What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making.

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https://www.backtable.com/app

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Timestamps

00:00 - Introduction
03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline
07:32 - Patient Experience with OAB
11:59 - Beta-3 Agonists vs Anticholinergics
15:15 - Botox Counseling and Dosing
18:11 - Tibial Nerve Stimulation
25:47 - Sacral Neuromodulation
32:09 - Cost Burden of OAB
39:38 - Evolution of OAB Care
41:39 - Future Research Directions

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More about this episode

The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently.

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Resources

The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)
https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

Anticholinergic Drug Exposure and the Risk of Dementia
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial

https://pubmed.ncbi.nlm.nih.gov/20171677/

Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registry
https://www.auajournals.org/doi/10.1097/UPJ.0000000000000916

A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?
https://pubmed.ncbi.nlm.nih.gov/33197059/

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BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.
Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.

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Are your patients looking for a nonhormonal option? Digital contraception could be the answer. In this episode of the BackTable Podcast, urologist Dr. Ruchika Talwar sits down with Dr. Kerry Krauss, an OBGYN and Senior Medical Advisor at Natural Cycles, to discuss the evolving landscape of digital health tools in women's reproductive care.

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This podcast is supported by

Natural Cycles
https://www.naturalcycles.com/

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Timestamps

01:29 - Introduction
03:02 - Contraception Pain Points
06:16 - Natural Cycles Origin
09:46 - How The App Works
12:44 - Effectiveness And Variability
15:18 - Ideal Users And Red Days
17:34 - Modes Beyond Birth Control
19:19 - Clinical Insights From Data
22:04 - Future And Privacy
24:31 - Counseling And Adoption Tips
27:19 - Conclusion

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More about this episode

Dr. Krauss shares her journey into tech and wearables and provides insights into the functionality, effectiveness, and future prospects of Natural Cycles, a digital contraceptive app. The discussion covers the utility of basal body temperature tracking, the unique features of the Natural Cycles algorithm, and real-world applications and user experiences. They also explore the broader implications and potential surrounding the integration of digital health tools into patient care, emphasizing the importance of meeting patients where they are.

What happens when a fully integrated healthcare system aligns training, data, and access to improve surgical outcomes? In this BackTable OBGYN episode, Dr. Eve Zaritsky joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss how Kaiser’s integrated health system enables rapid care coordination, large-scale quality improvement, and population-level research using one of the largest US datasets.

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Get the BackTable app

https://www.backtable.com/app

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Timestamps

01:17 - Introduction
03:35 - How Kaiser Works
07:24 - Research Using Big Data
09:19 - Changing Hysterectomy Culture
13:36 - Ending Racial Disparities
15:22 - Handling Large Uteri
17:52 - Vaginal Hysterectomy Trends
20:38 - Myomectomy Reintervention Rates
24:23 - Shared Decision Making
26:30 - Mini Lap Versus Robotic
27:41 - Hybrid Extraction Strategy
29:08 - Credentialing Robotic Myomectomy
30:19 - MIG Referral Pathways
32:03 - Fibroids Across Asian Subgroups
34:55 - Mentoring Research Pipeline
36:44 - Funding Analysts Through GME
40:49 - Endometriosis Disparities Findings
43:59 - Mentorship Mindset

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More about this episode

Dr. Zaritsky describes how a coordinated, system-wide effort transformed hysterectomy care, shifting from 80% open procedures to nearly 90% minimally invasive within five to eight years through focused training, reducing low-volume practice, and tracking system metrics, ultimately decreasing racial disparities once minimally invasive rates exceeded 90%. She also highlights Kaiser-based research on variation in vaginal hysterectomy by service area and surgeon volume, long-term reintervention rates for fibroids across procedures, increasing use of minimally invasive myomectomy, and a JAMA analysis showing differences in fibroid diagnosis among Asian subgroups with the highest rates in South Asians. The episode concludes with Dr. Zaritsky calling attention to how Kaiser’s research infrastructure creates robust opportunities for meaningful mentorship across all levels of training, supporting the development of physicians, residents, and medical students.

