BackTable Urology

How can clinics minimize toxicity and maximize outcomes in intravesical bladder cancer treatment? In this episode of BackTable Urology, host Dr. Vignesh Packiam talks with nurse practitioners Mary Dunn (UNC) and Meredith Donahue (Vanderbilt) about how advanced practice providers (APP) workflows and hands-on management are transforming care for non-muscle-invasive bladder cancer. The discussion highlights innovative strategies for symptom management, patient education, catheter techniques, and streamlined operational protocols across both established and emerging intravesical therapies.

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

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Introduction04:25 - Non Drug Symptom Tips09:39 - Day Of Treatment Clearance14:50 - Post Treatment Triage20:36 - Treatment Fatigue Strategies24:48 - Pelvic Floor And IC Tools27:33 - Teamwork Final Pearls

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More about this episode

They share individualized pharmacologic and non-pharmacologic approaches for managing lower urinary tract symptoms, such as NSAIDs, anticholinergics, beta-3 agonists, Pyridium, timed voiding, avoidance of irritants, and constipation management. The episode covers patient education resources from the Bladder Cancer Advocacy Network (BCAN), catheterization techniques tailored to patient needs, and a gravity installation method to reduce spasms. The conversation also reviews day-of-treatment clearance and triage protocols, operational considerations for new agents like Enlexo, Adstiladrin, and gemcitabine/docetaxel, as well as financial workflows that prevent drug wastage. Additional topics include managing cumulative bladder toxicity, pelvic floor PT, addressing treatment fatigue, and integrating multifactorial evaluation and exercise into patient care.

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Resources

Bladder Cancer Advocacy Network (BCAN) Basic Handbook & Patient Resources

https://bcan.org/bladder-cancer-basics-handbook/

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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 happens when urologists look beyond the clinic and take on leadership in the life sciences industry? In this episode of BackTable Urology, host Dr. Raj Pruthi talks with Dr. Kelly Parsons and Dr. Pat Keegan about their journeys from academic urology to executive roles in biotech and pharma. They discuss what motivated their transitions, how physician expertise adds value in industry, and the realities of life outside of traditional clinical practice.

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

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Timestamps

00:00 - Introduction05:36 - Choosing a Non-Clinical Path11:07 - Reactions from Mentors and Peers14:31 - What Feels Most Fulfilling18:31 - A Typical Week in Biotech26:04 - Working with Investors31:21 - Additional Degrees and MBA Debate35:31 - Is it Risky to Leave Clinical Practice?44:13 - Networking and Next Steps47:59 - Wrap Up

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More about this episode

The conversation explores the day-to-day work of industry leaders, the impact of advanced degrees like MBAs, and the importance of networking for physicians considering a nonclinical path. Drs. Parsons and Keegan reflect on the challenges and rewards of leaving clinical medicine, the support and reactions from mentors and peers, and what they miss most about patient care. They also share practical advice for urologists and other specialists who are curious about new career opportunities beyond the exam room.

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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

Why does up to 10% of bladder cancer pathology change on expert review, and what does that mean for your intermediate and high-risk patients? In this episode of BackTable, Dr. Bogdana Schmidt interviews urologists Dr. Kristen Scarpato and Dr. Sunil Patel to explore the complexities of diagnosis and risk assessment in non–muscle invasive bladder cancer (NMIBC). They discuss the real-world challenges of pathology interpretation, risk-group assignment, evolving diagnostic tools, and the impact these factors have on treatment decisions and patient outcomes.

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

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps00:00 - Introduction01:02 - Risk Stratification07:22 - Upstaging to High Risk10:06 - Calculators and Patient Education15:22 - Specific Tests Use Cases18:50 - Conflicting Biomarker Results21:36 - Adjunct Tests and Counseling24:03 - Recurrence After Chemo Next Steps27:01 - Escalation Deescalation Balance32:48 - Future Research Priorities35:43 - Biology Based Risk Stratification38:03 - Clinical Pearls and Wrap Up

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More about this episodeThe conversation highlights the heterogeneity of intermediate-risk disease, the role and importance of expert pathology over-reads, and the need to accurately document the risk category for ongoing care. They discuss selective use of urinary and genomic assays and how these tests fit alongside cystoscopy and blue light endoscopy. Practical treatment approaches are reviewed, including when to use intravesical gemcitabine or BCG, managing care during BCG shortages, and balancing escalation versus de-escalation of therapy. Additional topics include strategies for long-term surveillance, upper tract imaging, rising rates of bladder cancer in younger patients, and why thorough TURBT and strong patient-provider communication remain central to optimal management.

