BackTable Urology

What are the key decision points in managing renal, bladder, and urethral trauma? In this episode of BackTable Urology, Dr. Niels Johnson (Vanderbilt University Medical Center) joins host Dr. George Koch (Ohio State University) to discuss the 2025 American College of Surgeons (ACS) best practice guidelines for genitourinary trauma.

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Timestamps

00:00 - Introduction05:09 - Who Manages GU Trauma?13:53 - Purpose of ACS Guidelines16:13 - Development of ACS Guidelines20:01 - Foley Catheter Debate23:26 - Renal Trauma26:40 - Imaging Protocols and Delays29:30 - Bladder Trauma and Special Populations33:15 - Urethral Injuries38:02 - Genital Wounds and Antibiotics39:42 - Transfer Criteria and Resources41:26 - Conclusions

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More about this episode

Dr. Johnson and Dr. Koch review the rationale for developing multidisciplinary guidelines and the variability in genitourinary trauma care across institutions. The discussion highlights key management principles, including non-operative strategies for renal trauma, decision-making in bladder and urethral injuries, and how urinary diversion impacts orthopedic and trauma surgical planning. The episode also addresses considerations for special populations, long-term functional outcomes, and practical implementation tools, such as the ACS gap analysis checklist, designed to improve coordination and quality of care across trauma systems.

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Resources

ACS Best Practices Guidelines: Management of Genitourinary Injuries (August 2025)https://www.facs.org/media/ya5hcu0s/genitourinary_guidelines.pdf

What are the key practice changes introduced in the new American Urological Association (AUA) vasectomy guidelines? In this episode of BackTable Urology, Dr. Akanksha Mehta (Emory University), Vice Chair of the AUA Vasectomy Guidelines Committee, joins Dr. Catherine Nam (University of Michigan) to discuss the latest updates to vasectomy practice.

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SYNPOSIS

Dr. Mehta and Dr. Nam review the key changes in vasectomy guidelines. They address common misconceptions about sexual function and long-term health risks, as well as the role of telemedicine consultation and day-of-procedure examination. Their discussion also covers recommended surgical techniques and updated guidance on post-vasectomy semen analysis, including mail-in testing options. Finally, Dr. Mehta outlines fertility considerations after vasectomy, including cryopreservation, reversal, and sperm retrieval with IVF, and how clinicians can counsel patients about expectations and referral pathways.

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TIMESTAMPS00:00 - Introduction02:07 - Why Update the Guidelines05:38 - Key Guideline Changes11:02 - Sexual Function Concerns17:19 - Health Risks Debunked21:28 - Periprocedural Best Practices28:25 - Semen Analysis Follow Up37:12 - Future of Male Contraception39:11 - Conclusions

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RESOURCES

Vasectomy: AUA Guideline (2026)https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline

When a male patient presents with lower urinary tract symptoms, should you blame the bladder or bust the prostate? In this SUFU-sponsored episode of BackTable Urology, Dr. Benjamin Brucker (NYU) and Dr. Craig Comiter (Stanford) join host Dr. Chris Tenggardjaja (Kaiser Permanente) for a discussion on evaluating and treating male LUTS using a bladder-and-outlet framework.

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This podcast was developed in collaboration with:

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx

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SYNPOSIS

Through a case-based approach, they review initial evaluation strategies including symptom history, validated questionnaires, uroflowmetry, post-void residual measurement, and when tools like voiding diaries can help clarify the diagnosis. The conversation then moves to management, outlining a stepwise approach from behavioral interventions and medications to surgical options when symptoms persist. The doctors discuss how prostate anatomy, side effect profiles, and patient priorities guide treatment selection, when urodynamics may add diagnostic clarity, and why addressing outlet obstruction early may help prevent more difficult-to-treat bladder dysfunction over time.

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TIMESTAMPS

00:00 - Introduction06:31 - Workup for Frequency and Nocturia11:41 - When to Use a Voiding Diary19:18 - Behavioral Therapy26:40 - Post-Finasteride Syndrome30:03 - Surgical Options44:41 - Nocturia Counseling47:32 - Botox With Outlet Surgery49:47 - When to Order Urodynamics54:14 - Bladder or Prostate?

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RESOURCES

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home

Not every pediatric GU injury fits neatly into the guidelines. In this episode of BackTable Urology, trauma reconstructive urologist Dr. Travis Pagliara (Hennepin County Medical Center) joins hosts Dr. Arthi Hannallah and Dr. Niccolo Passoni to walk through practical management of pediatric renal, bladder, urethral, and genital injuries. Through case-based discussion, they highlight diagnostic decision-making, when to observe versus intervene, and how to approach these patients in the acute setting.

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SYNPOSIS

The conversation also explores operative pearls, the role of technologies like the Optilume balloon, and why thoughtful short-term follow up is critical for both patient outcomes and clinician learning. Together, they emphasize a measured, conservative mindset whenever appropriate to minimize morbidity while delivering high-quality trauma care.

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TIMESTAMPS

00:00 - Introduction03:07 - Kidney and Ureteric Trauma19:16 - Urethral Trauma34:42 - MRI vs Ultrasound47:56 - Collaboration in Reconstructive Urology52:26 - Testicular Trauma57:29 - Epididymal Injury01:02:35 - Follow-Ups Matter01:05:14 - Foreign Body Stories01:06:52 - Career Advice

What do the 2025 AUA guidelines change about how we evaluate and manage chronic male pelvic pain? In this episode of BackTable Urology, Dr. Susan MacDonald (Penn State) joins host Dr. George Koch (Ohio State University) to break down the new American Urological Association (AUA) guidelines on chronic male pelvic pain, including chronic prostatitis / chronic pelvic pain syndrome and chronic scrotal content pain.

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SYNPOSIS

They review a structured approach from initial evaluation and physical examination to pain management. The discussion outlines an evidence-informed, multimodal management framework incorporating medications, pelvic floor physical therapy, behavioral health interventions, neuromodulators, and selective procedural strategies, with an emphasis on realistic expectation setting in this complex patient population.

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TIMESTAMPS

00:00 - Introduction01:41 - Path to Chronic Pelvic Pain Work08:19 - Getting Involved with the AUA13:02 - Developing Guidelines19:56 - Initial Patient Evaluation27:11 - Setting Expectations32:05 - Making the Diagnosis35:17 - Success Rates and Counseling Patients39:51 - Central Sensitization44:31 - Physical Exam Recommendations49:26 - Non-Pharmacologic Options54:38 - Follow Up Cadence01:02:24 - Chronic Scrotal Pain vs CPPS01:08:26 - Conclusion

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RESOURCES

Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain