BackTable Urology

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. --- This podcast is supported by:Ferring Pharmaceuticals --- 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. --- TIMESTAMPS 00:00 - Introduction05:52 - Upper Tract Positive Cytology Dilemma09:10 - Cystectomy Considerations15:55 - Developing Better Patient-Reported Outcomes20:26 - Challenges with New Therapeutics26:31 - Deescalating Treatment for Low-Grade Cancer33:29 - Closing Remarks --- RESOURCES CISTO Trialhttps://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. --- 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. --- TIMESTAMPS 0:00 - Introduction3:29 - Current State of OR Waste20:09 - Strategies to Reduce Waste24:52 - Impact of Climate Change on Patients33:55 - Future Directions40:27 - 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. --- This podcast is supported by:Ferring Pharmaceuticals --- 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. --- TIMESTAMPS 00:00 - Introduction02:08 - Case Study: Initial Patient Assessment04:59 - Surgical Considerations and Techniques10:22 - Managing Bladder Cancer Recurrence11:15 - Treatment Options and Clinical Trials15:12 - Advanced Treatment Strategies28:14 - Closing Remarks and Credits --- RESOURCES VISTA Trial https://abstracts.mirrorsmed.org/abstracts/vista-phase-3-trial-vicinium-epcam-targeted-pseudomonas-exotoxin-bcg-unresponsive-non BRIDGE Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10515442/ CORE-008 Trialhttps://www.sciencedirect.com/science/article/abs/pii/S1078143924010147 GAIN Trialhttps://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. --- 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. --- TIMESTAMPS 00:00 - Introduction02:51 - The Path to Bladder Transplant Surgery05:00 - Scientific Challenges and Barriers06:45 - Patient Selection and Initial Outcomes12:28 - Quality of Life Considerations14:18 - Performing the First Bladder Transplant18:59 - Donor Matching21:28 - Ethical Considerations24:51 - Research Gaps and Future Prospects --- RESOURCES Clinical Trial: Vascularized Composite Bladder Allograft Transplantationhttps://www.clinicaltrials.gov/study/NCT05462561 Clinical Trial: Retro-active Immunological Tolerance in Patients With Well-functioning Pre-existing HLA-identical Kidney Transplantshttps://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. --- This podcast is supported by:Ferring Pharmaceuticals --- 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. --- TIMESTAMPS 00:00 - Introduction07:09 - Multidisciplinary Team Dynamics11:34 - Resources for Patients18:55 - Transvaginal Estrogen Cream26:56 - Optimizing Intravesical Therapy Clinics35:57 - The Importance of Multidisciplinary Collaboration36:27 - Conclusion

What does it take to save both life and function in a rapidly progressing infection? In this episode of BackTable Urology, Dr. Judith Hagedorn (University of Washington) joins Dr. George Koch (Ohio State University) to unpack the complexities of Fournier’s gangrene management. --- SYNPOSIS They discuss advances in surgical techniques like skin-sparing debridement and the value of high-volume centers for patient outcomes. They also explore the use of wound vacuums, the challenges related to testicular management, and the future of Fournier’s gangrene treatment, including early detection and better patient scoring systems. --- TIMESTAMPS 0:00 - Introduction3:04 - Evolution of Fournier’s Management7:50 - Management at High-Volume vs. Community Centers20:39 - Use of Wound Vacs27:03 - Testicular Management43:56 - Future Directions

