BackTable Urology

Physical performance, recovery, longevity–are these outcomes part of your urology practice? In this episode of BackTable Urology, Dr. Vonda Wright, a renowned orthopedic surgeon and expert in aging and longevity, joins Dr. Amy Pearlman to discuss the intersection of surgical practice, longevity medicine, and patient-centered healthcare in urology.

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SYNPOSIS

The discussion covers the significance of whole-person care in surgery and the critical role of empathy in surgical practice. Dr. Wright shares her experiences from her extensive career and research, including her innovative work in hip arthroscopy and advocacy for performance-based care for middle-aged patients. The surgeons also explore the impact of hormonal health on physical performance and quality of life, the value of tailored exercise and nutrition plans, and practical strategies for optimizing long-term vitality in both men and women. Dr. Wright emphasizes the need for healthcare professionals to lead by example in prioritizing their own well-being while staying informed on emerging science that supports longevity and quality of life.

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TIMESTAMPS

00:00 - Introduction
13:50 - Urology Applications in Orthopedics
24:18 - Optimizing Longevity and Lifestyle
29:08 - Musculoskeletal Syndrome of Menopause
42:12 - Approach to Protein Intake and Supplements
50:48 - Practicing Longevity Medicine
53:26 - Final Thoughts

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RESOURCES

Unbreakable: A Woman’s Guide to Aging with Power by Dr. Vonda Wright:
https://www.drvondawright.com/resources/books/unbreakable

Is one outdated warning label standing between millions of women and safe, effective care? In this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, a urologist specializing in female pelvic medicine and reconstructive surgery at UC San Diego, joins host Dr. Suzette Sutherland to discuss the black box warning on vaginal estrogen, its historical context, and the ongoing advocacy efforts to update outdated FDA guidelines.

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SYNPOSIS

The conversation covers the importance of low-dose vaginal estrogen in treating genitourinary syndrome of menopause (GSM), the fear surrounding hormone therapy due to misinterpreted data from the Women's Health Initiative (WHI) study, and the inequities faced in women's health, particularly in the context of hormone replacement therapies. They discuss the legislative and advocacy strategies needed to enact change, emphasizing the role of professional societies, legislative efforts, patient advocacy, and industry support in overcoming the barriers to updating the black box warning.

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TIMESTAMPS

00:00 - Introduction
03:43 - History Behind the Estradiol Black Box Warning
13:44 - The FDA Citizen Petition
18:18 - Gender Inequity in Medicine
24:05 - The Role of Organizational Guidelines in Patient Advocacy
28:51 - Vaginal Estrogen for Genitourinary Syndrome of Menopause (GSM)
32:57 - Medicare Spending and Legislative Advocacy
44:56 - Recap and Future Directions

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RESOURCES

(TRAVERSE Trial) Cardiovascular Safety of Testosterone-Replacement Therapy
https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
https://doi.org/10.1093/jnci/djac112

(ASCO Study) Use of local estrogen therapy among breast cancer patients in SEER-MHOS database
https://doi.org/10.1200/JCO.2025.43.16_suppl.578

Vaginal estrogen use in breast cancer survivors: a systematic review and meta-analysis of recurrence and mortality risks
https://doi.org/10.1016/j.ajog.2024.10.054

Have we been wrong about testosterone and prostate cancer all along? In this episode of BackTable Urology, Dr. Abraham Morgentaler, who pioneered the modern use of testosterone therapy, joins Dr. Amy Pearlman to discuss the evolving understanding of testosterone therapy in clinical practice and its implications on patient care.

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SYNPOSIS

Dr. Morgentaler shares insights from his decades-long career, including his pivotal research that refuted the presumed harms of testosterone therapy and belief that it contributes to the development of prostate cancer. The conversation explores the evolution of testosterone therapy, its misunderstood role in prostate cancer, and the need for broader clinical recognition of testosterone deficiency. The discussion also explores potential future applications of testosterone therapy, including its role in perioperative optimization and the growing need for nuanced, evidence-based guidelines in men’s health care.

