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In this episode of the BackTable OBGYN podcast, Drs. Kimberly (Kim) Kenton and Margaret (Maggie) Mueller discuss advancements in patient recovery guidelines, particularly after gynecologic surgeries.
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SYNPOSIS
The discussion first covers the evolution of post-operative care protocols, emphasizing the lack of evidence behind traditional post-op restrictions and highlighting recent studies that suggest liberal post-operative activities might lead to better recovery outcomes without compromising surgical results. Additionally, the episode touches on the impact of minimally invasive surgical techniques, such as single port surgeries, on patient recovery times and hospital system efficiencies. Finally, the conversation delves into the shift towards team-based care, where nurses and nurse practitioners actively participate in pre-op counseling, educating patients, and enhancing the overall healthcare team’s efficiency. The overarching theme is the crucial role of evidence-based practice in improving patient care and recovery in obstetrics and gynecology.
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TIMESTAMPS
00:00 - Introduction
02:57 - Exploring Postoperative Restrictions in Gynecologic Surgery
20:56 - Adapting Postoperative Visits
26:02 - Recovery Times, Hospital Stays, and the Impact on Patients and Healthcare
35:58 - Team-Based Care and Communication Strategies
44:38 - Surgical Techniques and Recovery Insights
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RESOURCES
Mueller MG, Kenton K. Activity Restrictions After Gynecologic Surgery. Obstet Gynecol. 2024 Mar 01; 143(3):378-382. PMID: 38207325; PMCID: PMC10863662. -
In this crossover episode of BackTable Urology and OBGYN, Dr. Suzette Sutherland interviews three urological/gynecologic innovators, Dr. Ali Haessler, Dr. Jay Shakuri-Rad, and Dr. Tova Weiss, who are all at different career stages and product development phases.
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SYNPOSIS
Dr. Tova Weiss, a urology resident at the University of Washington, discusses her development of a safer urinary catheter so that if a patient were to pull out their catheter, the distal part would disconnect from the catheter inside the urethra, preventing urethral trauma. Dr. Jay Shakuri-Rad, a practicing urologist specializing in robotics and neuromodulation, shares his creation of the Foramen Finder to enhance sacral neuromodulation procedures. Dr. Allie Haessler, a practicing urogynecologist, talks about her invention of a novel vaginal ring aimed at providing neuromodulation therapy for pelvic floor issues. They each discuss the inspiration behind their inventions, challenges faced, and the importance of failure in the path to innovation. The episode emphasizes the role of physicians in identifying healthcare gaps, collaborating across disciplines, and pushing the boundaries of medical technology to improve patient care.
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TIMESTAMPS
00:00 - Introduction
01:54 - Dr. Tova Weiss and the Urinary Catheter Accessory
08:49 - Dr. Jay Shakuri-Rad and the Foramen Finder
22:04 - Dr. Allie Haessler and the Neuromodulation Vaginal Ring
27:29 - Navigating the Patent Process and Protecting Innovation
29:52 - The Path to FDA Approval
37:11 - Advice for Aspiring Innovators in Medicine
40:52 - Embracing Failure and the Inventor’s Mindset -
Saknas det avsnitt?
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This episode of BackTable OBGYN features an extensive discussion with Dr. Keith Isaacson, a specialist in Reproductive Endocrinology and Infertility, regarding the complexities of diagnosing and treating adenomyosis, emphasizing surgery, medical treatments, and research in the field.
Dr. Isaacson describes the pivots in the field’s understanding of adenomyosis and endometriosis, including the impact of these conditions on fertility and potential treatment pathways. Adenomyosis has been redefined in the past five years as a disease that affects women of all reproductive ages and causes dysmenorrhea, heavy menstrual bleeding, and infertility. Because the disease is found in the myometrium of the uterus, it has historically been difficult to diagnose unless through pathology following hysterectomy; however, imaging has since improved and there are now criteria seen on ultrasound that are consistent with adenomyosis.
Dr. Isaacson then discusses the differences and misconceptions about adenomyosis compared to endometriosis. Additionally, the episode touches on the evolution of treatment strategies over the years, including medical therapy versus surgery. Furthermore, Dr. Isaacson highlights the crucial role of research in uncovering disease pathophysiology and new therapeutic approaches.
