BackTable Urology

With so many treatment options for bladder outlet obstruction, how do you select the best approach for each patient? On this episode of BackTable Urology, host Dr. Jose Silva is joined by Dr. John DiBianco for a practical discussion on evaluating lower urinary tract symptoms and matching patients with the right intervention. They emphasize confirming that symptoms are truly due to benign prostatic hyperplasia (BPH) before proceeding, and walk through triggers for intervention, including quality-of-life impact, UTIs, renal impairment, high post-void residual, bladder stones, and retention.

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Timestamps

00:00 - Introduction03:24 - Complex BPH Referrals and Symptom Assessment06:07 - Deciding When to Operate11:12 - Imaging and Prostate Sizing14:27 - When to Use Cystoscopy and Urodynamics16:43 - Incorporating Patient Preferences21:53 - Medical Therapy and Pills23:45 - Decision Aids and Personal Experience27:13 - Managing HoLEP Complications and Leakage32:57 - Advances in HoLEP Technique36:07 - TURP Indications and Outcomes38:36 - Special Considerations: Radiation and UroLift39:58 - ThULEP vs. HoLEP41:17 - Redo Surgery Strategies43:52 - Counseling Through Case Scenarios56:16 - Future Directions in BPH Treatment59:05 - Wrap Up and Credits

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More about this episode

The conversation covers everything from surveillance and imaging-based prostate sizing to when to use cystoscopy and urodynamics for complex or high-risk patients. Drs. Silva and DiBianco compare procedure options like HoLEP, TURP, GreenLight, UroLift, PAE, iTind, and aquablation, highlighting how factors like prostate size, morphology, history, and patient goals drive decision-making. They discuss durability, redo surgery issues, management of radiation patients, and postoperative care including leakage management and pelvic floor therapy. The episode wraps up with future directions in BPH procedures and practical counseling tips for patient satisfaction.

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Resources

Love this episode? Check out BackTable.com and search “BPH” to get more information on a variety of the surgical options discussed in this episode, including HoLEP, Aquablation, PAE, and more! Further resources include the BackTable App, which has a course on treating Benign Prostatic Hyperplasia.

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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

Can shared decision-making and patient support change the treatment journey for overactive bladder? On this episode of BackTable Urology, host Dr. Suzette Sutherland and OAB expert Dr. Jannah Thompson discuss how patient education, clear counseling, and ongoing follow-up improve care for patients with overactive bladder and urge incontinence. They cover practical strategies for building an effective OAB care pathway, staff training for better patient navigation, and proactive approaches that increase adherence and access to advanced therapies.

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Get the BackTable apphttps://www.backtable.com/app

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This podcast is supported by

Medtronic Pelvic Healthhttps://urgencyisreal.com/

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Timestamps

00:00 - Introduction04:00 - Shared Decision-Making06:51 - Clinic Efficiency10:38 - Expanding OAB Therapy Options12:27 - Long-Term OAB Care17:41 - Building an OAB Program18:18 - Staff Training and Follow-Up25:32 - OAB Navigator Implementation27:14 - Navigation Outcomes28:39 - Scaling with Staff and Epic30:35 - Algorithm Resources34:08 - Neuromodulation Advances38:37 - New Tibial and Battery-Free Devices40:56 - Quality of Life in OAB Care46:11 - Access and Adoption51:22 - Streamlining Therapy Discussions52:47 - Closing Remarks

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More about this episode

The conversation explores the diverse landscape of OAB treatment options, the evolving role of neuromodulation, and how new technologies are enabling more personalized care. Dr. Thompson shares insights on empowering staff as part of the clinical team, leveraging patient navigators to boost follow-up and advanced therapy uptake, and the importance of integrating patient preferences and lifestyle factors into every decision. They emphasize that quality of life, not just symptom control, should be central to OAB management, and discuss how to engage patients as partners throughout their treatment journey.

