BackTable Urology

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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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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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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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

What should you do differently when a UTI becomes a recurring problem? In this episode of the Backtable Podcast, host Dr. Anjali Kapur is joined by physician-scientist Dr. Glenn Werneburg to discuss the latest approaches to recurrent urinary tract infections, including key updates from the 2025 AUA, CUA, and SUFU guidelines. They use real clinical cases to explore diagnosis, prevention, antibiotic selection, and the management of complex patients.

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This podcast is supported by

Medtronichttps://www.medtronic.com/en-us/e/patients-caregivers/urinary/overactive-bladder.html

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Timestamps

00:00 - Introduction04:05 - Case One: Recurrent UTIs05:19 - Workup Basics08:50 - Non-Antibiotic Prevention11:42 - Antibiotic Prophylaxis Options15:16 - Case Two: Asymptomatic Bacteriuria 19:14 - Case Three: Complex Patients19:58 - Male vs. Female UTIs21:22 - Neurogenic Bladder Workup22:52 - Elderly Patients and ID Consults25:01 - Case Four: Transplant ESBL25:23 - Machine Learning for Antibiotics 29:49 - Catheter Biofilms31:55 - Embedded Bladder Reservoirs35:23 - Recurrent UTI Vaccine36:23 - Future of Recurrent UTIs39:04 - Wrap Up

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More about this episode

The doctors define recurrent UTI and outline the standard workup, including history, physical and pelvic exam, urinalysis, urine culture, and antibiotic sensitivities. They also review occasions where additional testing may be warranted. The discussion covers interpretation of urinalysis, non-antibiotic prevention options, and antibiotic prophylaxis strategies, with consideration of antibiotic resistance and microbiome disruption. They address asymptomatic bacteriuria and when treatment is indicated, along with management considerations for men, patients with neurogenic bladder or CIC, and elderly patients. Dr. Werneburg also discusses his work with machine learning tools to predict antibiotic susceptibility earlier, catheter biofilms, the concept of embedded bladder bacteria reservoirs, and his multidisciplinary complex UTI clinic.

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Resources

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

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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

Recurrent low-grade, intermediate-risk bladder cancer presents a unique treatment challenge: recurrence is common, progression is uncommon, and the burden of repeated procedures can add up quickly. On this episode of the BackTable Urology Podcast, Dr. Ruchika Talwar interviews Dr. Charles “Chas” Peyton about how to manage intermediate-risk bladder cancer patients while balancing disease control and quality of life. They discuss the cumulative impact of repeated TURBTs and explore the evolving role of office-based treatments and chemoablative therapies as alternatives to the traditional treatment cycle.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction05:58 - Comparing Office Ablation and OR TURBT08:26 - TURBT Impact on Quality of Life11:37 - Uncovering Hidden Patient Burdens and Costs14:44 - Integrating Chemoablation into Practice18:20 - ENVISION QoL Study Setup22:04 - Comparing TURBT Preferences27:40 - Counseling Risk-Averse Patients29:10 - Community Adoption Advice31:59 - Upcoming Clinical Trials35:28 - Biomarkers and Expanding Access36:23 - Final Thoughts and Closing Remarks

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More about this episode

The conversation covers practical strategies like office-based surveillance and fulguration for small recurrences, identifying triggers for returning to the OR, and recognizing the hidden burdens of TURBT complications such as hematuria, incontinence, and unplanned ER visits. Dr. Peyton reviews the role of chemoablative options for selected patients, discusses trial data on patient-reported outcomes, and addresses the mixed evidence, high costs, and need for individualized decision-making. The episode also explores new intravesical and FGFR-targeted therapies, underscores the importance of cost-conscious adoption and biomarkers, and considers how management approaches must evolve, especially in community practice settings.

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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