In this episode, host Dr. Aditya Bagrodia speaks with guests Dr. C.J. Stimson and Dr. Ruchika Talwar from Vanderbilt University about the relationship between physicians and big business in modern healthcare.

First, the doctors discuss significant transformation in the healthcare sector, with multiple corporations like Amazon, Walmart, and Best Buy entering the healthcare realm. Although earlier practices were physician-centric, the evolving trends show an inclination towards a more consumer-centric approach focusing on efficiency and value. The guests share their views on the necessity of doctors asserting their role in the changing landscape, emphasizing the importance of the doctor-patient relationship. The conversation also addresses innovations in the field such as value-based arrangements that prioritize patient experience while reducing costs.

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SHOW NOTES

00:00 - Understanding Market Dynamics in Urology

02:18 - The Role of Big Corporations in Healthcare

07:14 - The Shift from Doctor-Centric to Patient-Centric Care

13:07 - The Commodification of Healthcare Services

19:36 - The Future of Healthcare: Vertical Integration

21:22 - The Impact of Value-Based Care on Healthcare

29:28 - The Role of Employers in Healthcare

41:50 - The Future of Healthcare: An Optimistic Outlook

This week on BackTable Urology, urologic oncologist Dr. Bogdana Schmidt (University of Utah) hosts a discussion with medical oncology experts Dr. Rana McKay (UC San Diego) and Dr. Neeraj Agarwal (University of Utah) on recent clinical trials from bladder, kidney, and prostate cancer research presented at the 2023 European Society for Medical Oncology (ESMO) Meeting.

First, they discuss impactful data regarding bladder cancers, specifically the CheckMate 901 and the EV-302 trials which show improvement in overall survival and promise for urothelial carcinoma patients’ quality of life. The conversation moves onto kidney-specific trials such as the LITESPARK-005, which offers improved progression-free survival for patients through the use of belzutifan. The panel rounds off by discussing the progress made in prostate-specific trials with emphasis on the EMBARK and SPLASH trials involving Lutetium therapy. Finally, the doctors discuss the trend towards personalized treatment plans based on the unique goals and health requirements of the patients.

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SHOW NOTES

00:00 - Discussion on Urothelial Carcinoma: CheckMate 901 and EV-302

11:22 - Discussion on Kidney Cancer: LITESPARK-005

23:53 - Discussion on Prostate Cancer: EMBARK

31:41 - Discussion on Prostate Cancer: SPLASH vs PSMA

36:39 - Future Directions for Lutetium Therapy for Prostate Cancer

37:50 - Closing Remarks and Future Expectations

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RESOURCES

CheckMate 901 Trial Investigators. Nivolumab plus Gemcitabine-Cisplatin in Advanced Urothelial Carcinoma.

https://www.nejm.org/doi/full/10.1056/NEJMoa2309863

LBA6 EV-302/KEYNOTE-A39: Open-label, randomized phase III study of enfortumab vedotin in combination with pembrolizumab (EV+P) vs chemotherapy (Chemo) in previously untreated locally advanced metastatic urothelial carcinoma (la/mUC).

https://www.sciencedirect.com/science/article/pii/S0923753423042709

LBA88 Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): Randomized open-label phase III LITESPARK-005 study.

https://www.sciencedirect.com/science/article/pii/S0923753423042345

LBA02-09 EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-risk Biochemically Recurrent Prostate Cancer.

https://pubmed.ncbi.nlm.nih.gov/37119051/

177Lu-Labeled Prostate-Specific Membrane Antigen Radioligand Therapy of Metastatic Castration-Resistant Prostate Cancer: Safety and Efficacy.

https://pubmed.ncbi.nlm.nih.gov/26795286/

In this episode, Dr. Wayne Kuang (MD for Men LLC in Albuquerque, NM) discusses his initiative to redefine the benign prostatic hyperplasia (BPH) care pathway for patients, doctors, and the healthcare industry.

One of his main focuses is to prioritize bladder health and end the polypharmacy approach to BPH. Dr. Kuang also introduces the 5 Stages of Bladder Health, emphasizing the risks if BPH is not treated effectively and earlier. He underlines the importance of strategic treatment planning based on detailed data collection of the patient’s prostate and bladder health. Dr. Kuang also examines different surgical and medical treatments for BPH. He ends the episode by explaining the Man vs. Prostate initiative and the significant global impact of his advocacy.

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SHOW NOTES

00:00 - Introduction

02:01 - The Impact of BPH on Patients

05:57 - The Importance of Bladder Health

10:38 - The Five Stages of Bladder Health

23:00 - The Role of Primary Care Physicians in BPH Treatment

26:03 - The Role of Medications in Treating BPH

34:06 - The Role of Urologists in BPH Treatment

39:07 - The Importance of Personalized Therapy in BPH Treatment

44:17 - The Man vs. Prostate Initiative

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RESOURCES

Dr. Wayne Kuang on LinkedIn

https://www.linkedin.com/in/wayne-kuang-md/

Man vs. Prostate

https://www.manvsprostate.com/

In this episode, host Dr. Suzette Sutherland is joined by Dr. Kelly Casperson, a urologist who specializes in women’s sexual health, to discuss the importance of education, therapy, and hormone replacement in female sexual health.

