BackTable Urology

How many prostate medications and procedures should a man try before anyone checks his bladder? Dr. Bilal Chughtai has met men who worked through an alpha blocker, add-on medications, a minimally invasive prostate procedure, and even resective surgery before anyone named overactive bladder as part of the problem. On this episode of BackTable Urology, Dr. Anjali Kapur, urogynecologist at Hackensack Meridian Health, welcomes Dr. Chughtai, chief of urology at Northwell Health's Plainview and Syosset hospitals, to rethink how urologists separate overactive bladder (OAB) from benign prostatic hyperplasia (BPH) in men. Dr. Chughtai explains how he reads the storage and voiding items of the International Prostate Symptom Score (IPSS), why he usually starts with a beta-3 agonist rather than an anticholinergic, how he trims polypharmacy one medication holiday at a time, and when urodynamics helps decide whether to treat the prostate, the bladder, or both.

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This podcast is supported by

Sumitomo Pharma America, Inc.https://www.us.sumitomo-pharma.com/

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Timestamps

00:00 - Introduction02:37 - Initial Evaluation and First-Line Therapy06:11 - Combination Therapy and Medication Holidays09:37 - Reassessing Symptoms After an Outlet Procedure11:59 - Botox and Neuromodulation in Men15:14 - Persistent Symptoms After Prior BPH Treatment18:44 - The COURAGE Trial and Urge Incontinence23:22 - Combining Therapies and Setting Goals25:48 - Questionnaires, Bladder Diaries, and Underreporting29:05 - OAB Awareness in Primary Care31:14 - Nocturia and Sleep Apnea33:23 - Timing of Intervention and Bladder Health38:04 - Final Takeaways and Closing Remarks

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More about this episode

The two then turn to third-line therapy in men, including intradetrusor botulinum toxin, sacral neuromodulation, and tibial nerve stimulation, and to men whose storage symptoms persist or appear after an outlet procedure. Dr. Chughtai shares what the COURAGE trial of a beta-3 agonist added to BPH therapy taught him about asking men directly about urge incontinence, along with his goal of a 50% improvement in symptoms, the limits of questionnaires and bladder diaries, his research on OAB awareness in primary care, and the link between nocturia and sleep apnea. They close on the open question of when to treat the bladder before it changes, and why counseling should inform men without threatening them.

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Resources

Efficacy and Safety of Vibegron for Persistent Symptoms of Overactive Bladder in Men Being Pharmacologically Treated for Benign Prostatic Hyperplasia: Results From the Phase 3 Randomized Controlled COURAGE Trial. J Urol. 2024https://pubmed.ncbi.nlm.nih.gov/38708869/ Vibegron for overactive bladder in men with benign prostatic hyperplasia/obstruction: insights from the COURAGE trial. Transl Androl Urol. 2025https://pubmed.ncbi.nlm.nih.gov/40376518/ Lower Urinary Tract Symptoms Following Transurethral Resection of Prostate. Curr Urol Rep. 2018https://pubmed.ncbi.nlm.nih.gov/30128964/ 5-year outcome of surgical resection and watchful waiting for men with moderately symptomatic benign prostatic hyperplasia: a Department of Veterans Affairs cooperative study. J Urol. 1998https://pubmed.ncbi.nlm.nih.gov/9628595/ The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladderhttps://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder BackTable Urology Episode 138: Hood-Sparing & Greenlight Laser Therapy in BPH Managementhttps://www.backtable.com/shows/urology/podcasts/138/hood-sparing-greenlight-laser-therapy-in-bph-management Dr. Bilal Chughtai, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-bilal-chughtai Dr. Anjali Kapur, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-anjali-kapur

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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

By one estimate, half or more of all non-muscle invasive bladder cancer (NMIBC) is intermediate risk, yet the major guidelines still do not define it the same way, which leaves urologists sorting a large, mixed group of patients without a shared playbook for when to resect again, treat in the office, or start intravesical therapy. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Wesley Yip, urologic oncologist at City of Hope, to rethink what she calls the forgotten stepchild of bladder cancer: intermediate-risk non-muscle invasive bladder cancer (NMIBC). Dr. Yip explains why he sees the category as a catch-all rather than a single biological entity, by his estimate covering 50 to 60 percent of NMIBC, why he now relies on the International Bladder Cancer Group (IBCG) definition, and why tumor grade comes first, ahead of multiplicity, size, and recurrence timing.