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Resources

Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast Integrated Health System

https://pubmed.ncbi.nlm.nih.gov/28486359/

Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System

https://pubmed.ncbi.nlm.nih.gov/40839882/

Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care System
https://pubmed.ncbi.nlm.nih.gov/40172885/

When to test, how to prevent, and what you need to know about hereditary gynecologic cancer syndromes. Two USC gynecologic oncologists, Dr. Mona Guo and Dr. Marcia Ciccone, go in-depth in this BackTable OBGYN x Tumor Board crossover episode.

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Timestamps

00:00 - Introduction
01:37 - Why Hereditary Cancer Matters
04:51 - Family History Red Flags
09:01 - Who Should Order Genetic Testing
11:32 - Variants and Counseling Pitfalls
13:30 - Access and Remote Testing Options
19:27 - BRCA1 Positive Patient Walkthrough
24:52 - Risk-Reducing Surgeries
29:11 - Prevention and Screening Limits
32:38 - Why Ovarian Cancer Is Hard
34:04 - Combining Breast and Gyn Surgery
35:41 - Preop Ultrasound and CA-125
36:27 - BRCA Timing and HRT Nuance
42:32 - Nonhormonal Menopause Options
47:14 - Lynch Syndrome Screening Basics
54:22 - Endometrial Biopsy Debate
56:43 - Insurance and Coverage Pitfalls
59:00 - Fertility Preservation and REI
01:01:41 - Cascade Testing
01:02:45 - Conclusion

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More about this episode

Dr. Guo and Dr. Ciccone discuss how careful family history can identify patients who may benefit from genetic evaluation and highlight key red flags, including a family history of ovarian cancer, breast cancer at age 50 or younger, and metastatic prostate cancer. They explain the role of genetic counseling, including pre- and post-test discussions and how to approach variants of uncertain significance. They then cover BRCA counseling and risk-reduction strategies, including the timing of risk-reducing bilateral salpingo-oophorectomy, ongoing salpingectomy trials, and considerations for hysterectomy. Additionally, they touch on pathology protocols, breast cancer screening, and the potential protective effect of hormonal contraception.

The doctors address the limitations of ovarian cancer screening and outline patterns suggestive of Lynch syndrome, such as endometrial cancer occurring alongside gastrointestinal or urinary tract cancers. They review the Lynch workup, including tumor mismatch repair immunohistochemistry and MLH1 hypermethylation testing. Finally, they discuss practical considerations like barriers to access, Medicare coverage challenges, fertility preservation referrals, menopause management, and cascade testing in families, including the timing of testing in children.

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Resources

NCCN Guidelines: Detection, Prevention, and Risk Reduction
https://www.nccn.org/guidelines/category_2

As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients.

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SYNPOSIS

Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery.

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TIMESTAMPS

00:00 - Introduction
02:18 - Dr. Ackenbom’s Journey to Urogynecology
04:47 - Research on Brain Fog
06:18 - Personal Support and Hobbies
09:54 - Age vs Frailty in Surgery
13:05 - Procedures with Perioperative Complexity
16:11 - Counseling on Operative Risk
20:10 - ERAS and Earlier Discharge
23:35 - Patient Goals and Tradeoffs
27:53 - Surgical Clearance and Preop Consults
33:30 - Prehabilitation Basics
36:24 - Minimally Invasive Surgery Benefits
37:15 - Surgical Cognitive Complications with Age
41:42 - Finding the Surgery Window
46:05 - Cognitive and Frailty Screening
50:01 - Guidelines for Perioperative Care
52:52 - Future Research
54:07 - Conclusion

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RESOURCES

Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgery
https://pubmed.ncbi.nlm.nih.gov/32827107/

ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patient
https://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf

Trouble with bowel or bladder function? It might be time to partner with a specialist. In this episode of BackTable OBGYN, hosts Dr. Amy Park and Dr. Mark Hoffman are joined by Dr. Shannon Wallace and Dr. Anna Spivak, experts from the Cleveland Clinic specializing in pelvic floor disorders. They dive into the complex world of combined colorectal and urogynecological issues, discussing the importance of a multidisciplinary approach to treat conditions such as rectal prolapse, constipation, and incontinence.

