BackTable Urology

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Andrew Sun, director of the Center for Men's Health at Urology Partners of North Texas, about various men's health issues, such as sexual dysfunction, low testosterone, and infertility. --- CHECK OUT OUR SPONSOR KYZATREX™ www.kyzatrex.com --- SHOW NOTES First, the doctors discuss testosterone replacement therapy. They explain the tests and treatments available and the role of lifestyle factors and estradiol in testosterone production. They delve into the various protocols for administering testosterone injections, including the popular IM and subcutaneous methods and the pros and cons of weekly injections. Next, they cover alternative treatments, such as oral testosterone and testosterone gels. They look into the different types of first-line oral testosterone treatments available, such as KYZATREX, and examine the benefits of each. Additionally, they discuss the distribution model for oral testosterone treatments and the role of cash payments in increasing accessibility. Finally, they explore how a dedicated men's health center can offer quicker conversations with patients and how doctors can use specialty networks to purchase and dispense medications. Both doctors emphasize that having a passionate champion in men's health matters when it comes to successfully executing a men’s health program. --- RESOURCES KYZATREX™ by Marius Pharmaceuticals https://www.kyzatrex.com/

In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Mohit Khera, professor of Urology at Baylor College of Medicine, about hypogonadism and testosterone replacement therapy. --- CHECK OUT OUR SPONSOR KYZATREX™ www.kyzatrex.com --- SHOW NOTES First, Dr. Khera explains how comorbid conditions, such as diabetes, metabolic syndrome, and obesity, can decrease testosterone levels as men age. We also discuss the importance of the four pillars of health - diet, exercise, sleep, and stress reduction - and the role of weight loss in increasing natural testosterone levels. Additionally, Dr. Kera outlines the lab results he orders to confirm hypogonadism, which includes testosterone, free testosterone, LH, FSH, prolactin, estradiol, DHT, TSH, IGF-1, and vitamins D and B12. Next, Dr. Khera discusses how to detect low free testosterone levels in patients with normal total testosterone levels and how to adjust treatment depending on the patient's sensitivity to testosterone. The doctors also discuss the role of testosterone in treating depression, the importance of managing estrogen levels, and avoiding overuse of aromatase inhibitors. Dr. Khera gives a brief history of testosterone replacement therapy (TRT), starting from the first oral testosterone formulation created in the 1930s to the new testosterone products developed in 2019. They also discuss the FDA's 2015 requirement for hypertensive testing, as well as the low risk of erythrocytosis associated with these new medications. Finally, Dr. Khera discusses the importance of checking testosterone levels frequently and the controversy surrounding the best time to do so. He explains the difference between using injectables, gels, and pellets, and the importance of checking the trough level instead of the mid-week level. He ends by sharing why it is important to consider the whole couple when treating patients with testosterone and not just one partner. --- RESOURCES Miner MM, Khera M, Bhattacharya RK, Blick G, Kushner H. Baseline data from the TRiUS registry: symptoms and comorbidities of testosterone deficiency. Postgrad Med. 2011 May;123(3):17-27. doi: 10.3810/pgm.2011.05.2280. PMID: 21566412. https://pubmed.ncbi.nlm.nih.gov/21566412/ KYZATREX™ by Marius Pharmaceuticals https://www.kyzatrex.com/

This week on BackTable Urology, Dr. Juan Javier-Desloges, a urologic oncologist at UC San Diego, interviews Dr. Neil Taunk, a radiation oncologist leading the Brachytherapy and Procedural Radiation program at the University of Pennsylvania, about his experience with using SpaceOAR rectal spacer for prostate cancer radiotherapy. --- CHECK OUT OUR SPONSOR Boston Scientific SpaceOAR Hydrogel https://www.bostonscientific.com/spaceoar --- SHOW NOTES First, the doctors explore the nuances of rectal spacing and the best candidates for this procedure. They discuss various large-scale trials from different research institutions about the efficacy of rectal spacing in different types of radiation, like proton beam, external beam, and brachytherapy. He also notes the time crunch that comes with using a spacer and highlights the importance of understanding a patient's anatomy before performing the procedure. Additionally, he shares his insight on how extracapsular extension of the tumor can affect the rectal spacing procedure, as well as the potential benefits of rectal spacing for certain patient populations. Dr. Taunk also considers the differences between the two gels (Barrigel and SpaceOAR) available on the market and delves into specific differences between the two products. Lastly, they emphasize the importance of pre-operative counseling for the imperfect management of patients because suboptimal gel placements and complications, such as intravascular injection and pulmonary embolism, are possible. --- RESOURCES SpaceOAR Hydrogel by Boston Scientific https://www.bostonscientific.com/spaceoar

