BackTable Urology

This week on BackTable Urology, Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the diagnosis and treatment of genitourinary syndrome of menopause (GSM) with vaginal estrogen.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aj8lvI---SHOW NOTESGSM is not only a condition of "vaginal dryness", but rather a multi-faceted symptom set including pain with sitting, urinary frequency and urgency, bladder pain, opioid use, and recurrent UTIs. First, the doctors discuss the myths and misconceptions about the use of estrogen creams, suppositories, and rings to treat GSM . However, Suzette and Rachel also discuss the importance of advocating against the misrepresentation of vaginal estrogen in box labeling. They conclude that the benefits of using a low-dose vaginal estrogen far outweigh the risks, and doctors should advocate for better labeling and understanding of this treatment.Suzette and Rachel also discuss the American Urologic Association (AUA) guidelines for GSM and its importance. Systemic hormone therapy is rarely enough to address GSM symptoms, so screening for GSM symptoms is essential. They also talk about estrogen therapy for special patients, such as those on hormone replacement therapy (HRT) and cancer survivors. Suzette and Rachel emphasize the importance of understanding the general hormone fluctuations of patients particularly oral contraceptives, those with disordered eating, those who are breastfeeding, and those who are transgender. They end the episode by encouraging the production of more research and data to back up treatment options for GSM in premenopausal women.---RESOURCESWellPrepthttps://wellprept.com/Femringhttps://www.femring.com/

This week on BackTable Urology, Dr. Aditya Bagrodia, Dr. Ashley Winter, and Dr. Jennifer Anger explore truths and myths about women’s health topics, covering pelvic floor health, sexual health, and postpartum care.---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/yaRhyX---SHOW NOTESFirst, the doctors discuss aging and the role and safety of hormone replacement therapy. They stress the importance of educating urologists on the risks of estrogen and progesterone, as unopposed estrogen can cause endometrial cancer.Next, they discuss how pregnancy-related health changes. Ashley shares her first-hand experience on urologic, sexual, and hormonal health during and after her pregnancy. New symptoms, such as increased urgency and frequency during pregnancy, hot flashes, hair loss, and vaginal dryness, may arise during and after pregnancy. Then, they discuss the options women have for delivery, including cesarean section, and the need for pre-birth counseling.Additionally, they discuss general women’s health topics that are often stigmatized, such as vaginal prolapse and vaginal odors. Different treatment options available for prolapse, such as pessaries. Then, they explore the complexities of vaginal odors, which may point to a dietary or infectious cause. Finally, the doctors conclude the episode by debunking myths about hygiene, UTIs, and vaginal rejuvenation.---RESOURCESWellPrepthttps://wellprept.com/“A Woman’s Guide to Her Pelvic Floor” by Jennifer Anger MD, Karyn Eilber MD, and Victoria Scott MDhttps://www.amazon.com/Womans-Guide-Her-Pelvic-Floor/dp/B0BXND9896

This week on BackTable Urology, Dr. Aditya Bagrodia and Dr. Dharam Kaushik, a urologic oncologist from Houston Methodist Hospital, discuss the impact of yoga on their lives in preventing burnout and encouraging compassion.---SHOW NOTESFirst, Dharam shares how he discovered yoga and how it has been beneficial to his health. He discusses his journey to becoming a certified yoga teacher and the importance of prioritizing time for it with a family. He also considers how this can be a struggle for female colleagues as they strive to balance work and home life based on societal expectations.Then, the doctors emphasize the significance of self-care for healthcare workers and its effects on their physical and mental health. They discuss how a few minutes of box breathing can help reduce stress and enable more mindful reactions to difficult circumstances. Breath work can be used to anchor feelings of calm and relaxation, and yoga can be used to target specific muscles used in robotic surgery.Next, Aditya and Durham discuss the importance of incorporating stretching and yoga into one's daily routine. They summarize different yoga poses for healthcare workers, including the Warrior poses, Airplane Pose, Runner's Lunge, Cobra Pose, Locust Pose, and many more.---RESOURCESWellPrepthttps://wellprept.com/