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Timestamps

00:00 - Introduction02:24 - Defining Intermediate-Risk NMIBC07:53 - Case Presentation and the Initial TURBT10:42 - Evaluating the First Recurrence13:09 - High-Grade Cytology and Blue Light Cystoscopy15:01 - The Burden of Repeat TURBT16:57 - Office Fulguration and Chemoablation20:23 - Chemoablation Tolerability and Patient Selection24:24 - Intravesical Chemotherapy and Treatment Barriers28:08 - New Formulations and Upcoming Trials33:12 - Recurrence After Chemoablation and De-escalation38:00 - Future Directions and Patient-Centered Endpoints42:39 - Closing Remarks

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More about this episode

Working through the case of a healthy 67-year-old man with recurrent low-grade Ta disease, the two discuss what to document at the first resection, how to counsel patients, when to return to the operating room, and when office fulguration, intravesical chemoablation, or intravesical chemotherapy with gemcitabine and docetaxel makes more sense. They cover the cumulative burden of repeat transurethral resection, practical lessons from bringing chemoablation into the clinic, how to read new trial data, and when to de-escalate surveillance. Dr. Yip closes with his hopes for the next five years: a biology-based definition and trials that measure fewer recurrences, fewer procedures, and better quality of life.

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Resources

Intermediate-risk Non-muscle-invasive Bladder Cancer: Updated Consensus Definition and Management Recommendations from the International Bladder Cancer Group. Eur Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35718695/ Intermediate-risk Non-muscle-invasive Bladder Cancer: Recommendations for Definitions, Risk Stratification, Management Strategies, and Clinical Trial Design from the International Bladder Cancer Group. Eur Urol Oncol. 2025https://pubmed.ncbi.nlm.nih.gov/41076366/ All High-Grade Ta Tumors Should Be Classified as High Risk: Bacillus Calmette-Guérin Response in High-Grade Ta Tumors. J Urol. 2022https://pubmed.ncbi.nlm.nih.gov/35770498/ Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guidelinehttps://www.auanet.org/guidelines-and-quality/guidelines/bladder-cancer-non-muscle-invasive-guideline EAU Guidelines on Non-muscle-invasive Bladder Cancerhttps://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer Bladder Cancer Advocacy Network (BCAN)https://bcan.org Dr. Wesley Yip, City of Hope physician profilehttps://www.cancercenter.com/physician-directory/wesley-yip Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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

By his own estimate, an AI scribe gives one urologist about two hours of his day back, and an evidence tool built into it has taught him something new in the clinic almost every day. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes back Dr. David Canes, urologist at Lahey Hospital & Medical Center and founder of WellPrept, to talk about how urologists can practically put AI to work. Dr. Canes explains why he sees this moment as a renaissance for physicians, how an AI scribe turned him from author into proofreader, by his estimate saving about two hours a day, and why evidence tools running alongside the scribe now answer questions in the exam room, including a question about post-prostatectomy dysorgasmia, a complaint that rarely comes up in clinic.

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Timestamps

00:00 - Introduction03:32 - Getting Started With AI in Practice07:24 - AI Scribes and Cognitive Load14:18 - AI Evidence Tools at the Point of Care18:41 - Context, Pre-Charting, and Evidence in the Exam Room24:52 - AI for Email and Personal Workflow29:09 - Building a Permanent AI Memory34:20 - AI Skepticism, Privacy, and Intellectual Honesty40:47 - Will AI Replace Physicians?46:39 - Pre-Charting, Patient Education, and Care Journeys49:27 - Reducing the In-Basket Burden53:04 - Where to Start With AI55:27 - Closing Remarks

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More about this episode

The conversation then moves beyond the clinic. Dr. Canes describes an AI layer on email that flags what cannot wait, and a permanent AI memory built from plain text files that keeps research, licenses, talks, and family life organized, with a firm rule that no protected health information goes anywhere without a business associate agreement. He and Dr. Talwar discuss what work is worth delegating to AI, push back on a recent JAMA perspective arguing that autonomous AI may outperform physicians, and run through tools for pre-charting, patient education, postoperative care journeys, and front-desk calls. Dr. Canes closes with simple advice for exhausted physicians: ask the AI you already use to build you a 90-day plan.

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Resources

Will Autonomous AI Exceed AI-Aided Physicians as the Best Medical Care? JAMA. 2026https://jamanetwork.com/journals/jama/fullarticle/2852952 The utility of tamsulosin in the management of orgasm-associated pain: a pilot analysis. Eur Urol. 2005https://pubmed.ncbi.nlm.nih.gov/15716202/ WellPrepthttps://www.wellprept.com BackTable Urology Episode 55: Patient Preparation Made Easy: The WellPrept Storyhttps://www.backtable.com/shows/urology/podcasts/55/patient-preparation-made-easy-the-wellprept-story Dr. David Canes, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-david-canes Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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

Every prostate cancer biomarker returns a number, but the real question is whether that number changes what you do next for the patient. On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Amir Lebastchi, urologic oncologist at Keck Medicine of USC, to discuss how biomarkers are moving prostate cancer care from numbers to meaningful clinical decisions. They define what makes a biomarker clinically useful, organize the growing list of blood, urine, and tissue tests into pre-biopsy, post-negative-biopsy, and post-diagnosis settings, and talk through where these tests fit alongside MRI after an elevated PSA.