This week on BackTable Urology, Dr. Jill Buckley speaks with internationally-renowned urologic reconstructive surgeon, Dr. Sanjay Kulkarni, about his upbringing, training, and insights on urethroplasty. --- SHOW NOTES First, Dr. Kulkarni discusses his upbringing and the importance of education in his family. Then he outlines the challenges he faced in the 1980s when he began to introduce urethroplasty in his hometown in India. He established a small hospital with two operating theaters and 20 beds in 1995 that transformed into a 100-bed urology center in 2021. Additionally, he started the Kulkarni School of Urethral Surgery, which has since been an international training site for surgeons from around the world. Next, Dr. Kulkarni elaborates about the mentors and experiences that have shaped his career. He introduced the buccal mucosa technique in 1997, applied it to penile urethra in 2000, and innovated the one-side dissection technique in 2009. The doctors then discuss the potential advances in urethral surgery, including stem cells and tissue engineering, and Dr. Kulkarni’s interest in robotics and reconstructive urology. Finally, Dr. Kulkarni shared his admiration for his various peers and mentors in the field. Finally, he shares his last surgical pearls and emphasizes the importance of attending workshops and observing in the theater to develop one's technique and passion for surgery. He ends the episode by highlighting the importance of out-of-the-box thinking and how it can lead to innovation.

In this episode of BackTable Urology, Dr. Ranjith Ramasamy and Dr. Dipen J. Parekh, COO and urology department chair at the University of Miami Health system, discuss Dr. Parekh’s journey to institutional leadership and career advice as a surgeon-leader. --- SHOW NOTES First, Dr. Parekh explains his role as the chief operating officer (COO) of a major hospital system. The COO is entrusted with clinical decision making. Various services and departments report to the COO, such as patient safety and quality, construction and facilities, pharmacy, and patient experience. Dr. Parekh’s experience at the health system has taught him an enormous amount of discipline and strategic planning. He balances multiple tasks each day and surrounds himself with world class, high quality people. Then, Dr. Parekh proposes rethinking how physicians go about their training, emphasizing quality over quantity in the promotion process. He suggests recognizing those who are stellar clinicians and those who make immediate and tangible impact on outcomes in the community and patient populations. The doctors also discuss the importance of teaching the business of medicine in medical school, residency, and fellowship. Dr. Parekh then explains the importance of sustainability in academic health systems in different areas, such as in leadership. He also considers the future of the academic physician model, noting characteristics that build resilience in the long-term. Finally, Dr. Parekh shares his perspective on how to balance innovation and leadership in medicine. He provides advice for the younger generation of physicians and healthcare professionals by emphasizing the need to be original and to focus on their own goals and successes. --- RESOURCES WellPrept https://wellprept.com/

In this episode of BackTable Urology, Dr. Silva and Dr. Zamip Patel, a urologist specializing in male infertility and andrology at Southeast Male Infertility and Urology/Andrology, discuss infertility trends and causes, as well as artificial intelligence in surgical robotics and fertility. --- SHOW NOTES First, the doctors discuss the rising rate of infertility in the US and around the world, and the potential causes behind it. They consider the impact of obesity and environmental cues, like endocrine disruptors, on fertility rates. Then, they transition to reflecting on the rapidly changing landscape of infertility treatments and how insurance coverage and third party providers are playing a role in treatment selection. They also examine the impact of government mandates on fertility coverage, and the implications for employers who want to provide fertility benefits to their employees. Next, they explore the challenges of diagnosing infertility, such as lack of awareness and the importance of optimizing the male side to improve IVF outcomes. Zamip then explains artificial intelligence (AI) can augment male fertility diagnostics and therapeutics. Advanced neural networks have enabled us to identify candidate genes in large sets of data that weren't available before, leading to a more accurate diagnosis. AI can also help the fertilization process, as it can aid in selecting the most viable sperm and egg, and identify the best embryos for implantation. Zamip also adds that AI can assist in the genetic analysis of blastocysts and how it may help avoid discarding embryos unnecessarily. We consider the potential benefits of AI alongside the ethical implications of using AI in such delicate procedures. Although AI can dramatically improve the healthcare industry and revolutionize treatments for men's health, both doctors agree that there is a need for a humanistic touch in the medical field, even as AI becomes more advanced. --- RESOURCES WellPrept https://wellprept.com/

In this episode of BackTable Urology, Dr. Bagrodia interviews Dr. Peter Scardino, world-renowned urologist and professor emeritus of urology at Memorial Sloan Kettering Cancer Center (MSK), about his journey to becoming a urologist and life lessons he has learned along the way. Dr. Scardino was born in Portsmouth Naval Hospital at the end of World War II and grew up in Savannah, Georgia. The fact that his father was a urologist and his attendance at a National Science Foundation special summer science program started his interest in medicine. He had an early interest in science and worked harder than anyone else. This work ethic led him to pursue an undergraduate degree at Yale and a medical degree at Duke. Then, he trained in general surgery at Massachusetts General and pursued urology training at UCLA. Dr. Scardino also speaks about his experience in hospital administration and business management. We discuss how he was inspired to gain knowledge in the field, and how a group of faculty members got together to learn from a retired businessman and the University of Houston. He shares personal stories about his mentors and insights on how mentors can help guide people to their best interests. He also emphasizes the importance of engaging in leadership and administration early on in a career. Additionally, he shares about the challenges he faced when making the decision to move from being chair of urology at Baylor College of Medicine to Memorial Sloan Kettering. They also discuss the division of attitudes towards making urology a department, and how it affected Dr Scardino's personal life. Finally, Dr Scardino reflects on the lessons he has learned throughout his career and the importance of striking a balance between work and personal life.

