) Tan of UNC Health sits down with host Dr. Ruchika Talwar to unpack why decision-making around small renal masses, low-risk prostate cancer, and other GU conditions can be so challenging. Dr. Tan explains the concept of decisional conflict, a patient’s internal uncertainty about the “right” course of action, and how it predicts downstream satisfaction and health outcomes.

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SYNPOSIS

Dr. Tan shares practical, evidence-based strategies for improving decision-making conversations, from clearer framing to simple visual aids that reduce anxiety. They discuss how patients often perceive much greater risk of metastasis than what data shows, and why “turning down the temperature” is essential before discussing options. They also touch on evolving tools, including AI, that may improve how clinicians communicate risk and support patients through uncertainty.

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TIMESTAMPS

00:00 - Introduction
01:02 - Journey to Decision Science
05:59 - Research on Decision Making
14:41 - Shared Decision Making in Practice
22:39 - Resources for Shared Decision Making
39:54 - Improving Decision-Making Conversations

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RESOURCES

Decisional conflict among patients newly diagnosed with clinical T1 renal masses: a prospective study
https://pmc.ncbi.nlm.nih.gov/articles/PMC11233232/

Decisional Quality in Patients With Small Renal Masses
https://pubmed.ncbi.nlm.nih.gov/29574123/

Impact of renal mass biopsy on decision-making experience for clinical T1 renal masses
https://pubmed.ncbi.nlm.nih.gov/41151063/

MUSIC Patient and Provider Resources for Shared Decision Making
https://musicurology.com/programs/kidney/

P3P - Prostate Cancer Shared Decision Making Resource
https://www.p3p4me.org/users/login

Best Case/Worst Case Treatment Decision Tool
https://patientpreferences.org/best-case-worst-case/

Better Conversations Treatment Decision Tool
https://patientpreferences.org/better-conversations/

One of the most common dilemmas in urologic oncology: what do you do when a patient has T1 disease in both the bladder and the ureter? In the final episode of the 2025 NMIBC Creator Weekend™ series, Dr. Vignesh Packiam, Dr. Mark Tyson and Dr. Sarah Psutka share how they approach complex bladder cancer cases with upper tract involvement.

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This podcast is supported by:
Ferring Pharmaceuticals

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SYNPOSIS

The doctors discuss complex bladder cancer cases, sequencing treatments for patients with dual ureteral and bladder T1 disease, the impact of cystectomy on quality of life, and the use of blue light cystoscopy and intravesical therapy. They also delve into the rise of bladder cancer in younger patients, considerations for low-grade intermediate-risk disease, and emerging therapeutic options.

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TIMESTAMPS

00:00 - Introduction
05:52 - Upper Tract Positive Cytology Dilemma
09:10 - Cystectomy Considerations
15:55 - Developing Better Patient-Reported Outcomes
20:26 - Challenges with New Therapeutics
26:31 - Deescalating Treatment for Low-Grade Cancer
33:29 - Closing Remarks

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RESOURCES

CISTO Trial
https://pubmed.ncbi.nlm.nih.gov/37980511/

Can we reduce OR waste without compromising patient care? In this episode of BackTable Urology, Dr. Sunil Patel (Johns Hopkins) joins host Dr. Ruchika Talwar (Vanderbilt) to explore strategies for improving environmental sustainability in surgical practice.

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SYNPOSIS

They discuss the scope of OR-generated waste, the impact of plastics and carbon emissions, and emerging data linking environmental exposures to carcinogenesis. Dr. Patel highlights evidence supporting reusable vs. single-use instruments, shares examples of successful waste-reduction initiatives, and emphasizes the importance of cross-disciplinary collaboration to make sustainable practices achievable across healthcare systems.

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TIMESTAMPS

0:00 - Introduction
3:29 - Current State of OR Waste
20:09 - Strategies to Reduce Waste
24:52 - Impact of Climate Change on Patients
33:55 - Future Directions
40:27 - Conclusion

When standard therapy fails, it does not have to be the end of the road for high-risk bladder cancer patients. Modern treatments, biomarkers, and clinical studies have opened up new avenues for treating recurrent non-muscle invasive bladder cancer (NMIBC). The penultimate episode of the 2025 NMIBC Creator Weekend™ series features urologic oncologists Dr. Vignesh Packiam, Dr. Mark Tyson, and Dr. Sarah Psutka discussing how they navigate complex bladder cancer scenarios.