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TIMESTAMPS

00:00 - Introduction
08:45 - The Evolution of Testosterone Therapy
20:10 - Challenging Conventional Wisdom on Testosterone
34:04 - Reevaluating Testosterone and Prostate Cancer
51:20 - Testosterone and Prostate Cancer Recurrence
55:44 - Managing Testosterone Therapy in Prostate Cancer Patients
01:12:45 - Final Thoughts

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RESOURCES

The Sex Doctors:
https://www.amazon.com/The-Sex-Doctors/dp/B0DCJQ5B5Q

Often misunderstood as end-of-life care, palliative care is actually about improving quality of life at any stage of serious illness. In this episode of BackTable Urology, Dr. Ashwin Kotwal, a geriatrician and palliative care physician at UCSF, and Dr. Pauline Filippou, a urologic oncologist at Kaiser Permanente in Northern California join hosts Dr. Gina Badalato and Dr. Lindsay Hampson to discuss the importance of palliative care in the field of urology.

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SYNPOSIS

The episode covers how palliative care can improve quality of life for patients with serious illnesses, the challenges and opportunities of integrating palliative care into urology practice, and specific training resources and frameworks for effective communication and symptom management. From addressing common misconceptions to providing practical advice on implementing palliative care, this episode is an essential guide for trainees and urology professionals looking to deepen their understanding of palliative care and enhance their practice.

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TIMESTAMPS

00:00 - Introduction
03:04 - Understanding Palliative Care
04:43 - Misconceptions and Communication Strategies
07:45 - Integrating Palliative Care in Urology
10:26 - Collaborative Approaches and Multidisciplinary Teams
15:48 - Training and Education for Trainees
20:25 - Effective Communication Techniques
28:18 - Impact of Palliative Care
34:33 - Final Thoughts and Takeaways

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RESOURCES

Center to Advance Palliative Care website:
https://www.capc.org/

AUA White Paper:
https://www.auanet.org/documents/guidelines/white%20papers/postoperative.pdf

VitalTalk:
https://www.vitaltalk.org/

Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters:
https://link.springer.com/article/10.1007/s11606-018-4540-5

Family Meetings on Behalf of Patients with Serious Illness:
https://www.nejm.org/doi/full/10.1056/NEJMvcm1913056

Prostate biopsy is evolving rapidly, offering urologists more precision - but also more decisions. In this episode of BackTable Urology, Dr. Ricardo Sánchez-Ortiz, a pioneer in robotic surgery and neuro-urology in Puerto Rico, joins host Dr. Jose Silva to discuss the shifting landscape of prostate biopsy and emerging strategies that improve accuracy and personalize care.

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SYNPOSIS

The conversation explores the transition from transrectal to transperineal prostate biopsy, emphasizing the role of PSA density and modern imaging in refining patient selection. Dr. Sánchez-Ortiz highlights the value of biomarkers in improving diagnostic accuracy and focal therapy as a promising, less invasive treatment option.
Beyond clinical innovations, the doctors also discuss the importance of communication in urology practice. Dr. Sánchez-Ortiz shares how tools like WellPrept can enhance patient education and engagement, reinforcing the need for individualized care strategies in an increasingly complex diagnostic landscape.

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TIMESTAMPS

00:00 - Introduction
02:14 - Evolution of Prostate Biopsy Methods
17:51 - Transperineal vs. Transrectal Approaches
22:52 - Use of Sedation
35:10 - PSA Screening
41:48 - Rise in Metastatic Prostate Cancer
50:44 - Potential of Focal Ablation
55:58 - Use of WellPrept

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RESOURCES

WellPrept:
https://www.wellprept.com/

Is your patient’s sexual dysfunction an early indicator of serious cardiovascular disease? In this episode of BackTable Urology, Dr. Amy Pearlman teams up with preventative cardiologist Dr. Dapo Iluyomade to discuss the relationship between erectile dysfunction (ED) and cardiovascular disease, and the holistic approach needed to prevent both of these chronic conditions from worsening.