This week on BackTable Urology, Dr. Suzette Sutherland (University of Washington) and Dr. Olivia Chang (UC Irvine) discuss reasons for uterine preservation and hysteropexy techniques for prolapse repair. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/f2sdAy --- SHOW NOTES First, Suzette and Olivia discuss the value of keeping the uterus in place for women undergoing prolapse repairs, as well as the indications for apical suspension surgery. They also note the historical context of hysterectomy and why it has been the go-to treatment for so long. Next, the doctors discuss the advantages of hysteropexy over hysterectomy for prolapse repair, such as a shorter operative time, less bleeding, and a quicker recovery. The doctors then go into more detail about the best approaches for prolapse repair, like weighing the options of permanent sutures versus delayed absorbable sutures. They also analyze recurrence rates after prolapse surgery, specifically in the anterior compartment. Then, they explore the data on how the choice to keep the uterus in place can stem from a woman's personal and cultural views. Olivia shares about the Value of Uterus questionnaire, a six-question survey instrument that can quantify how a woman values her uterus. It can streamline clinic visits and help to predict whether a woman would choose a uterine-preserving procedure. The doctors note that there is research demonstrating a correlation between valuing the uterus and sexual activity. Finally, Suzette and Olivia contraindications for leaving the uterus in place. They emphasize the importance of assessing for abnormal uterine bleeding and cervical pathology before recommending uterine preservation. They suggest that listeners review the current guidelines around preoperative workup and consider transvaginal ultrasound or endometrial biopsy first. Lastly, they emphasize the importance of symptom and risk stratification and shared decision making when it comes to uterine preservation. --- RESOURCES Chang OH, Walters MD, Yao M, Lapin B. Development and validation of the Value of Uterus instrument and visual analog scale to measure patients' valuation of their uterus. Am J Obstet Gynecol. 2022 Jun 25:S0002-9378(22)00483-5. doi: 10.1016/j.ajog.2022.06.029. Epub ahead of print. PMID: 35764134. https://pubmed.ncbi.nlm.nih.gov/35764134/

This week on BackTable Urology, Dr. Suzette Sutherland and Dr. Rachel Rubin discuss the diagnosis and treatment of genitourinary syndrome of menopause (GSM) with vaginal estrogen. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/aj8lvI --- SHOW NOTES GSM is not only a condition of "vaginal dryness", but rather a multi-faceted symptom set including pain with sitting, urinary frequency and urgency, bladder pain, opioid use, and recurrent UTIs. First, the doctors discuss the myths and misconceptions about the use of estrogen creams, suppositories, and rings to treat GSM . However, Suzette and Rachel also discuss the importance of advocating against the misrepresentation of vaginal estrogen in box labeling. They conclude that the benefits of using a low-dose vaginal estrogen far outweigh the risks, and doctors should advocate for better labeling and understanding of this treatment. Suzette and Rachel also discuss the American Urologic Association (AUA) guidelines for GSM and its importance. Systemic hormone therapy is rarely enough to address GSM symptoms, so screening for GSM symptoms is essential. They also talk about estrogen therapy for special patients, such as those on hormone replacement therapy (HRT) and cancer survivors. Suzette and Rachel emphasize the importance of understanding the general hormone fluctuations of patients particularly oral contraceptives, those with disordered eating, those who are breastfeeding, and those who are transgender. They end the episode by encouraging the production of more research and data to back up treatment options for GSM in premenopausal women. --- RESOURCES WellPrept https://wellprept.com/ Femring https://www.femring.com/

This week on BackTable Urology, Dr. Aditya Bagrodia, Dr. Ashley Winter, and Dr. Jennifer Anger explore truths and myths about women’s health topics, covering pelvic floor health, sexual health, and postpartum care. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/yaRhyX --- SHOW NOTES First, the doctors discuss aging and the role and safety of hormone replacement therapy. They stress the importance of educating urologists on the risks of estrogen and progesterone, as unopposed estrogen can cause endometrial cancer. Next, they discuss how pregnancy-related health changes. Ashley shares her first-hand experience on urologic, sexual, and hormonal health during and after her pregnancy. New symptoms, such as increased urgency and frequency during pregnancy, hot flashes, hair loss, and vaginal dryness, may arise during and after pregnancy. Then, they discuss the options women have for delivery, including cesarean section, and the need for pre-birth counseling. Additionally, they discuss general women’s health topics that are often stigmatized, such as vaginal prolapse and vaginal odors. Different treatment options available for prolapse, such as pessaries. Then, they explore the complexities of vaginal odors, which may point to a dietary or infectious cause. Finally, the doctors conclude the episode by debunking myths about hygiene, UTIs, and vaginal rejuvenation. --- RESOURCES WellPrept https://wellprept.com/ “A Woman’s Guide to Her Pelvic Floor” by Jennifer Anger MD, Karyn Eilber MD, and Victoria Scott MD https://www.amazon.com/Womans-Guide-Her-Pelvic-Floor/dp/B0BXND9896