They explore topics such as the role of estrogen and testosterone in women’s sexual desire, FDA-approved medications for hypoactive sexual desire disorder, and the importance of sex education and communication within relationships. They also highlight the topic of gender inequality in sexual health care delivery and the lack of clinical resources specifically tailored to women’s needs. In sum, they aim to provide a deeper understanding of female sexual health and offer strategies for practitioners to provide more effective care.

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SHOW NOTES

00:00 - Introduction

05:53 - The Role of Urologists in Women’s Sexual Health

07:18 - The Importance of Communication in Addressing Sexual Dysfunction

10:23 - The Role of the Clitoris in Female Orgasm

19:52 - Understanding the Hormones Behind Female Sexual Desire

25:32 - The Misconceptions and Gender Bias Surrounding Hormones

26:04 - The Role of Testosterone in Menopause and Sexual Desire

30:02 - The Challenges of Commercially Available Testosterone Products

32:52 - Non-Hormonal Treatments for Low Libido

42:41 - The Importance of Referring to Sex Therapists and Other Resources

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RESOURCES

Dr. Kelly Casperson’s Website

https://kellycaspersonmd.com/

You Are Not Broken Podcast

https://kellycaspersonmd.com/you-are-not-broken-podcast/

“You Are Not Broken” by Kelly Casperson

https://kellycaspersonmd.com/you-are-not-broken-book/

“Magnificent Sex” by Peggy Kleinplatz

https://www.amazon.com/Magnificent-Sex-Lessons-Extraordinary-Lovers/dp/0367181371

American Association of Sexuality Educators, Counselors, and Therapists

https://www.aasect.org/

In this episode, Dr. Suzette Sutherland and Dr. Alana Desai from the University of Washington discuss the management of urinary tract stones in pregnant patients, considerations for ureteroscopy, and consequences of radiation exposure in the fetus.

First, the doctors underscore the importance of ultrasound as the first line imaging modality to minimize fetal exposure to radiation. Dr. Sutherland and Dr. Desai also delve into nausea and pain management options, recommended diets for prevention of stone formation during pregnancy, and the necessity of involving a multidisciplinary team in such cases. The episode concludes with a remarkable case study from Dr. Desai’s experience.

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SHOW NOTES

00:00 - Introduction

02:06 - Incidence and Risk Factors of Kidney Stones in Pregnancy

03:29 - Physiological Changes and Stone Formation in Pregnancy

07:04 - Diagnosing Kidney Stones in Pregnancy

13:08 - Expectant Management vs. Intervention

14:41 - Managing Pain and Nausea in Pregnant Patients with Kidney Stones

17:13 - Decompression Methods for Kidney Stones in Pregnancy

23:13 - Ureteroscopy as a Preferred Intervention

26:05 - Case Description from Dr. Desai

30:04 - Considerations for Ureteroscopy in Pregnant Patients

31:14 - Preventing Kidney Stones in Pregnancy

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RESOURCES

Lyon, M., Sun, A., Shah, A., Llarena, N., Dempster, C., Sivalingam, S., Calle, J., Gadani, S., Zampini, A., & De, S. (2023). Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology, 182, 61–66. https://doi.org/10.1016/j.urology.2023.09.023

Thongprayoon, C., Vaughan, L. E., Chewcharat, A., Kattah, A. G., Enders, F. T., Kumar, R., Lieske, J. C., Pais, V. M., Garovic, V. D., & Rule, A. D. (2021). Risk of Symptomatic Kidney Stones During and After Pregnancy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 78(3), 409–417. https://doi.org/10.1053/j.ajkd.2021.01.008

In this episode, Dr. Aditya Bagrodia (UC San Diego), Dr. Lindsay Hampson (UC San Francisco) and Dr. Gina Badalato (Columbia University) discuss the impact of the COVID-19 pandemic on urology education.

They discuss the conception and impact of virtual lecture series like EMPIRE and Urology COVID on residents’ education. They also underline how being adaptive and open to change can help residents shape the future of their own learning. The doctors also explain how resident-led and resident-focused educational resources came into existence, and what more is envisioned for education in urology. The episode ends with a discussion about unmet needs in education and the significance of diverse perspectives in teaching surgical procedures.

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SHOW NOTES

00:00 - Introduction

01:15 - Reflections on Urology Education and Early Career Experiences

04:08 - The Evolution of Learning and Engagement in Medical Training

07:55 - Transitioning from Medical School to Residency

08:34 - The Creation of the Intern Academy for the American Urological Association

14:24 - The Impact of COVID-19 on Virtual Learning

16:12 - The Role of Residents in Virtual Learning

19:24 - The Future of Virtual Learning and Education

20:00 - The Role of Innovation and Adaptability in Education

23:07 - The Role of Residents in Shaping Their Own Learning

42:28 - The Future of Education in Urology

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RESOURCES

AUA Intern Academy

https://auau.auanet.org/content/intern-academy-2023

AUA EMPIRE Lecture Series

https://nyaua.com/empire/

UCSF Urology Collaborative Online Virtual Didactics (COViD) Lecture Series

https://urologycovid.ucsf.edu/

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/