BackTable Urology

What are the key practice changes introduced in the new American Urological Association (AUA) vasectomy guidelines? In this episode of BackTable Urology, Dr. Akanksha Mehta (Emory University), Vice Chair of the AUA Vasectomy Guidelines Committee, joins Dr. Catherine Nam (University of Michigan) to discuss the latest updates to vasectomy practice.

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SYNPOSIS

Dr. Mehta and Dr. Nam review the key changes in vasectomy guidelines. They address common misconceptions about sexual function and long-term health risks, as well as the role of telemedicine consultation and day-of-procedure examination. Their discussion also covers recommended surgical techniques and updated guidance on post-vasectomy semen analysis, including mail-in testing options. Finally, Dr. Mehta outlines fertility considerations after vasectomy, including cryopreservation, reversal, and sperm retrieval with IVF, and how clinicians can counsel patients about expectations and referral pathways.

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TIMESTAMPS00:00 - Introduction02:07 - Why Update the Guidelines05:38 - Key Guideline Changes11:02 - Sexual Function Concerns17:19 - Health Risks Debunked21:28 - Periprocedural Best Practices28:25 - Semen Analysis Follow Up37:12 - Future of Male Contraception39:11 - Conclusions

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RESOURCES

Vasectomy: AUA Guideline (2026)https://www.auanet.org/guidelines-and-quality/guidelines/vasectomy-guideline

When a male patient presents with lower urinary tract symptoms, should you blame the bladder or bust the prostate? In this SUFU-sponsored episode of BackTable Urology, Dr. Benjamin Brucker (NYU) and Dr. Craig Comiter (Stanford) join host Dr. Chris Tenggardjaja (Kaiser Permanente) for a discussion on evaluating and treating male LUTS using a bladder-and-outlet framework.

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This podcast was developed in collaboration with:

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home.aspx

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SYNPOSIS

Through a case-based approach, they review initial evaluation strategies including symptom history, validated questionnaires, uroflowmetry, post-void residual measurement, and when tools like voiding diaries can help clarify the diagnosis. The conversation then moves to management, outlining a stepwise approach from behavioral interventions and medications to surgical options when symptoms persist. The doctors discuss how prostate anatomy, side effect profiles, and patient priorities guide treatment selection, when urodynamics may add diagnostic clarity, and why addressing outlet obstruction early may help prevent more difficult-to-treat bladder dysfunction over time.

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TIMESTAMPS

00:00 - Introduction06:31 - Workup for Frequency and Nocturia11:41 - When to Use a Voiding Diary19:18 - Behavioral Therapy26:40 - Post-Finasteride Syndrome30:03 - Surgical Options44:41 - Nocturia Counseling47:32 - Botox With Outlet Surgery49:47 - When to Order Urodynamics54:14 - Bladder or Prostate?

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RESOURCES

Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)https://sufuorg.com/home

Not every pediatric GU injury fits neatly into the guidelines. In this episode of BackTable Urology, trauma reconstructive urologist Dr. Travis Pagliara (Hennepin County Medical Center) joins hosts Dr. Arthi Hannallah and Dr. Niccolo Passoni to walk through practical management of pediatric renal, bladder, urethral, and genital injuries. Through case-based discussion, they highlight diagnostic decision-making, when to observe versus intervene, and how to approach these patients in the acute setting.

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SYNPOSIS

The conversation also explores operative pearls, the role of technologies like the Optilume balloon, and why thoughtful short-term follow up is critical for both patient outcomes and clinician learning. Together, they emphasize a measured, conservative mindset whenever appropriate to minimize morbidity while delivering high-quality trauma care.

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TIMESTAMPS

00:00 - Introduction03:07 - Kidney and Ureteric Trauma19:16 - Urethral Trauma34:42 - MRI vs Ultrasound47:56 - Collaboration in Reconstructive Urology52:26 - Testicular Trauma57:29 - Epididymal Injury01:02:35 - Follow-Ups Matter01:05:14 - Foreign Body Stories01:06:52 - Career Advice

What do the 2025 AUA guidelines change about how we evaluate and manage chronic male pelvic pain? In this episode of BackTable Urology, Dr. Susan MacDonald (Penn State) joins host Dr. George Koch (Ohio State University) to break down the new American Urological Association (AUA) guidelines on chronic male pelvic pain, including chronic prostatitis / chronic pelvic pain syndrome and chronic scrotal content pain.

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SYNPOSIS

They review a structured approach from initial evaluation and physical examination to pain management. The discussion outlines an evidence-informed, multimodal management framework incorporating medications, pelvic floor physical therapy, behavioral health interventions, neuromodulators, and selective procedural strategies, with an emphasis on realistic expectation setting in this complex patient population.

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TIMESTAMPS

00:00 - Introduction01:41 - Path to Chronic Pelvic Pain Work08:19 - Getting Involved with the AUA13:02 - Developing Guidelines19:56 - Initial Patient Evaluation27:11 - Setting Expectations32:05 - Making the Diagnosis35:17 - Success Rates and Counseling Patients39:51 - Central Sensitization44:31 - Physical Exam Recommendations49:26 - Non-Pharmacologic Options54:38 - Follow Up Cadence01:02:24 - Chronic Scrotal Pain vs CPPS01:08:26 - Conclusion

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RESOURCES

Diagnosis and Management of Male Chronic Pelvic Pain (Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Chronic Scrotal Content Pain): AUA Guideline (2025)https://www.auanet.org/guidelines-and-quality/guidelines/male-chronic-pelvic-pain

What do you do when metastatic urothelial cancer responds dramatically to systemic therapy? In this episode of BackTable Urology, Dr. Abhinav Khanna (Mayo Clinic) speaks with host Dr. Daniel Roberson about the growing question of consolidative surgery after enfortumab vedotin plus pembrolizumab. They discuss how EV-pembro has reshaped treatment expectations, why unexpected complete or near-complete responses are prompting tumor board debates about cystectomy, and how careful multidisciplinary decision-making guides which patients may be considered for surgery.

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SYNPOSIS

The conversation reviews early outcomes showing high rates of pathologic downstaging and the possibility that many patients may avoid additional systemic therapy after surgery, while emphasizing this approach is not yet standard of care. Dr. Khanna highlights coordination with medical oncology, radiology, and pathology, postoperative considerations, and the potential future role of biomarkers such as ctDNA. Ultimately, the episode underscores the need for clinical trials and thoughtful patient selection as clinicians navigate integrating surgery into an evolving systemic therapy landscape.

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TIMESTAMPS

00:00 - Introduction02:19 - The Evolution of Urothelial Carcinoma Treatment05:23 - Rationale for Consolidative Surgery12:32 - Patient Selection Criteria15:23 - Surgical Approach and Considerations23:58 - Pathologic Findings31:34 - The Role of Radiation39:38 - Biomarkers44:10 - Prospective Trials and Future Directions53:06 - Guidance for Urologists

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RESOURCES

Consolidative Surgery for Advanced Urothelial Carcinoma Following Induction Enfortumab Vedotin and/or Immune Checkpoint Inhibitor Therapy: A Multicenter Analysishttps://pubmed.ncbi.nlm.nih.gov/40425390/

Enfortumab Vedotin and Pembrolizumab in Untreated Advanced Urothelial Cancerhttps://www.nejm.org/doi/full/10.1056/NEJMoa2312117

Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancerhttps://www.nejm.org/doi/abs/10.1056/NEJMoa2401497