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SYNPOSIS

Dr. Iluyomade shares his preventive cardiology workup, the significance of lipid panels, and advanced diagnostics. They also explore the effects of common cardiovascular medications like beta blockers on sexual health and address common concerns related to testosterone and hormone therapies in both men and women. The conversation underscores the importance of interdisciplinary collaboration between urology and cardiology for optimal outcomes in patients with sexual dysfunction.

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TIMESTAMPS

00:00 - Introduction
01:52 - The Intersection of Cardiology and Urology
03:43 - Understanding Preventive Cardiology
07:56 - Patient Risk Stratification and Workup
16:35 - Cardiovascular Health in Women
20:07 - Testosterone Therapy and Cardiovascular Risk
26:39 - Hormone Replacement Therapy in Men and Women
36:09 - Beta Blockers and Sexual Dysfunction
42:36 - Diuretics and Sexual Health
48:57 - A Message to Urologists from a Cardiologist

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RESOURCES
TRAVERSE Trial Results: https://www.nejm.org/doi/full/10.1056/NEJMoa2215025

Menopause isn’t just a diagnosis—it’s a transition, and the way we treat it needs to change. Dr. Kelly Casperson joins Dr. Suzette Sutherland in this urogynecology crossover episode of BackTable to challenge outdated beliefs about menopause and hormone replacement therapy (HRT). They revisit the impact of the 1990s Women’s Health Initiative (WHI) study and explain how its findings—especially around synthetic hormones—were widely misinterpreted and continue to adversely influence patient and provider decisions today.

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SYNPOSIS

Dr. Casperson breaks down the differences between the hormones used in WHI and the safer, more targeted options available today. The conversation explores the broad benefits of modern HRT, including reduced risks of cardiovascular disease, osteoporosis-related fractures, and even dementia. Beyond the science, the episode also addresses the urgent need for better medical education and updated guidelines around menopause care.
Dr. Casperson and Dr. Sutherland make the case for empowering patients through informed consent and better clinician training. They also discuss Dr. Casperson’s upcoming book, The Menopause Moment, which aims to equip women with the tools and knowledge to navigate this life stage with confidence.

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TIMESTAMPS

00:00 - Introduction
02:50 - Focus on Menopause and Hormone Replacement Therapy
04:20 - The Women's Health Initiative (WHI) Study
05:39 - Understanding Risks and Misconceptions
12:43 - Reevaluation of the Women’s Health Initiative Study
18:31 - Impact of Media and Physician Education
19:58 - Current State of Hormone Therapy
22:17 - Broader Implications and Future Directions
27:17 - Evaluating FDA Warnings and Gender Bias in Hormone Treatments
29:49 - The Impact of Hormone Therapy on Women's Health
32:11 - Risks of Not Using Hormones
35:44 - Hormones and Brain Health: Debunking Myths
40:41 - The Timing Hypothesis and Long-Term Hormone Use
46:32 - Advocacy and Education for Menopause Awareness
48:04 - Conclusion and Upcoming Resources

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RESOURCES

PBS: The M Factor: Shredding the Silence on Menopause:
https://www.pbs.org/show/the-m-factor-shredding-the-silence-on-menopause/

The Menopause Moment by Dr. Kelly Casperson: https://kellycaspersonmd.com/the-menopause-moment-book/

Systematic review and meta-analysis of the effects of menopause hormone therapy on risk of Alzheimer's disease and dementia:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/

With BCG in short supply and recurrence rates still high, the race is on for better intravesical options. In this episode of BackTable Tumor Board, Dr. Lindsey Herrel, urologic oncologist at the University of Michigan, joins Dr. Ruchika Talwar to explore the evolving landscape of intravesical therapy for intermediate risk bladder cancer.