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SYNPOSIS

The conversation covers detailed diagnostic methods like manometry and defecography, various surgical options, and the crucial role of pelvic floor physical therapy in patient recovery. They also provide insights into setting up effective multidisciplinary clinics and emphasize the need for teamwork and administrative support in delivering optimal patient care. This episode is a valuable resource for both specialists and generalists aiming to enhance their understanding and treatment of pelvic floor dysfunctions.

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TIMESTAMPS

01:05 - Introduction
05:40 - Multi-Compartment Prolapse & Second Opinions
08:14 - Pelvic Floor Compartments Explained
10:36 - When Internal Prolapse Becomes Surgical
11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage
16:55 - Fluoro vs MRI and When to Order It
23:47 - Anorectal Manometry
26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup
29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches
34:43 - When (and Why) to Consider Biologics
36:46 - Resection Rectopexy
38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders
42:55 - Pelvic Floor PT After Surgery and Recovery Timelines
47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)
49:53 - Symptom Improvement vs Retraining the 'New Normal'
52:20 - Fecal Incontinence & Sacral Neuromodulation
57:08 - Diarrhea-Driven Incontinence
58:56 - Building a Multidisciplinary Pelvic Floor Program
01:04:04 - Conclusion

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RESOURCES

Pelvic Floor Disorders Consortium (American Society of Colon & Rectal Surgeons) https://fascrs.org/Web/Web/My-ASCRS/Education/Pelvic-Floor-Disorders-Consortium.aspx

From diagnosis to treatment, hysteroscopy plays a pivotal role in modern gynecologic care. In this episode of BackTable OBGYN, Dr. Christina Salazar, a minimally invasive gynecologic surgeon and associate professor at Dell Medical School in Austin, Texas, joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss the value of hysteroscopy in managing complex intrauterine pathology.

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SYNPOSIS

Dr. Salazar shares her introduction to hysteroscopy and the mentors who shaped her early training. She discusses her expertise in hysteroscopic surgery and its broad applications, with a focus on the complexities of Asherman syndrome, dysmorphic uteri, and the critical role of endometrial health assessment. The conversation also covers surgical techniques, post-operative care, and emerging technologies in hysteroscopic and reproductive care. Dr. Salazar concludes by emphasizing the need for improved classification systems for Asherman syndrome and future directions in reproductive health innovation.

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TIMESTAMPS

00:00 - Introduction
05:34 - Training and Mentorship in Hysteroscopy
11:21 - Dr. Salazar's Practice and Techniques
14:00 - Challenges and Trends in Surgical Practices
18:58 - Referral Practices and Advanced Hysteroscopy
21:58 - Understanding Dysmorphic Uterine Population
24:08 - T-Shaped Uteri Description
26:09 - Hysteroscopic Metroplasty: Methods and Risks
29:17 - Innovations in Hysteroscopy
32:38 - Value of Ultrasound in Hysteroscopy
36:35 - Post-Operative Management and Estrogen Therapy
39:23 - Challenges and Future Directions in Hysteroscopy
44:23 - Concluding Thoughts

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RESOURCES

The epidemiology, clinical burden, and prevention of intrauterine adhesions (IUAs) related to surgically induced endometrial trauma: a systematic literature review and selective meta-analyses
https://academic.oup.com/humupd/article/31/6/588/8248883

Hysteroscopy Newsletter
https://hysteroscopynewsletter.com/

Learn how ACOG turns advocacy into action, supports clinicians, and creates community. Plus, get tips on how you can get involved. In this episode of BackTable OBGYN, Dr. Sivani Aluru from Endeavor Health in Chicago shares her journey and involvement with ACOG, from her medical school days to her current role as the national JFCAC Chair.

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SYNPOSIS

Dr. Aluru describes her experiences on various task forces, including the ACOG 75th Anniversary Task Force, and emphasizes the importance of education, advocacy, and community within the organization. She offers insights into the challenges and benefits of participating in ACOG, provides tips for getting involved, and highlights the ongoing efforts to address critical issues in women's health. The conversation also touches on adapting to the changes brought by the COVID-19 pandemic and the value of staying organized and connected in a demanding field.

Find out what ACOG is working on, how it benefits patient care, how it benefits provider education and resources, how it builds community. Get involved! Go to meetings! There are so many roles. If you don’t get your role on the first go, try again. Showing up is huge!

