Ep. 278 Shared Decision Making in GU Cancer Management with Dr. Hung-Jui "Ray" Tan
When it comes to GU cancers, fear and uncertainty often shape a patient’s treatment decisions well before the clinical data does. Dr. Hung-Jui (Ray) Tan of UNC Health sits down with host Dr. Ruchika Talwar to unpack why decision-making around small renal masses, low-risk prostate cancer, and other GU conditions can be so challenging. Dr. Tan explains the concept of decisional conflict, a patient’s internal uncertainty about the “right” course of action, and how it predicts downstream satisfaction and health outcomes.
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SYNPOSIS
Dr. Tan shares practical, evidence-based strategies for improving decision-making conversations, from clearer framing to simple visual aids that reduce anxiety. They discuss how patients often perceive much greater risk of metastasis than what data shows, and why “turning down the temperature” is essential before discussing options. They also touch on evolving tools, including AI, that may improve how clinicians communicate risk and support patients through uncertainty.
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TIMESTAMPS
00:00 - Introduction01:02 - Journey to Decision Science05:59 - Research on Decision Making14:41 - Shared Decision Making in Practice22:39 - Resources for Shared Decision Making39:54 - Improving Decision-Making Conversations
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RESOURCES
Decisional conflict among patients newly diagnosed with clinical T1 renal masses: a prospective studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC11233232/
Decisional Quality in Patients With Small Renal Masseshttps://pubmed.ncbi.nlm.nih.gov/29574123/
Impact of renal mass biopsy on decision-making experience for clinical T1 renal masseshttps://pubmed.ncbi.nlm.nih.gov/41151063/
MUSIC Patient and Provider Resources for Shared Decision Makinghttps://musicurology.com/programs/kidney/
P3P - Prostate Cancer Shared Decision Making Resourcehttps://www.p3p4me.org/users/login
Best Case/Worst Case Treatment Decision Toolhttps://patientpreferences.org/best-case-worst-case/
Better Conversations Treatment Decision Toolhttps://patientpreferences.org/better-conversations/
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Ep. 277 NMIBC Tumor Board: Upper Tract Challenges with Dr. Mark Tyson and Dr. Sarah Psutka
One of the most common dilemmas in urologic oncology: what do you do when a patient has T1 disease in both the bladder and the ureter? In the final episode of the 2025 NMIBC Creator Weekend™ series, Dr. Vignesh Packiam, Dr. Mark Tyson and Dr. Sarah Psutka share how they approach complex bladder cancer cases with upper tract involvement.
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This podcast is supported by:
Ferring Pharmaceuticalshttps://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1
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SYNPOSIS
The doctors discuss complex bladder cancer cases, sequencing treatments for patients with dual ureteral and bladder T1 disease, the impact of cystectomy on quality of life, and the use of blue light cystoscopy and intravesical therapy. They also delve into the rise of bladder cancer in younger patients, considerations for low-grade intermediate-risk disease, and emerging therapeutic options.
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TIMESTAMPS
00:00 - Introduction05:52 - Upper Tract Positive Cytology Dilemma09:10 - Cystectomy Considerations15:55 - Developing Better Patient-Reported Outcomes20:26 - Challenges with New Therapeutics26:31 - Deescalating Treatment for Low-Grade Cancer33:29 - Closing Remarks
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RESOURCES
CISTO Trialhttps://pubmed.ncbi.nlm.nih.gov/37980511/
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Ep. 276 Understanding Medical Waste Management in Operating Rooms with Dr. Sunil Patel
Can we reduce OR waste without compromising patient care? In this episode of BackTable Urology, Dr. Sunil Patel (Johns Hopkins) joins host Dr. Ruchika Talwar (Vanderbilt) to explore strategies for improving environmental sustainability in surgical practice.