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SHOW NOTES
00:00 - Introduction
04:06 - Definitions, Symptoms, and Insights
11:33 - Exploring Treatment Options for Adenomyosis and Infertility
21:30 - The Intersection of Endometriosis and Adenomyosis
30:09 - Imaging, Surgery, and Pathology
36:31 - The Future of Research and Patient-Centric Care
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RESOURCES
Moawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: An Updated Review on Diagnosis and Classification. J Clin Med. 2023 Jul 21;12(14):4828. doi: 10.3390/jcm12144828. PMID: 37510943; PMCID: PMC10381628. -
This episode features host Dr. Mark Hoffman and guest Dr. Jessica Ritch as they discuss the lack of menopause education and research during medical training, and the necessity for practitioners to learn more about menopausal symptoms and management strategies.
The episode begins with Dr. Ritch, a minimally invasive gynecologic surgeon, describing her path into menopause care, including the development of her podcast, EnRitched Menopause. She touches on the role of laboratory workup in menopause, but emphasizes the patient’s symptoms are more important to address than numerical values on labs. She then delves into treatment options, including the complexities of hormone replacement therapy, and the multifactorial nature of sexual function issues. Most importantly, the physicians emphasize listening to patients, offering comprehensive care beyond hormone therapy, and utilizing resources like podcasts to educate both practitioners and patients. Finally, they explore new treatments and the potential future advancements in menopause care.
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EARN CME
Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/I7Ougz
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SHOW NOTES
00:00 - Introduction
08:52 - The EnRitched Menopause Podcast: A Resource for Patients and Practitioners
15:22 - Common Patient Presentations of Menopause
20:43 - The Role of Laboratory Evaluation of Hormone Levels
24:20 - Testosterone in the Menopausal Patient
27:13 - Navigating Hormone Therapy: Estrogen, Progesterone, and Testosterone
31:03 - Physiologic Hormonal Changes in Menopause
35:00 - Shared Decision-Making
39:00 - Exploring Sexual Function and Libido in Menopause
45:38 - The Power of a Physician’s Support and Trusted Advice
50:09 - Innovative Approaches and Future Directions in Menopause Care
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RESOURCES
EnRitched Menopause Podcast:
https://podtail.com/en/podcast/enritched-menopause/welcome-to-enritched-menopause/
Rosy App:
https://play.google.com/store/apps/details?id=com.rosywellness&pli=1 (Google)
https://apps.apple.com/us/app/rosy-womens-sexual-health/id1444780510 (Apple) -
In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair.
Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures.
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SHOW NOTES
00:00 - Introduction
07:18 - Defining Isthmocele and the History of Isthmocele
10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility
19:31 - Exploring Surgical Techniques for Isthmocele Repair
27:54 - Understanding Hysteroscopic Resection
30:12 - Addressing C-Section Ectopics and Isthmocele Repairs
36:46 - Adapting the Surgical Approach to Different Patient Scenarios
39:35 - Postoperative Complications and Safety Measures
40:55 - The Future of Isthmocele: Surgical Standardization
50:51 - Closing Thoughts and Acknowledgements
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RESOURCES
Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840. -
In this episode of the BackTable OBGYN Podcast, hosts Dr. Mark Hoffman and Dr. Amy Park discuss how cultivating an effective team culture in surgery can mitigate complications.
The physicians emphasize that how surgical teams treat each other can significantly affect patient outcomes. They suggest under-promising and over-delivering to patients, their family, and members of the surgical team. The doctors recommend having a care culture, allowing everyone to voice their concerns without fear of reprisals. They also discuss the importance of self-management, leadership, and taking responsibility inside and outside the OR for complications and places where the surgery could have gone smoother. They agree that those who nurture a positive OR culture have higher success rates, noting that complications demand more than technical skills to handle - it takes emotional intelligence, humility, and a good support network.
