BackTable OBGYN BackTable

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

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.