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Resources

The Memorial Studyhttps://www.mskcc.org/cancer-care/clinical-trials/19-288

The BRIDGE Studyhttps://www.nejm.org/doi/full/10.1056/NEJMoa1501035

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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

Robotic technology is expanding what’s possible in reconstructive urology, prompting surgeons to rethink traditional approaches and consider new minimally invasive procedures. In this episode of BackTable Urology, Dr. Ziho Lee joins host Dr. George Koch to explore the rapid evolution of robotic reconstructive surgery and its expanding role in complex pelvic and retroperitoneal procedures.They discuss the the role of single-port platforms, new strategies for managing ureteral strictures and urinary diversion, and how research, training, and patient-reported outcomes are shaping the future of minimally invasive urologic care.

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

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Timestamps00:00 - Introduction03:10 - Bridging Reconstruction and Robotics07:41 - Where Robots Help Most14:33 - Ureteral Rest16:41 - 20% Nephrectomy Rule19:04 - Single Port Indications20:55 - Ileal Ureter Tips and Tricks22:34 - Robotic Reconstruction Course28:55 - Case: VUAS Repair39:35 - Final Advice

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ResourcesUreteral Rest is Associated With Improved Outcomes in Patients Undergoing Robotic Ureteral Reconstruction of Proximal and Middle Ureteral Strictureshttps://pubmed.ncbi.nlm.nih.gov/33639184/

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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 matters most to patients with non-muscle invasive bladder cancer (NMIBC)? In this episode of BackTable Urology, Dr. Kelly Bree, Dr. Saum Ghodoussipour, and Meredith Donahue, N.P., join host Dr. Vignesh Packiam to discuss the power of shared decision-making across the NMIBC spectrum. They explore risk-adapted treatment selection, when to escalate or de-escalate therapy, and how to navigate conversations about recurrence risk, treatment burden, quality of life, and the possibility of cystectomy.

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

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This podcast is supported by an educational grant from Johnson & Johnson.

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Timestamps

00:00 - Introduction01:55 - Second Opinions and Patient Counseling06:08 - Intermediate Risk Stratification12:13 - Treatment Options for Intermediate Risk NMIBC16:20 - BCG and Alternative Treatments for High Risk NMIBC26:49 - Options for BCG-Unresponsive NMIBC31:42 - Sequencing and Cystectomy37:03 - Financial and Time Toxicity41:08 - Biomarkers and ctDNA44:04 - Future Trials and NMIBC Innovations

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More about this episode

They also review emerging therapies such as ZUSDURI, the evolving role of intravesical treatments, and the promise of biomarkers and ctDNA for personalized care. The discussion covers practical strategies for patient counseling, key updates to clinical guidelines, and a preview of innovations shaping the future of NMIBC management.

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Resources

Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection: The Randomized Noninferiority Phase 3 JCOG1019 Trial:https://pubmed.ncbi.nlm.nih.gov/41571573/

Twelve-Month Results From the CISTO Study Comparing Radical Cystectomy Versus Bladder-Sparing Therapy for Recurrent High-Grade Non–Muscle-Invasive Bladder Cancerhttps://ascopubs.org/doi/10.1200/JCO-25-01324

CIRCULATING TUMOR DNA AS A BIOMARKER FOR UPSTAGING AND ADVERSE PATHOLOGY IN HIGH-RISK NON–MUSCLE-INVASIVE BLADDER CANCER:https://www.auajournals.org/doi/abs/10.1097/01.JU.0001191388.74345.c9.09

Preoperative Circulating Tumor DNA Predicts Upstaging and Recurrence in High-Risk Nonmuscle-Invasive Bladder Cancer Undergoing Radical Cystectomyhttps://pubmed.ncbi.nlm.nih.gov/41843048/

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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