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SYNPOSIS
They discuss the scope of OR-generated waste, the impact of plastics and carbon emissions, and emerging data linking environmental exposures to carcinogenesis. Dr. Patel highlights evidence supporting reusable vs. single-use instruments, shares examples of successful waste-reduction initiatives, and emphasizes the importance of cross-disciplinary collaboration to make sustainable practices achievable across healthcare systems.
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TIMESTAMPS
0:00 - Introduction3:29 - Current State of OR Waste20:09 - Strategies to Reduce Waste24:52 - Impact of Climate Change on Patients33:55 - Future Directions40:27 - Conclusion
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Ep. 275 NMIBC Tumor Board: Nuances in Management with Dr. Mark Tyson and Dr. Sarah Psutka
When standard therapy fails, it does not have to be the end of the road for high-risk bladder cancer patients. Modern treatments, biomarkers, and clinical studies have opened up new avenues for treating recurrent non-muscle invasive bladder cancer (NMIBC). The penultimate episode of the 2025 NMIBC Creator Weekend™ series features urologic oncologists Dr. Vignesh Packiam, Dr. Mark Tyson, and Dr. Sarah Psutka discussing how they navigate complex bladder cancer scenarios.
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This podcast is supported by:
Ferring Pharmaceuticalshttps://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1
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SYNPOSIS
The doctors share treatment strategies, staging processes, and post-therapy patient management techniques. They address recurrent disease, approaches to different stages of cancer, the role of biomarkers in determining treatment paths, and considerations for both high-risk and intermediate-risk patients. Additionally, the episode touches on new treatments, clinical trials, and patient quality of life post-treatment.
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TIMESTAMPS
00:00 - Introduction02:08 - Case Study: Initial Patient Assessment04:59 - Surgical Considerations and Techniques10:22 - Managing Bladder Cancer Recurrence11:15 - Treatment Options and Clinical Trials15:12 - Advanced Treatment Strategies28:14 - Closing Remarks and Credits
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RESOURCES
VISTA Trial https://abstracts.mirrorsmed.org/abstracts/vista-phase-3-trial-vicinium-epcam-targeted-pseudomonas-exotoxin-bcg-unresponsive-non
BRIDGE Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10515442/
CORE-008 Trialhttps://www.sciencedirect.com/science/article/abs/pii/S1078143924010147
GAIN Trialhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10176900/
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Ep. 274 Techniques & Challenges in Bladder Transplant Surgery with Dr. Nima Nassiri
For the first time in history, a human bladder was transplanted. Dr. Nima Nassiri (UCLA) joins Dr. Ruchika Talwar to share how his team completed this landmark operation alongside a kidney transplant. He walks through the clinical scenario, key steps in donor and recipient selection, and how years of preclinical work informed the operative approach.
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SYNPOSIS
The conversation explores the broader future of bladder transplant surgery, from ethical considerations to the potential for merging bladder transplantation with tolerance-induction protocols that could one day eliminate the need for lifelong immunosuppression. Dr. Nassiri reflects on the importance of patient-first decision-making, teamwork, and careful innovation as the field moves toward new possibilities in restorative urology and transplant medicine.
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TIMESTAMPS
00:00 - Introduction02:51 - The Path to Bladder Transplant Surgery05:00 - Scientific Challenges and Barriers06:45 - Patient Selection and Initial Outcomes12:28 - Quality of Life Considerations14:18 - Performing the First Bladder Transplant18:59 - Donor Matching21:28 - Ethical Considerations24:51 - Research Gaps and Future Prospects
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RESOURCES
Clinical Trial: Vascularized Composite Bladder Allograft Transplantationhttps://www.clinicaltrials.gov/study/NCT05462561
Clinical Trial: Retro-active Immunological Tolerance in Patients With Well-functioning Pre-existing HLA-identical Kidney Transplantshttps://clinicaltrials.gov/study/NCT05525507
The BackTable Urology Podcast is a resource for practicing urologists to learn tips, techniques, and practical advice from their peers in the field. Listen here or on the streaming platform of your choice.
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