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SHOW NOTES
00:00 - Introduction
02:07 - Dealing with Surgical Complications
04:24 - The Emotional Impact of Complications on Surgeons
07:24 - The Importance of Patient Communication and Care Post-Complication
08:35 - The Role of Consent and Preoperative Counseling in Managing Complications
11:18 - The Importance of a Supportive and Open Culture in Medicine
15:32 - The Importance of Learning from Mistakes in Medicine
24:28 - The Role of Leadership and Teamwork in the Operating Room
29:56 - The Value of Familiarity in a Medical Team
30:38 - The Importance of Recognizing and Appreciating All Roles in a Medical Team
34:31 - The Role of Care and Empathy in Medical Practice
37:28 - The Role of Preparation in Avoiding Complications
40:53 - The Importance of Scheduling and Time Management in Medical Practice
50:31 - The Impact of Culture on Reporting and Addressing Adverse Events
51:19 - The Importance of Feedback and Self-Reflection in Medical Practice -
In this episode of BackTable OBGYN, host Dr. Mark Hoffman engages in a comprehensive discussion with Dr. Jorge Carrillo, a MIGS specialist at the Orlando VA Healthcare System and Site Director for the UCF/HCA Healthcare OB/GYN Residency Program, about the complexities of chronic pelvic pain from the perspective of a biopsychosocial model.
The conversation dwells mostly on the intricate relationship between pain, trauma, and the patient’s psychological state as it relates to chronic pelvic pain. Dr. Carrillo emphasizes the importance of adopting a trauma-informed care approach that creates a safe environment for patients. The discussion also covers the use of surveys for patient information, the importance of organizing thoughts during patient evaluation, and an outline of the four major categories of pelvic pain: gynecologic, urologic, gastrointestinal, and musculoskeletal. Dr. Carrillo shares valuable insights into managing complex conditions such as pelvic pain, providing an education-first approach for patients with emphasis on shared decision-making, and outlines how he and his team operate within a multidisciplinary framework for patient treatment.
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SHOW NOTES
00:00 - Introduction
04:32 - Dr. Carrillo’s Journey in the Medical Field
08:51 - The Importance of Trauma-Informed Care in Chronic Pelvic Pain
14:54 - Understanding the Biopsychosocial Model in Chronic Pelvic Pain
19:49 - The Initial Approach to Evaluating Patients with Chronic Pelvic Pain
25:25 - Understanding Nociplastic Pain and Sensitization
28:00 - Treatment Approaches for Sensitization
29:26 - The Importance of Organized Thinking in Pain Management
30:20 - The Role of Questionnaires in Patient Assessment
35:10 - The Importance of Multimodal Approach in Pain Management
43:00 - The Role of the Provider in Organizing Patient Care
45:37 - The Importance of Education in Pelvic Pain Management
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RESOURCES
International Pelvic Pain Society Handouts for Different Disorders of Chronic Pelvic Pain:
https://www.pelvicpain.org/public/resources/educational-resources/informational-handouts -
On this episode of the BackTable OBGYN Podcast, host Dr. Mark Hoffman is joined by Dr. Arpit Davé, an assistant professor at Penn State Health Milton S. Hershey Medical Center in the Department of Obstetrics and Gynecology. Together, they discuss the importance of surgical education and best practices for teaching new generations of surgeons.
Both Dr. Davé and Mark emphasize TATA, or tools, access, tissue handling, and anatomy, when practicing and teaching how to master surgery. They discuss the benefits of fostering a “sandbox-learning” environment, or a zone of safety where learners can practice techniques on patients. They also delve into systematic approaches for surgical training and the challenges in measuring the progress of trainees. Most importantly, Dr. Davé and Mark explore how to teach trainees not just surgery, but how to learn about surgery so that they feel competent doing new surgeries as their career in medicine progresses.