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This podcast is supported by an educational grant from UroGen Pharma. UGN-102 was approved by the FDA on June 12, 2025.

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SYNPOSIS

The doctors break down the nuances of defining this risk category and the clinical gray zones that complicate treatment decisions. Dr. Herrell shares her patient-centered approach to surveillance and therapy, and introduces promising new agents, including Anktiva, UGN-102, and the gemcitabine-releasing TAR-200 "pretzel" device. The discussion also highlights how advances in molecular profiling are reshaping care strategies.
This episode underscores the urgent need for clearer guidelines and continued innovation to improve outcomes and quality of life for patients with this nuanced disease subtype.

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TIMESTAMPS

00:00 - Introduction
02:03 - Defining Intermediate Risk Bladder Cancer
06:12 - Intravesical Therapy Options
08:47 - Quality of Life and Patient Counseling
10:18 - New Treatments on the Horizon
12:56 - Practical Tips for TURBT Recovery
17:03 - In-Office Procedure Management
21:38 - Managing Symptoms and Quality of Life
31:50 - A Note on Smoking Cessation
33:37 - Conclusion and Future Directions

Global medical missions bring unique challenges and powerful rewards—something Dr. Spencer Hiller and Dr. Kenneth Peters know firsthand. In this episode of BackTable Urology, they join host Dr. Jose Silva to reflect on their work in global health, focusing on their surgical missions to Zambia to treat complex urologic conditions, including vesicovaginal fistula, and a variety of general urologic cases.

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SYNPOSIS

The discussion covers the origins and evolution of their missions, the preparation required for high-volume surgical trips, and the clinical impact on both patients and participating healthcare providers. Dr. Peters and Dr. Hiller detail the logistical and financial hurdles involved, the emphasis on sustainable care models, and their strategies for fundraising. They also emphasize the value of cultural immersion and the long-term goal of establishing educational and medical infrastructure within the communities they serve.

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TIMESTAMPS

00:00 - Introduction
01:23 - The Mission to Africa: How It All Began
02:32 - Challenges and Logistics of Medical Missions
06:02 - Resident Involvement and Impact
09:10 - Preparation and Experiences in Africa
11:38 - Overcoming Obstacles: Supplies and Customs
19:18 - Types of Procedures and Medical Work in Africa
21:45 - Upgrading Equipment and Training Local Staff
28:28 - Daily Operations and Patient Management
31:00 - Post-Trip Activities and Community Engagement
34:26 - Funding and Sustainability Efforts
40:31 - Personal Reflections and Future Plans

Counseling patients with intermediate-risk non-muscle invasive bladder cancer can be complex, with a wide range of treatment options and care pathways. In this episode of BackTable Urology, urologic oncologists Dr. Ruchika Talwar and Dr. Kelly Bree explore how to approach this challenge with clarity and compassion.

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This podcast is supported by an educational grant from UroGen Pharma. UGN-102 was approved by the FDA on June 12, 2025.

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SYNPOSIS

They emphasize a shift toward patient-centered, less aggressive treatment strategies, highlighting the importance of quality of life in clinical decision-making. The discussion includes risk stratification, the use of intravesical gemcitabine, and ongoing clinical trials. Dr. Bree also offers actionable tips for optimizing patient preparation and recovery. This episode underscores the growing importance of listening to patient voices to shape future standards of care.

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TIMESTAMPS

00:00 - Introduction and Overview
02:09 - Risk Stratification and Treatment Approaches
06:12 - Intravesical Therapy Options
08:47 - Quality of Life and Patient Counseling
12:56 - Practical Tips for TURBT Recovery
17:03 - In-Office Procedures and Patient Management
21:23 - Resources and Support for Patients
24:13 - Future Directions and Final Thoughts

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RESOURCES

Society of Urologic Oncology
https://suonet.org/home.aspx