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TIMESTAMPS

00:00 - Introduction
03:41 - Residency and Early Involvement in ACOG
07:29 - Advocacy and Government Affairs
18:40 - Balancing Professional and Organizational Work
24:28 - Listening to Members' Needs
26:36 - Challenges and Value of ACOG Membership
29:00 - The Importance of In-Person Meetings
34:45 - ACOG's Legislative Advocacy and Future Plans
35:48 - Advice for Getting Involved with ACOG
40:16 - Conclusion

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RESOURCES

ACOG (American College of Obstetricians and Gynecologists)
https://www.acog.org/

ACOG CAARE Delegation https://www.acog.org/about/diversity-equity-and-inclusive-excellence/collective-action-strategy/caare-delegation

ACOG CREOG (Council on Resident Education in Obstetrics and Gynecology) https://www.acog.org/education-and-events/creog/about

Some of the biggest advances in women’s health start with a simple question: why hasn’t this been fixed yet? In this episode of BackTable OBGYN, Dr. Tess Kim, a minimally invasive gynecologic surgeon at Massachusetts General Hospital and the founder of Fruits of Labor, a women's health medical device innovation company, joins host Dr. Amy Park.

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SYNPOSIS

Dr. Kim’s educational journey began with medical school at Emory, followed by residency at Beth Israel Deaconess Hospital, and fellowship training at MGH. She discusses the founding of Fruits of Labor, which began with the Perry Peach—a warm compress device designed to reduce severe perineal tearing during childbirth and now acquired by Medicines360. Dr. Kim also talks about her creative process, the importance of addressing historically neglected areas in women's health, and the potential impact of her new project, Mellomallows, which aims to reduce discomfort during gynecological procedures such as IUD placement. The conversation concludes with a discussion of the challenges and opportunities in women's health innovation, the significance of supportive networks, and the role of passion and commitment in driving meaningful change.

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TIMESTAMPS

00:00 - Introduction
02:03 - The Birth of PeriPeach: Addressing Severe Tearing
06:51 - New Medical Devices: Mellomallows
08:41 - The Creation and Mechanism of PeriPeach
11:11 - Company Development: Mentorship and Resources
17:37 - Pitching Practice and Experience
19:26 - Project Funding and Working with Medicines360
21:51 - Advice for Aspiring Innovators
23:52 - Concerns About AI in Healthcare
26:48 - Innovations in Women's Health
29:06 - Challenges in Academic Medicine
32:01 - The Importance of Female Innovators
34:00 - Forming a Startup in Women's Health
36:10 - Parting Advice for Future Innovators
37:37 - The Future of Women's Health Innovations
40:10 - Conclusion

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RESOURCES

Fruits of Labor website:
https://www.fruitsoflabormed.com/home

PeriPeach website:
https://www.peripeach.com/

Fibroid care: how it was, how it’s changing, and where it’s headed next. In this episode of BackTable OBGYN, hosts Dr. Mark Hoffman and Dr. Amy Park welcome minimally invasive GYN surgeon Dr. Arleen Song to discuss the evolving landscape of fibroid care.

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SYNPOSIS

Dr. Song, a veteran in the field with nearly 20 years of experience, shares her journey from Michigan to Duke, current treatments in fibroid management, and the importance of personalized care. The team explores new surgical techniques, the role of medical therapies such as Ella GnRH antagonists, and the importance of patient education. They also address challenges such as access to care, the significance of research funding, and the evolving understanding of fibroid genetics and long-term management. This episode provides a comprehensive overview of the state of fibroid care and the strides being made in this vital aspect of women's health.

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TIMESTAMPS

00:00 - Introduction
02:21 - Evolution of Fibroid Treatment
05:50 - Advancements in Minimally Invasive Surgery
08:47 - Longitudinal Care and Personalized Treatment
13:00 - Modern Approaches to Fibroid Treatment
21:15 - New Technologies and Procedures
27:01 - Preoperative Assessment and Imaging
31:15 - Preoperative Counseling and Risk Assessment
33:14 - Medications for Fibroid and Endometriosis
37:59 - Challenges in Access to Care
38:43 - Racial Disparities in Fibroid Research
42:35 - The Importance of Specialized Care
49:22 - Future Directions in Fibroid Treatment