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SHOW NOTES
00:00 - Introduction
04:34 - The Role of Teaching in Medicine and Lifelong Learning in Surgery
07:15 - The Challenges of Surgical Training Volume
09:22 - The Journey of Learning and Teaching Surgery
17:59 - Understanding TATA: Surgical Tools, Access, Tissue Handling, and Anatomy
27:01 - The Importance of Practice in Surgical Training
30:04 - The Role of Tissue Handling in Surgical Training
31:20 - Creating Zones of Safety in Surgical Practice
33:31 - The Concept of “Sandboxing” in Surgical Training
34:27 - The Importance of Incremental Learning in Surgery
35:22 - The Importance of Breaking Down Surgical Procedures into Steps
42:32 - The Meaning of “Access” in Surgery
47:26 - How to Teach Trainees to Handle Tough Surgeries and the Unknown
50:05 - The Future of Surgical Training and Education -
This episode of BackTable OBGYN features Dr. Matt Reeves, a seasoned OBGYN and CEO/Founder of the DuPont Clinic, and host Dr. Amy Park as they discuss the use of Rh immune globulin (RhoGAM) in pregnancy.RhoGAM is traditionally administered to Rh- women at 28 weeks gestation, within 72 hours of birth, and frequently after an abortion in order to prevent Rhesus alloimmunization in future pregnancies. However, with recent data showing negligible Rh- blood cell exposure in early pregnancy terminations, the need for RhoGAM in such cases is being questioned. Additionally, considering the scarcity of RhoGAM and the reality of smaller family sizes globally, the importance of RhoGAM in Rh alloimmunization prevention might not be as significant as previously thought. However, limited evidence and ingrained medical practices may cause the transition to be slow.---SHOW NOTES00:00 - Introduction03:09 - Understanding RhoGAM: Origin and Development06:06 - The Science Behind RhoGAM and Its Role in Pregnancy08:13 - The Controversy and Debate Around RhoGAM Usage11:52 - The Impact of RhoGAM on Public Health and Medical Practice15:25 - The Future of RhoGAM: Perspectives and Predictions29:24 - Closing Thoughts and Further Resources---RESOURCESHorvath, S., Goyal, V., Traxler, S., & Prager, S. (2022). Society of Family Planning committee consensus on Rh testing in early pregnancy. Contraception, 114, 1–5.https://doi.org/10.1016/j.contraception.2022.07.002Horvath S, Huang Z, Koelper NC, et al. Induced Abortion and the Risk of Rh Sensitization. JAMA. 2023;330(12):1167–1174. doi:10.1001/jama.2023.16953
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In this episode, host Dr. Suzette Sutherland is joined by Dr. Kelly Casperson, a urologist who specializes in women’s sexual health, to discuss the importance of education, therapy, and hormone replacement in female sexual health.
They explore topics such as the role of estrogen and testosterone in women’s sexual desire, FDA-approved medications for hypoactive sexual desire disorder, and the importance of sex education and communication within relationships. They also highlight the topic of gender inequality in sexual health care delivery and the lack of clinical resources specifically tailored to women’s needs. In sum, they aim to provide a deeper understanding of female sexual health and offer strategies for practitioners to provide more effective care.
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SHOW NOTES
00:00 - Introduction
05:53 - The Role of Urologists in Women’s Sexual Health
07:18 - The Importance of Communication in Addressing Sexual Dysfunction
10:23 - The Role of the Clitoris in Female Orgasm
19:52 - Understanding the Hormones Behind Female Sexual Desire
25:32 - The Misconceptions and Gender Bias Surrounding Hormones
26:04 - The Role of Testosterone in Menopause and Sexual Desire
30:02 - The Challenges of Commercially Available Testosterone Products
32:52 - Non-Hormonal Treatments for Low Libido
42:41 - The Importance of Referring to Sex Therapists and Other Resources
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RESOURCES
Dr. Kelly Casperson’s Website
https://kellycaspersonmd.com/
You Are Not Broken Podcast
https://kellycaspersonmd.com/you-are-not-broken-podcast/
“You Are Not Broken” by Kelly Casperson
https://kellycaspersonmd.com/you-are-not-broken-book/
“Magnificent Sex” by Peggy Kleinplatz
https://www.amazon.com/Magnificent-Sex-Lessons-Extraordinary-Lovers/dp/0367181371
American Association of Sexuality Educators, Counselors, and Therapists
https://www.aasect.org/ -
In this episode, Dr. Suzette Sutherland and Dr. Alana Desai from the University of Washington discuss the management of urinary tract stones in pregnant patients, considerations for ureteroscopy, and consequences of radiation exposure in the fetus.
First, the doctors underscore the importance of ultrasound as the first line imaging modality to minimize fetal exposure to radiation. Dr. Sutherland and Dr. Desai also delve into nausea and pain management options, recommended diets for prevention of stone formation during pregnancy, and the necessity of involving a multidisciplinary team in such cases. The episode concludes with a remarkable case study from Dr. Desai’s experience.