This week on the BackTable Urology Podcast, Dr. Jose Silva discusses sexual health with Dr. Arthur “Bud” Burnett, professor of urology at John Hopkins University, with an emphasis on the importance of preventative medicine in improving sexual health and different treatments for erectile dysfunction.---SHOW NOTESFirst, Bud and Jose explore the various treatments available for patients with erectile dysfunction (ED). They not only discuss how oral drugs can be used to treat the majority of patients, but also how to manage a young patient with a single episode of ED. Furthermore, they evaluate the safety of these oral drugs and the alternatives, such as injections, rings, and vacuum erection device therapy.Next, they note the important role of testosterone replacement therapy (TRT) in improving sexual health for prostate cancer survivors. They also delineate various modalities of testosterone replacement therapy such as gels, injectables, and pellets, and their safety profiles. They both agree that it is important to follow guidelines and monitor patients who are on TRT. Additionally, they note the prevalence of Peyronie's Disease, and the psychological implications the condition can have on men.The doctors then move onto the topic of priapism, a condition where a man experiences an erection for a prolonged period of time. They explore the potential causes of the disorder, the treatments available, and the potential therapies that may help prevent it from occurring. Finally, Dr. Burnett also shares his journey to writing his book, The Manhood Rx, in order to provide men with a comprehensive resource to improve their sexual health and overall wellness.---RESOURCESThe Manhood Rx: Every Man's Guide to Improving Sexual Health and Overall Wellness by Arthur Burnetthttps://www.amazon.com/Manhood-Rx-Improving-Overall-Wellness/dp/1538166593WellPrepthttps://wellprept.com/

This week on the BackTable Urology Podcast, Dr. Bagrodia talks with Dr. Daniel Spratt, professor and chairman of radiation oncology at Case Western University in Cleveland, about the workup and treatment of high risk prostate cancer.---CHECK OUT OUR SPONSORVeracytehttps://www.veracyte.com/decipher---SHOW NOTESFirst, Dr. Spratt defines high risk prostate cancer and discusses how to evaluate non-specific PSMA PET findings. He notes the importance of standardized systems to avoid over-calling such findings and discusses the role of CT scans and MRI scans when necessary. Finally, the doctors emphasize the importance of synthesizing PSMA PET findings into their decision-making. Next, the doctors discuss the use of germline and genomic testing, specifically Decipher testing, to characterize the tumor. Germline testing can determine eligibility for neoadjuvant PARP inhibitor trials, and biomarkers have the potential to improve radiation therapy outcomes. Although they quickly summarize the NCCN guidelines, they also emphasize the importance of patient counseling to determine the right treatment plan.Then, the doctors move on to discuss the different radiation treatments available for treating high-risk prostate cancer, such as conventional fractionation, brachytherapy, and ultrahypofractionated radiotherapy. They also explain the use of protons in treating high-risk prostate cancer, which is difficult because of the lack of high-level evidence and financial benefit when using protons compared to conventional radiation treatments.Finally, they wrap up the episode by explaining the correlation between early PSA responses and the success of radiation therapy. Surgery and radiation are often used together in treating most cancers, and how combining both can cut down the chances of PSA recurrence.---RESOURCESVeracyte Decipher:https://decipherbio.com/

Dr. David Albala, chief of urology at Crouse Hospital, discusses the benefits of biomarkers in prostate cancer diagnosis. They explore the history of PSA testing and the importance of considering clinical risk factors. The use of urine and blood biomarkers to determine the need for biopsy is also discussed. The integration of the ExoDx Prostate Test and MRI in diagnosis is explained, highlighting the benefits and limitations. The significance of early diagnosis, screening, and advancements in patient care are emphasized.

In this episode of BackTable Urology, Dr. Bagrodia, program director Dr. Steve Hudak (UTSW) and resident doctor Dr. Theresa Olmstead (UC San Diego) discuss the tangible advice for having successful urology away rotations and crafting an outstanding urology residency application.---SHOW NOTESFirst, the doctors discuss advice for first and second-year medical students interested in urology. Students in the early stages of their medical journey should be honest and transparent with themselves and mentors about their interests, abilities, and goals. The removal of STEP 1 scores and other metrics has allowed students to determine if a specialty is right for them without the fear of being turned away. Connections, research, and opportunities for first and second year medical students are important, but taking the time to find a mentor who resonates with them and committing to projects that will help them move forward is also essential.Then, the doctors discuss the process of applying for away rotations and Theresa shares her experience of doing three away rotations. Additionally, they explain the job interview-like process of away rotations and how to best prepare for the process, like taking the time to understand and orient oneself in the situation. Both Theresa and Steve agree that punctuality, being oneself, and assessing program fit are very important.Next, the doctors share tangible advice on how to ask for stellar letters of recommendation, such as having tangible examples to share with letter writers, taking the time to talk to faculty ahead of time, and providing their curriculum vitae and personal statement. They also discuss the pros and cons of the signaling process. Finally, they give interview tips, such as having unique stories to share, and being concise and succinct when answering questions.