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This podcast is supported by:
Ferring Pharmaceuticals

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SYNPOSIS

The doctors share treatment strategies, staging processes, and post-therapy patient management techniques. They address recurrent disease, approaches to different stages of cancer, the role of biomarkers in determining treatment paths, and considerations for both high-risk and intermediate-risk patients. Additionally, the episode touches on new treatments, clinical trials, and patient quality of life post-treatment.

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TIMESTAMPS

00:00 - Introduction
02:08 - Case Study: Initial Patient Assessment
04:59 - Surgical Considerations and Techniques
10:22 - Managing Bladder Cancer Recurrence
11:15 - Treatment Options and Clinical Trials
15:12 - Advanced Treatment Strategies
28:14 - Closing Remarks and Credits

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RESOURCES

VISTA Trial https://abstracts.mirrorsmed.org/abstracts/vista-phase-3-trial-vicinium-epcam-targeted-pseudomonas-exotoxin-bcg-unresponsive-non

BRIDGE Trial
https://pmc.ncbi.nlm.nih.gov/articles/PMC10515442/

CORE-008 Trial
https://www.sciencedirect.com/science/article/abs/pii/S1078143924010147

GAIN Trial
https://pmc.ncbi.nlm.nih.gov/articles/PMC10176900/

For the first time in history, a human bladder was transplanted. Dr. Nima Nassiri (UCLA) joins Dr. Ruchika Talwar to share how his team completed this landmark operation alongside a kidney transplant. He walks through the clinical scenario, key steps in donor and recipient selection, and how years of preclinical work informed the operative approach.

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SYNPOSIS

The conversation explores the broader future of bladder transplant surgery, from ethical considerations to the potential for merging bladder transplantation with tolerance-induction protocols that could one day eliminate the need for lifelong immunosuppression. Dr. Nassiri reflects on the importance of patient-first decision-making, teamwork, and careful innovation as the field moves toward new possibilities in restorative urology and transplant medicine.

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TIMESTAMPS

00:00 - Introduction
02:51 - The Path to Bladder Transplant Surgery
05:00 - Scientific Challenges and Barriers
06:45 - Patient Selection and Initial Outcomes
12:28 - Quality of Life Considerations
14:18 - Performing the First Bladder Transplant
18:59 - Donor Matching
21:28 - Ethical Considerations
24:51 - Research Gaps and Future Prospects

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RESOURCES

Clinical Trial: Vascularized Composite Bladder Allograft Transplantation
https://www.clinicaltrials.gov/study/NCT05462561

Clinical Trial: Retro-active Immunological Tolerance in Patients With Well-functioning Pre-existing HLA-identical Kidney Transplants
https://clinicaltrials.gov/study/NCT05525507

With the right protocols (and the right team!), urology clinics can proactively manage the side effects of intravesical therapy. This in-studio episode from the 2025 NMIBC Creator Weekend™ series features unique perspectives from Vanderbilt nurse practitioner Meredith Donahue and surgical neuro-oncology nurse Brynn Moore, both with focuses in urologic oncology. Hosted by Dr. Ruchika Talwar, we cover the practical and logistical considerations in intravesical therapy administration.

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This podcast is supported by:
Ferring Pharmaceuticals

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SYNPOSIS

Donahue and Moore share their experiences with intravesical therapy, discussing practical issues such as patient management, scheduling, and handling side effects. They emphasize the importance of creating a supportive environment in clinics, proactive treatment plans, and ensuring effective communication among the multidisciplinary team. They also share resources and tips for nurses and nurse practitioners new to urologic oncology.

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TIMESTAMPS

00:00 - Introduction
07:09 - Multidisciplinary Team Dynamics
11:34 - Resources for Patients
18:55 - Transvaginal Estrogen Cream
26:56 - Optimizing Intravesical Therapy Clinics
35:57 - The Importance of Multidisciplinary Collaboration
36:27 - Conclusion