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SHOW NOTES
00:00 - Introduction
02:06 - Incidence and Risk Factors of Kidney Stones in Pregnancy
03:29 - Physiological Changes and Stone Formation in Pregnancy
07:04 - Diagnosing Kidney Stones in Pregnancy
13:08 - Expectant Management vs. Intervention
14:41 - Managing Pain and Nausea in Pregnant Patients with Kidney Stones
17:13 - Decompression Methods for Kidney Stones in Pregnancy
23:13 - Ureteroscopy as a Preferred Intervention
26:05 - Case Description from Dr. Desai
30:04 - Considerations for Ureteroscopy in Pregnant Patients
31:14 - Preventing Kidney Stones in Pregnancy
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RESOURCES
Lyon, M., Sun, A., Shah, A., Llarena, N., Dempster, C., Sivalingam, S., Calle, J., Gadani, S., Zampini, A., & De, S. (2023). Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology, 182, 61–66. https://doi.org/10.1016/j.urology.2023.09.023
Thongprayoon, C., Vaughan, L. E., Chewcharat, A., Kattah, A. G., Enders, F. T., Kumar, R., Lieske, J. C., Pais, V. M., Garovic, V. D., & Rule, A. D. (2021). Risk of Symptomatic Kidney Stones During and After Pregnancy. American journal of kidney diseases : the official journal of the National Kidney Foundation, 78(3), 409–417. https://doi.org/10.1053/j.ajkd.2021.01.008 -
In this crossover episode of BackTable OBGYN with Urology, Dr. Suzette Sutherland, Director of Female Urology at the University of Washington, and Dr. Anne Cameron, Professor of Urology at the University of Michigan, share their insights on the prevention and management of urinary tract infections (UTIs).
First, they emphasize the importance of dispelling misconceptions about recurrent UTIs being a result of poor hygiene or incorrect behaviors, explaining that they can stem from genetic or hormonal risk factors. Dr. Cameron describes her algorithm for managing UTIs in specific patient populations. She further discusses the impact of factors such as fluid intake, bowel habits, and vaginal health on the incidence of UTIs. Dr. Cameron also highlights the potential for UTIs in diabetic patients on certain medications and the importance of a collaborative approach with diabetic healthcare teams. Additionally, the doctors explore various treatment strategies, such as cranberry supplements and gentamicin bladder installations, cautioning against antibiotic overuse due to the risk of resistance.
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EARN CME
Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/2P5fzK
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SHOW NOTES
00:00 - Introduction
02:13 - Understanding UTIs: Definitions, Symptoms, and Prevalence
04:39 - Recurrent UTIs: Definitions, Causes, and Treatment Challenges
12:00 - Understanding Asymptomatic Bacteriuria
15:00 - Cystitis vs. Pyelonephritis vs. Urosepsis
20:57 - Antimicrobial Resistance and Antibiotic Stewardship
24:36 - Treatment Guidelines for UTIs
31:13 - Self-start Antibiotic Therapy for UTIs
34:37 - Preventing UTIs: Hydration, Lifestyle Factors, and Bowel Health
38:33 - The Connection Between Vaginal Health and UTIs
42:40 - The Role of Supplements in UTI Prevention: D-Mannose and Cranberry, and Methenamine Hippurate
57:18 - Identification and Treatment of UTIs in Patients with Indwelling Catheters
01:00:04 - The Role of Gentamicin Bladder Installations in UTI Prevention
01:04:27 - The Impact of Diabetes Medications on UTIs
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RESOURCES
AUA Guidelines for UTI Treatment:
https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti -
In this episode of BackTable OBGYN, Dr. Mark Hoffman is joined by Dr. Sarah Rassier, a minimally invasive gynecologic surgeon and Director of the Fibroid Clinic at Mayo Clinic, to discuss the multiple treatment modalities of fibroids with a focus on laparoscopic myomectomy.
Drs. Hoffman and Rassier discuss the various factors they consider when deciding on the most suitable approach for a myomectomy. Specifically, they touch on pre-surgical patient optimization, the use of laparoscopic techniques in surgery, and the significance of efficient incision planning and closure. Dr. Rassier also highlights the practice of using preventative measures, such as iron infusions and Lupron, in certain patients to manage fibroids before surgical intervention. The conversation wraps up with a discussion about how future developments could potentially revolutionize fibroid management.
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SHOW NOTES
00:00 - Introduction and Overview of the Podcast
03:32 - Discussion on Fibroids and Their Different Treatment Options
06:40 - The Future of Fibroid Treatment
09:17 - Patient-Centered Decision Making in Fibroid Treatment
11:40 - Preparation and Approach for Myomectomy
13:18 - Discussion on the Use of MRI in Fibroid Treatment
15:55 - The Role of Laparoscopy in Myomectomy
29:00 - Umbilicus vs. Suprapubic Approach
32:04 - Cosmetic Considerations in Surgery
32:27 - - C-sections After Myomectomies?