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Resources

Patient navigation for overactive bladder improves access to carehttps://link.springer.com/article/10.1007/s00192-019-04085-7

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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 are the key considerations for choosing between surveillance, surgery, and chemotherapy in testicular cancer? On this episode of BackTable Urology, host Dr. Rich Matulewicz is joined by Dr. Sean Kern and Dr. Sam Funt for an in-depth discussion on clinical approaches to testicular cancer. They start with a real-world case, reviewing initial evaluation, imaging, tumor markers, and counseling on fertility, body image, and hypogonadism. The conversation highlights how nuanced patient selection influences decisions between surveillance, surgical intervention, and adjuvant chemotherapy.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction01:40 - Initial Case Workup and Counseling06:28 - Why Testicular Cancer Happens09:17 - Management Considerations with Post-Orchiectomy Pathology19:21 - RPLND Benefits and Drawbacks23:39 - Surveillance Schedule and Long Term Follow Up28:17 - Second Tumor Risk30:36 - Evolving Seminoma Treatment37:57 - RPLND Selection Factors40:10 - Adjuvant Chemo Debate and Pathology46:06 - Closing Takeaways

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More about this episode

The episode explores postoperative management, including long-term surveillance, risk of a second tumor, and strategies for lifelong follow-up. The doctors discuss evolving practice in the management of low-volume stage II seminoma, the increasing use of RPLND to reduce chemo and radiation exposure, and the importance of extended patient counseling over multiple visits. The discussion emphasizes individualized care, the role of new diagnostics, and the need for reassurance and support throughout the treatment journey.

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Resources

Society of Urologic Oncology https://suonet.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

How can high-stakes surgical cases be optimized for teaching while ensuring patient safety and trainee growth? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Kelvin Moses about intentional strategies for surgical education, especially during complex urologic oncology operations. They discuss workflows that prioritize preoperative planning, structured debriefs, and progressive autonomy for trainees, as well as the importance of psychological safety and open communication with patients and families.

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Get the BackTable apphttps://www.backtable.com/app

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Timestamps

00:00 - Introduction02:19 - Teaching In High Stakes Cases07:57 - Rethinking See One, Do One, Teach One10:24 - Assessing Trainee Readiness14:29 - Preop Preparation 16:06 - Teaching Cues in the OR 17:42 - Tips for Trainees21:40 - Intentional Teaching24:02 - Teaching Rare and Complex Cases26:40 - Anticipating Complications and Debrief After Disaster33:09 - Psychological Safety In the OR37:41 - Reflections on Past, Current, and Future Training Models43:56 - Patients And Trainees46:51 - Takeways

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More about this episode

The conversation explores practical intraoperative teaching cues, tips for trainees such as visualization, recording cases, and repetition, and methods for relating rare cases to more common procedures. Dr. Moses reflects on the strengths and challenges of past, present, and future training models, including the debate over whether surgical education has gone “too soft.” The episode emphasizes the value of mentorship, transparency with patients, and the need to continually adapt surgical training for the next generation.

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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 an elevated prostate-specific antigen (PSA) the beginning or the end of the prostate cancer workup? On this episode of BackTable Urology, Dr. Ruchika Talwar interviews Dr. Tarik Benidir to explore the “PSA problem,” explaining why PSA is biologically useful but clinically imprecise, often leading to false positives, unnecessary biopsies, and detection of indolent disease. They discuss a rational, patient-centered approach to elevated PSA, including when to repeat the test, how to interpret results in the context of age, race, family history, and prostate size, and the use of PSA density and age-adjusted norms instead of rigid cutoffs.

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Get the BackTable apphttps://www.backtable.com/app

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This podcast is supported byCleveland Diagnosticshttps://www.isopsa.com/

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Timestamps

00:00 - Introduction04:03 - Why PSA Can Be Misleading06:43 - Approach to Elevated PSA and Initial Workup09:51 - MRI, PSA Density, and Biomarker Testing14:31 - Guidelines, Diagnostics, and When to Biopsy20:16 - Comparing 4K, IsoPSA, and Other Biomarkers25:23 - Choosing Between Transperineal and Transrectal Biopsy28:42 - Management Considerations for Elderly and Comorbid Patients33:09 - Active Surveillance, Recurrence, and Long-Term Monitoring40:47 - Key Takeaways and Closing Remarks

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More about this episode

The conversation highlights the role of reflex biomarkers, MRI scans, and selective biopsy strategies to reduce unnecessary procedures and focus on identifying clinically significant cancers. Dr. Benidir explains how to weigh MRI results, when to use biomarkers, and how to approach decisions in elderly or comorbid patients. They also discuss new biopsy modalities, active surveillance, and future directions for optimizing PSA-based screening and management.

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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