As new genetic and AI-powered tools emerge for bladder cancer screening, are we getting closer to reducing the need for invasive cystoscopies? In part five of the 2025 BackTable NMIBC Creator Weekend™ series, host Dr. Vignesh Packiam engages in an insightful discussion with Dr. Sarah Psutka from the University of Washington and Dr. Katie Murray from NYU about the complexities and potential benefits of using biomarkers in non-muscle invasive bladder cancer (NMIBC). --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The conversation covers the current challenges of interpreting positive biomarkers without clinical correlates, the gold standard of biopsies, and the potential of various biomarkers such as urine cytology, FISH, and newer genomic tests like the Decipher Bladder Genomic Classifier. They also touch upon the role of AI in pathology, the cost implications of biomarkers, and how these tools might influence future clinical practices and patient decisions. The episode emphasizes the need for precision medicine, careful patient counseling, and the impact of false positives and negatives on both patients and healthcare providers. --- TIMESTAMPS 00:00 - Introduction05:25 - Challenges with Current Biomarkers08:10 - New Biomarkers and Genomic Classifiers21:10 - AI and Pathology in Bladder Cancer35:13 - Screening and Future Directions41:20 - Challenges and Future Directions in Bladder Cancer Surveillance57:51 - Conclusion --- RESOURCES DaBlaCa-15 Trialhttps://pubmed.ncbi.nlm.nih.gov/40280776/ Sam Chang CHAI Studyhttps://pubmed.ncbi.nlm.nih.gov/40514253/

Considering a reconstructive urology fellowship or already in the thick of it? This episode is for you. Dr. Rachel Mann (University of Minnesota) sits down with Dr. George Koch (Ohio State University) to discuss her journey in reconstructive urology and the mentors who shaped it. Together, they explore how creativity, adaptability, and mentorship fuel progress in this evolving subspecialty.---SYNPOSISDr. Mann also shares practical advice for residents and fellows who are planning their next steps in training. She reflects on how to identify the right fellowship, make the most of a unique learning year, and transition effectively into independent practice. The episode closes with a discussion of the future of reconstructive urology, including global health opportunities, the potential for dedicated transgender surgery fellowships, and the mindset required to continue evolving as a reconstructive surgeon.---TIMESTAMPS00:00 - Introduction03:01 - Training and Mentorship11:09 - The Evolution and Scope of Reconstructive Urology32:49 - The Future of Reconstructive Urology35:01 - Expanding Internationally38:24 - Rapid Fire Advice for Residents45:59 - Advice for Fellows---RESOURCESThe Trauma and Urologic Reconstructive Network of Surgeons (TURNS)https://www.turnsresearch.org/Optilume ROBUST III trialhttps://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.312RD-180 Suture Devicehttps://pubmed.ncbi.nlm.nih.gov/35070820/

Dr. Jason Hafron, a urologic oncologist and chief medical officer at Solaris Health, dives into the shifting landscape of prostate cancer screening. He discusses the limitations of traditional PSA tests and introduces innovative blood-based biomarkers like IsoPSA and 4Kscore. These advancements promise to enhance diagnosis and minimize unnecessary biopsies. Dr. Hafron also explores the potential of artificial intelligence to refine risk assessments and personalize patient management, showcasing a future where precision in prostate cancer detection is within reach.

With the introduction of checkpoint inhibitors into non-muscle invasive bladder cancer (NMIBC) management, who’s on point for planning, administering, and optimizing combination therapies? Is it still the urologist, or does medical oncology play a more significant role now than it did before? In this episode of the BackTable 2025 NMIBC Creator Weekend™ series, host Dr. Bogdana Schmidt sits down with Dr. Tyler Stewart, medical oncologist from the University of California San Diego, to discuss the contemporary role of medical and surgical oncology in treating non-muscle invasive bladder cancer. --- This podcast is supported by:Ferring Pharmaceuticals --- SYNPOSIS The conversation covers the efficacy and safety of checkpoint inhibitors like pembrolizumab, the importance of a multidisciplinary approach, and the challenges of balancing systemic and localized treatments. They also touch upon the potential future role of biomarkers in reducing invasive procedures and improving patient outcomes. --- TIMESTAMPS 00:00 - Introduction02:04 - The Role of Medical Oncologists in Bladder Cancer12:58 - Combination Therapies and Patient Outcomes21:18 - The CREST Study26:59 - Managing Adverse Events34:44 - Collaboration Between Urologists and Oncologists41:06 - Conclusion and Final Thoughts --- RESOURCES CREST Trialhttps://www.nature.com/articles/s41591-025-03738-z CISTO Studyhttps://pubmed.ncbi.nlm.nih.gov/37980511/