34:51 Instruments and Techniques for Fibroid Removal
36:28 - Minimizing Blood Loss in Surgery
38:47 - The Importance of Efficient Closure in Surgery
44:46 - Tissue Extraction Techniques
49:02 - The Future of Myomectomy -
In this episode of the Backtable OBGYN Podcast, host Dr. Suzette Sutherland (University of Washington) and Dr. Tamsin Greenwell (University College London Hospitals) discuss surgical treatments for incontinence and their comparative efficacies.
They focus mainly on midurethral slings and a new urethral bulking agent called Bulkamid. They further analyze how conditions like product expectations, surgeon expertise, data availability, patient preferences, and financial costs influence the choice of procedure. Additionally, they discuss the impact of mesh-related complications and how they affected the usage of synthetic slings in the UK. Finally, they touch on the role of shared decision making in choosing treatment strategies.
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EARN CME
Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/p4RNfi
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SHOW NOTES
00:00 - Introduction
03:48 - Discussion on Midurethral Slings
11:05 - The Mesh Controversy and Its Impact
22:21 - Shared Decision Making in Treatment Options
26:47 - The Role of Urethral Bulking Agents
32:51 - Comparative Trial and EAU Guidelines
42:12 - Conclusion and Closing Remarks
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RESOURCES
Bulkamid Injections
https://bulkamid.com/en-US -
In this episode of the BackTable OBGYN Podcast, Dr. Princess Urbina shares her experiences with medical mission trips to underserved areas in the Philippines, where she was born, and the logistical challenges and rewards that come with this work. She also emphasizes the importance of providing sustainable healthcare solutions that empower local healthcare providers and meet the long-term needs of the community. The discussion further explores how these trips shape her perspective towards healthcare delivery.
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EARN CME
Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/jq41GW
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SHOW NOTES
01:14 - Introducing the Guest: Dr. Princess Urbina
01:46 - Dr. Urbina's Background and Journey
02:44 - First Mission Trip to the Philippines
05:23 - Logistics and Challenges of the Mission Trip
07:47 - Sustainability and Impact of the Mission
16:54 - Patient Selection and Care in the Mission
19:03 - Cultural Competence and Professional Culture
21:12 - Sustainability and Education in Surgical Teams
21:41 - Leaving Behind Equipment and Training
23:08 - Addressing Health Issues: HPV Vaccination and Cervical Cancer
28:59 - Patient Follow-up and Communication
30:59 - Support from Academic Institutions
38:09 - Getting Started with International Medical Missions -
In this episode, hosts Dr. Mark Hoffman and Dr. Amy Park invite Dr. Jocelyn Fitzgerald to discuss the relationships among chronic inflammatory pelvic diseases, focusing on painful bladder syndrome / interstitial cystitis (IC) and endometriosis. Dr. Fitzgerald is a urogynecologist at Magee Women’s Hospital in Pittsburgh, PA.
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SHOW NOTES
The episode begins with Dr. Fitzgerald describing her pathway into urogynecology, including training with MIGS physicians. This allowed her to make the connection between many young, reproductive-aged women with painful urination who also have endometriosis. She then goes into how to define IC, which can be difficult. Officially, it is bothersome urinary symptoms lasting more than 6 weeks without other identifiable causes. It is almost always a diagnosis of exclusion after negative urine cultures and other tests. Cystoscopy is no longer needed for diagnosis as it is often normal. However, the best understood phenotype of IC is bladder-centric IC, and these have Hunter lesions seen with cystoscopy. This type responds very well to fulguration, Kenalog, or steroid injections with 85% of patients experiencing improvement.
Dr. Fitzgerald further discusses treatments for IC. Behavior modification is essential, and she advises that patients avoid alcohol, coffee, tea, soda, spicy things, acidic things, and any other dietary triggers. She is also doing trials of giving patients an “IC bundle” which includes neurogenic medications like amitriptyline or gabapentin, vaginal estrogen, scheduled Pyridium, Hiprex, and aloe vera tablets. For some patients, she offers bladder instillations (comprised of heparin, lidocaine, bicarbonate, kenalog, +/- gentamicin), pelvic floor injections of bupivacaine and kenalog, and pelvic floor PT.
