BackTable Urology

When Renal Cell Carcinoma (RCC) invades the veins, the stakes and the surgical challenges rise. Are you prepared? In this episode, Dr. Vidit Sharma (Mayo Clinic) joins guest host Dr. Daniel Roberson to review Renal Cell Carcinoma (RCC) with Venous Tumor Thrombus (VTT), seen in 4 to 10% of cases. They review Mayo level classification and how CT and MRI venography guide surgical planning by defining thrombus extent and IVC involvement.

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Timestamps

00:00 - Introduction03:03 - What is a Venous Tumor Thrombus?12:32 - Presentation and Workup31:49 - Preoperative Considerations40:26 - Building the Dream Team46:06 - Preop Counseling and Risks51:24 - The Operation01:31:01 - Outcomes and Adjuvant Immunotherapy01:36:40 - Future Neoadjuvant Shrinkage01:39:40 - Final Takeaways

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They also cover key management decisions, including when anticoagulation is appropriate and why embolic urgency is often overestimated. Dr. Sharma highlights the importance of experienced multidisciplinary teams, reviews surgical considerations across thrombus levels, and discusses outcomes, including risk stratification with the TeNNiS model and evolving roles for systemic therapy.

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Resources

Outcomes for patients with renal tumors and venous tumor thrombushttps://www.mayoclinic.org/medical-professionals/urology/news/outcomes-for-patients-with-renal-tumors-and-venous-tumor-thrombus/mac-20570379

TeNNiS Scorehttps://www.goldjournal.net/article/S0090-4295(26)00078-6/fulltext

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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When does urodynamics actually change management and when is it unnecessary? In BackTable Urology’s latest collaboration with the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), Dr. Howard Goldman and Dr. David Ginsberg join Dr. Giulia Ippolito to discuss the evidence-based use of urodynamics across a range of clinical scenarios.

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Timestamps

00:00 - Introduction 05:04 - Case: Male Urinary Retention12:38 - Case: Failed Sling18:44 - Case: Parkinson’s OAB21:50 - Case: Post-Prostatectomy26:48 - Prolapse Without Urodynamics32:29 - Obstruction Workup36:16 - Refractory OAB42:49 - Interstitial Cystitis45:18 - Recurrent UTI Evaluation50:16 - Conclusions

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They review guideline-driven indications and limitations of urodynamic testing, emphasizing that many common conditions do not routinely require testing. Through case-based discussion, they highlight situations where urodynamics can meaningfully inform care, such as complex neurogenic patients and cases requiring differentiation between obstruction and detrusor underactivity. The conversation highlights the importance of clinical judgment, targeted use of adjuncts such as uroflow, and aligning testing with decision-making to optimize patient outcomes.This podcast is supported by the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

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Resources

Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study)https://pubmed.ncbi.nlm.nih.gov/34702331/

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

Is your “yes” advancing your career or just adding to your workload? In collaboration with the Society of Women in Urology (SWIU), this episode of BackTable Urology features timely professional advice from Dr. Anne Cameron (University of Michigan, former SWIU president) and Dr. Helen Bernie (Indiana University) on how to approach yes and no decisions with intention across different stages of your medical career.

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Timestamps

00:00 - Introduction02:43 - How Yes Changes Over Time11:34 - Power Dynamics For Trainees16:11 - Housekeeping Work18:46 - Kind Versus Nice22:52 - Delegating And Mentoring28:07 - Decision-Making Framework36:21 - FOMO Versus Opportunity40:30 - Mentorship45:02 - Final Takeaways

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Early in training, saying yes is often driven by power dynamics, while later in a career, it’s competing priorities that make those decisions harder. According to Dr. Cameron, a clear, timely “no” is not only acceptable but often more professional than a delayed response, and leaders play a key role in reinforcing this by giving trainees the space to decline opportunities. This episode also highlights the disproportionate share of “housekeeping” work taken on by women and junior faculty, adding another layer to these decisions. To navigate these challenges, Dr. Cameron offers a practical framework that considers time, role expectations, energy, personal fulfillment, CV value, and long-term goals, while emphasizing the role of mentors and trusted colleagues in providing perspective.

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Resources

Society of Women in Urology (SWIU)https://swiu.org/home.aspx

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BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists.

Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

► https://www.backtable.com/app

What role does prostate artery embolization (PAE) play in modern prostate cancer care? In this episode of BackTable Urology, Dr. Nainesh Parikh (Interventional Radiology at Moffitt Cancer Center) and Dr. Kosj Yamoah (Radiation Oncology at Moffitt Cancer Center) join Dr. Ruchika Talwar (Vanderbilt University) to discuss how PAE could become a key adjunct in optimizing radiation therapy outcomes.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction01:44 - Why Use PAE in Cancer04:08 - Neoadjuvant and Salvage Use07:26 - Radiation Planning Benefits12:51 - PAE vs. Surgery18:36 - SBRT Access20:48 - Current Evidence and Trials25:29 - Patient Selection32:18 - PAE After Radiation36:56 - When to Avoid PAE40:29 - Long-Term Implications44:28 - Conclusions

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They review how PAE can improve lower urinary tract symptoms and reduce prostate volume, potentially optimizing patients for radiation therapy, including stereotactic body radiotherapy (SBRT) and brachytherapy. The discussion highlights early clinical data and patient selection considerations such as gland size and symptom burden. Finally, they examine post-radiation applications, technical challenges, and current limitations, emphasizing the need for larger, multicenter trials to better define PAE’s role in prostate cancer treatment pathways.

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Resources

Prostate Artery Embolization in the Setting of Prostate Cancer: Review and Opinionhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11775958/

What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making.

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Timestamps

00:00 - Introduction03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline07:32 - Patient Experience with OAB11:59 - Beta-3 Agonists vs Anticholinergics15:15 - Botox Counseling and Dosing18:11 - Tibial Nerve Stimulation25:47 - Sacral Neuromodulation32:09 - Cost Burden of OAB39:38 - Evolution of OAB Care41:39 - Future Research Directions

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The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently.

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Resources

The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

Anticholinergic Drug Exposure and the Risk of Dementiahttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial

https://pubmed.ncbi.nlm.nih.gov/20171677/

Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registryhttps://www.auajournals.org/doi/10.1097/UPJ.0000000000000916

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?https://pubmed.ncbi.nlm.nih.gov/33197059/