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

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This podcast is supported by

Cleveland Diagnosticshttps://www.isopsa.com/

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Timestamps

00:00 - Introduction02:59 - Clinical Utility and a Framework for Biomarkers08:43 - Workup of an Elevated PSA11:42 - Pre-Biopsy Blood and Urine Tests13:29 - Equivocal MRI, Outside Imaging, and Community Practice20:26 - Patient Factors and Practical Considerations24:44 - Case: Elevated PSA and a Negative MRI30:11 - Case: Biopsy Approach and Discordant Results34:41 - Counseling on PSA Limitations and Overdiagnosis37:05 - Biomarkers in Active Surveillance and Renaming Grade Group 140:56 - AI and the Future of Biomarkers44:38 - Take-Home Points and Closing Remarks

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More about this episode

The discussion covers equivocal MRI findings, patient counseling, and the practical impact of age, family history, and race when interpreting PSA levels. Through real cases, Dr. Lebastchi explains when he repeats a PSA, how he performs a templated transperineal biopsy, and why a negative MRI plus a negative biomarker can give him the confidence to forgo a biopsy. They also touch on active surveillance, the debate over renaming grade group 1 prostate cancer, and how AI may help future tests guide treatment intensity rather than just risk category. Dr. Lebastchi closes with the clinician’s obligation to know all available tests and use those that truly inform management.

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Resources

Early Detection of Prostate Cancer: AUA/SUO Guideline (2023)https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guidelines Clinical validation of IsoPSA, a single parameter, structure-focused assay for improved detection of prostate cancer: A prospective, multicenter study. Urol Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35840465/ Using IsoPSA With Prostate Imaging Reporting and Data System Score May Help Refine Biopsy Decision Making in Patients With Elevated PSA. Urology. 2023https://pubmed.ncbi.nlm.nih.gov/36965817/ Low-Grade Prostate Cancer: Time to Stop Calling It Cancer. J Clin Oncol. 2022https://pubmed.ncbi.nlm.nih.gov/35436144/ The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer. J Natl Cancer Inst. 2023https://pubmed.ncbi.nlm.nih.gov/37285311/ Dr. Amir Lebastchi, Keck Medicine of USC physician profilehttps://keckmedicine.org/provider/amir-h-lebastchi Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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 is suction technology changing what it means to be “stone-free” after ureteroscopy? On this episode of BackTable Urology, Dr. Ruchika Talwar welcomes Dr. Karen Stern, endourologist at Mayo Clinic Arizona, for a practical discussion of how ureteroscopy is evolving in the era of suction. They discuss how thin-slice CT has revealed just how much stone typically remains after surgery, why dusting versus fragmenting is now a patient-dependent choice, and what to consider when selecting between suction sheaths, aspiration scopes, and traditional access.

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

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This podcast is supported by

Dornierhttps://www.dornier.com/backtable

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Timestamps

00:00 - Introduction02:16 - Residual Stone and Defining Success04:59 - Dusting, Fragmentation and Suction Devices07:15 - Patient Selection, OR Setup and Laser Settings11:39 - Evidence, Stone Clearance and Infection Risk15:39 - Community Adoption and Technique Pearls20:05 - Integrated Systems and Artificial Intelligence22:29 - Take-Home Points and Closing Remarks

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More about this episode

The doctors discuss patient selection, OR setup, stenting, and why stones over a centimeter benefit most from a suction approach. Dr. Stern shares her tips for suction device setup, irrigation and suction settings, and how even a short learning curve can make these techniques routine. They review infection risks, evidence on residual stone volume, pearls for community adoption, and look ahead to integrated laser-suction platforms and AI tools that may one day help define when a case is truly finished. Dr. Karen Stern closes with advice for urologists on the fence: every technology works, but the best choice is the one that fits your practice.

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Resources

Are We Overreporting Post-Op Sepsis? The Difference Between Reported and Verified Rates of Post-Ureteroscopy Sepsis Using the Sepsis 3 Criteria at a Single Institution. J Endourol. 2026https://doi.org/10.1177/08927790251394736 Flexible Ureteroscopy with a Flexible and Navigable Suction Ureteral Access Sheath Versus Mini-Percutaneous Nephrolithotomy for Treatment of 2-3 cm Renal Stones: An International, Multicenter, Randomized, Noninferiority Trial. Eur Urol. 2026https://doi.org/10.1016/j.eururo.2025.06.001 Dr. Karen Stern, Mayo Clinic physician profilehttps://www.mayoclinic.org/biographies/stern-karen-l-m-d/bio-20464490 Dr. Ruchika Talwar, BackTable Urology contributor pagehttps://www.backtable.com/shows/urology/contributors/dr-ruchika-talwar

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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