In this episode of BackTable Urology, Dr. Jose Silva and Dr. Suzette Sutherland, director of Female Urology at the University of Washington, discuss new therapies for overactive bladder (OAB).---CHECK OUT OUR SPONSORWellprepthttps://wellprept.com/---EARN CMEReflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/V7Flno---SHOW NOTESFirst, they describe the symptoms of OAB which include an increased frequency and urgency of urination, sometimes leading to urinary incontinence. Conservative measures include pelvic floor exercises, diet, and lifestyle changes. If patients fail conservative measures, urologists can prescribe anticholinergics. However,beta agonists are preferable because they do not cross the blood-brain barrier. Then. the doctors briefly chat about the use of these agents in Alzheimer disease patients as well, which may be dependent on insurance approval.Next, Dr. Sutherland summarizes surgical devices to treat OAB and the clinical trials supporting each of them. Sacral nerve neuromodulation is a device that has been on the market for years, but newer models that include fixed and rechargeable batteries are starting to become more available. Additionally, the Neuspera is a sacral nerve neuromodulation that operates wirelessly through Bluetooth. The doctors also compare the two existing models of sacral neuromodulation (Medtronic vs. Axonics).One newer surgical treatment is tibial nerve stimulation, and Dr. Sutherland summarizes her placement technique, voltage settings, intraoperative testing, and the importance of a healthy ankle evaluation prior to placing the device. promising results, in-office, sedation, healthy ankle evaluation. She also notes that repositioning the leads in sacral and tibial neuromodulation in a followup visit may be necessary. Finally, she shares about Fempulse, vaginal stimulator mimicking a pessary, that is still being tested in research trials.---RESOURCESWellprept​​https://wellprept.com/

In this episode of BackTable Urology, Dr. Bagrodia and urologic oncologist Dr. Piyush Agarwal (University of Chicago) discuss the impact of music to keep them focused and set the mood in the OR.---CHECK OUT OUR SPONSORWellprepthttps://wellprept.com/---SHOW NOTESFirst, the doctors explore different types of music that can be used in the OR to help set a certain tone or rhythm for a procedure. They discuss the use of Bollywood, classic rock, show tunes, EDM, R&B, lo-fi, as well as other music genres to help create a more enjoyable OR environment. They also touch on the importance of having the right crew to enjoy music in the OR, as well as the humorous associations that some surgeons have with certain music. Dr. Agarwal then explains why Apple Music and Spotify are his preferred platforms for streaming music in the OR. Additionally, they look at the power of sharing playlists on Spotify to create a community.Finally, they discuss the importance of engaging the team in the OR and encouraging other members to contribute to the music selection. They end the episode by exploring how nostalgic music can bring back fond memories of childhood and lift the spirits of everyone in the OR.

In this episode of BackTable Urology, Dr. Jose Silva, radiation oncologist Dr. Neil Mariados, and urologic oncologist Dr. Dan Welchons discuss techniques and benefits of rectal spacing for radiation therapy in prostate cancer patients.---CHECK OUT OUR SPONSORBarrigelhttps://barrigel.com/---SHOW NOTESFirst, Dr. Mariados explains the need for rectal spacing in order to minimize the toxicities of prostate radiation. He then discusses the national rectal spacing trials (SpaceOAR and Barrigel) that he and Dr. Welchons participated in. The doctors also mention that most patients are interested in rectal spacing in order to minimize toxicities, but having a tumor with extracapsular extension is a contraindication of the procedure.Then, the doctors compare two rectal spacing products, SpaceOAR and Barrigel, in the context of setup and product materials. They explain the Barrigel technique, which is performed through the transperineal approach. Preoperatively, their patients receive Valium and oxycodone. After the surgery, the spacer can be visualized through a CT scan. Dr. Welchon also reflects on his process of learning the Barrigel procedure and the satisfaction that comes with helping patients avoid toxicities.The stability of Barrigel is 1 year. Most patients feel little to no discomfort after the procedure, and the doctors do not prescribe any postoperative antibiotics. The most serious complication of rectal wall spacing is rectal wall invasion, which occurs after incorrect product placement. However, the doctors discuss ways to avoid this complication, like using tactile feedback. They also emphasize the similarities between rectal spacing technique and transperineal prostate biopsies. Finally, they emphasize the importance of publications and education to avoid misunderstanding and myths about rectal spacing.---RESOURCESBarrigel Rectal Spacerhttps://barrigel.com/