Next, Dr. Fitzgerald discusses the basic science research she has done that connects pain pathways throughout the pelvis. Chronic pelvic inflammatory disorders cross-talk through central sensitization. The lumbosacral plexus nerve roots receive pain signals from the bladder, colon, and other pelvic organs, explaining the relationship between IBS, endometriosis, and IC. The pathways are well understood, but we don’t yet know how to reverse central sensitization.
Finally, Dr. Fitzgerald ends by describing the multidisciplinary clinic for endometriosis at Pittsburgh: MIGS, urogynecologists, pelvic floor PT, and behavioral health teams all work together to care for these complex patients holistically. She stresses the importance of teamwork and great administrators who have made this happen. She finishes by discussing how researching more about mast cells, especially through COVID patients, can help us learn more about these chronic inflammatory disorders of the pelvis.
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RESOURCES
Fitzgerald JJ, Ustinova E, Koronowski KB, de Groat WC, Pezzone MA. Evidence for the role of mast cells in colon-bladder cross organ sensitization. Auton Neurosci. 2013 Jan;173(1-2):6-13. doi: 10.1016/j.autneu.2012.09.002. Epub 2012 Nov 24. PMID: 23182915; PMCID: PMC3715122.
AUA Guidelines for Diagnosis and Treatment of IC:
https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-treatment-interstitial-of-cystitis/bladder-pain-syndrome-(2022) -
This week on BackTable OBGYN, Drs. Mark Hoffman and Amy Park are joined by Dr. Barbara Levy to discuss the latest advancements in endometrial ablation using cryotherapy. Dr. Levy, a professor at George Washington University and a volunteer at the University of California San Diego OBGYN and reproductive sciences department, has dedicated her career to gynecological advancements.
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CHECK OUT OUR SPONSOR
Cerene Cryotherapy
https://cerene.com/healthcare-professionals/
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SHOW NOTES
Initially, the physicians delve into the history of endometrial ablation, originally conceived as an alternative to hysterectomy for severe menstrual bleeding. The early method involved using a fiber to ablate the entire cavity, followed by electrosurgery using a roller ball, which has various control-related challenges. This approach necessitates operating room time, anesthesia, and prolonged recovery with significant pain. As techniques advanced, complications, including burns and bowel injuries, emerged. The introduction of cryotherapy marked a significant breakthrough in ablation. However, it initially had a steep learning curve.
Barbara then details the new Cerene handheld cryoablation device, highlighting its advantages over traditional rollerball electrocautery. The primary benefit of cryotherapy is the improved healing pattern of the uterus compared to electrocautery. Electrocautery often results in Asherman's syndrome, leading to scarring and adhesions, making visualizing the uterine cavity for concern of future pathologies very difficult. Cryotherapy offers over 90% visibility into the cavity, making assessment for uterine or endometrial cancer much easier.
Barbara emphasizes that cryotherapy minimizes or avoids complications such as abnormal vaginal discharge, prolapsed fibroids, dyspareunia, persistent bleeding, and post-ablation pain syndrome when compared to heat-based methods.She outlines various patient-centric advantages, notably in pain management. Cryotherapy numbs nerves before ablation, allowing in-office procedures without sedation or anesthesia. Patients can tolerate the procedure well, typically requiring only NSAIDs for comfort during device insertion through the cervix. The accessibility of this procedure through telehealth and brief in-office appointments reduces the impact on patients' daily lives and costs, eliminating the need for operating room time and anesthesia. Instead, patients only pay a copay in the office.
Barbara highlights specific patient populations that can benefit from this therapy, including those with heavy menorrhea leading to iron deficiency anemia. It is also suitable for women unable to use additional hormones due to breast cancer concerns or those who prefer not have an IUD but suffer from heavy menorrhea. Patients facing barriers to healthcare, such as those in rural areas, those with time constraints due to work, or financial constraints, may significantly improve their quality of life. Additionally, women in their forties, no longer in their childbearing years, with heavy periods and an alternate form of long-term contraception, can particularly benefit from this therapy. -
In this episode, host Dr. Amy Park interviews co-host Dr. Mark Hoffman about laparoscopic hysterectomies.
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SHOW NOTES
The episode begins with Mark describing his journey to becoming a minimally invasive gynecologic surgeon, with more exposure to traditional laparoscopic surgery (“straight stick”) throughout his career, but with a recent revival of robotic surgery as well. Overall, Mark still prefers traditional laparoscopy. However, there are certain instances where robotics is especially helpful – namely in patients with a high BMI and in myomectomies where robots make the extensive suturing more manageable. Additionally, robotic surgery is easier to do in a situation where students and residents are not available to assist. Most importantly, he likes to get an MRI, look at the anatomy, and decide what the best approach is for each individual patient. And of course, the doctors emphasize the importance of having a strong team to operate with.
Next, Mark discusses his tips and tricks to a successful laparoscopic hysterectomy. He likes to be in the operating room before the patient is there to ensure it is set up correctly. Once the patient arrives, he stresses the importance of proper patient positioning on the bed, with the arms always tucked at the patient’s side, and then inserting the Foley catheter after draping. The doctors then discuss incision locations and sizes, with Mark preferring all 5 cm incisions. Mark continues with the steps of the procedure – he starts with the fallopian tubes, then gets the utero-ovarians and carries around the round ligament to move the ovaries laterally. He then emphasizes skeletonizing the uterines/posterior peritoneum. He saves the anterior incisions for last as they can get complicated with adhesions from prior C-sections, for example. Mark highlights the “critical view,” which is the anterior cup, posterior cup, ring, and vessels on the other side. The doctors go on to discuss colpotomy, barbed sutures, visualization, antibiotics, and more.
The physicians end by expressing the importance of asking for help, knowing your limits as a surgeon, and ensuring patient safety.
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RESOURCES
ACOG: Choosing the Route of Hysterectomy for Benign Disease
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/06/choosing-the-route-of-hysterectomy-for-benign-disease -
In this episode, hosts Dr. Mark Hoffman and Dr. Amy Park have an in-depth discussion on the topic of vaginal hysterectomy. Amy, who handles a substantial caseload of vaginal hysterectomies, takes the lead in this conversation as she walks through the procedure and its intricacies. In Mark's practice as a Minimally Invasive Gynecologic Surgery (MIGS) surgeon, he typically deals with cases involving candidates for laparoscopic hysterectomies, while many vaginal hysterectomy cases are referred to urogynecologists.
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SHOW NOTES
Both Amy and Mark stress the critical importance of selecting a surgical approach that aligns with a patient's medical history and anatomical considerations. Amy asserts that a patient is a suitable candidate for a vaginal hysterectomy when they possess a tall and mobile uterus, with ample vaginal space, and a pelvic outlet of sufficient width. Furthermore, she highlights that patients with a cervix located within 6 cm from the hymenal remnant are good candidates for vaginal hysterectomies.
The physicians delve into the topics of competency and confidence within the operating room. They agree that the volume of surgeries, repeated practice, pattern recognition, and experience in managing complications are pivotal factors contributing to a surgeon's growing competence with each case. Both doctors concur that it typically takes approximately three to five years to achieve confidence and a reduction in anxiety levels regarding surgical cases.
Amy proceeds to describe each step of a vaginal hysterectomy and shares her preferred practices in the operating room. To ensure patient comfort and safety, she positions her patients in the dorsal lithotomy position, taking special care to avoid exerting pressure on the peroneal and femoral nerves. While providing sacral support, she positions the remainder of the perineum as close to the edge of the table as possible to maximize vaginal access. Amy initiates the procedure with a posterior colpotomy using a 10-blade after administering lidocaine. Gradually, she progresses anteriorly, retracting the vaginal epithelium until the peritoneal folds become visible. She tags the uterosacral ligaments and proceeds to access the pelvis anteriorly, paying careful attention to avoid injuring the ureters. She systematically advances to the utero-ovarian ligament and artery, concluding by addressing the fallopian tube and ovary. Amy emphasizes her preference for two-handed knotting in all vaginal cases to achieve optimal tension and mentions her infrequent use of energy devices.
Finally, Mark and Amy discuss the evolution of training within the operating room over the years, acknowledging the changing landscape due to advancements in technology and varying case volumes. They underscore the significance of mastering technical skills outside of the operating room, which enables trainees to dedicate the necessary time to enhancing their operative abilities. - Visa fler