BackTable Women's Health

With contemporary treatment options, your female patients don’t have to live with urinary incontinence! In this crossover episode of BackTable Urology and OBGYN, host Dr. Suzette Sutherland from University of Washington interviews Dr. Sarah Boyles, a urogynecologist at The Oregon Clinic, regarding female urinary incontinence, its diagnostic criteria, and various treatment options to help improve quality of life in the incontinence patient.

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PearsonRavitz

https://pearsonravitz.com/backtable

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SYNPOSIS

First, Dr. Boyles explains the importance of patient history and physical examination, along with the need for certain diagnostic tests for proper characterization of the type of urinary incontinence in a patient. She also explores behavioral treatments, pelvic floor physical therapy, vaginal pessaries, and advanced interventions such as urethral bulking and surgery for stress incontinence. The doctors further discuss innovative pharmaceutical and neuromodulation options for urge incontinence.

Dr. Boyles concludes with a mention of patient education resources that are available on her platform, thewomensbladderdoctor.com.

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TIMESTAMPS

00:00 - Introduction

02:35 - The Women’s Bladder Doctor Initiative

07:03 - Types of Urinary Incontinence

11:49 - Diagnostic Approaches to Urinary Incontinence

28:39 - Treatment Algorithms for Urinary Incontinence

31:12 - Bladder Retraining and Pelvic Floor Therapy

40:00 - Urethral Seals and Vaginal Pessaries

50:47 - Treatment for Urgency

57:51 - Future Directions

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RESOURCES

Pearson Ravitz

https://pearsonravitz.com/

The Women’s Bladder Doctor

https://thewomensbladderdoctor.com/

Often the first practical thing we’re taught in medical school is the importance of taking a thorough patient history. In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Ted Lee bring us back to the basics and emphasize the importance of conducting a quality patient interview to elucidate symptoms of endometriosis.

The physicians first explore the limitations and practicalities of patient surveys, and move on to discuss the importance of thorough history taking along with specific symptoms to look for. The conversation also delves into the diagnostic challenges and delay of diagnosis in endometriosis patients. They explain the role of surgical diagnosis in endometriosis, emphasizing the necessity of listening to and believing patients’ experiences with chronic pelvic pain.

TIMESTAMPS: 

00:00 - Introduction

00:14 - Initial Patient Workup: Surveys and History

01:19 - Key Patient History Indicators

04:24 - Endometriosis Symptoms

07:49 - Treatment Approaches and Surgical Considerations

09:32 - Barriers to Diagnosis

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep. 30: Ambulatory Workup of Endometriosis Patients

https://www.backtable.com/shows/obgyn/podcasts/30/ambulatory-workup-of-endometriosis-patients

In the modern era of rapid technological progress and AI, the medical community is abuzz with discussions on how medicine will change and how practice will adapt. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park welcome Dr. Arnold Advincula, a leading figure in minimally invasive and robotic surgery, to discuss the evolution and impact of robotic surgery in the field of gynecology.

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SYNPOSIS

Dr. Advincula shares his journey from training to pioneering robotic-assisted procedures, emphasizing the benefits and challenges faced along the way. The conversation delves into the future of robotics, including the potential of AI in surgery and the integration of digital tools to enhance surgical outcomes. Listeners gain insights into the importance of ergonomic surgery, the advancements in robotic technology, the future of minimally invasive gynecologic surgery, and the collaborative efforts required to elevate patient care in gynecology.

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TIMESTAMPS

00:00 - Introduction

06:05 - Pioneering Robotic Surgery

12:50 - Challenges and Innovations

24:43 - Allure of Robotic Surgery

28:05 - Challenges in Rural Healthcare

35:00 - Future of Minimally Invasive Surgery

42:00 - Advancements in Surgical Training

43:35 - Ergonomics

49:28 - The Future of Gynecologic Surgery

53:06 - Closing Thoughts

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RESOURCES

BackTable OBGYN Ep. 2: Surgeon Ergonomics

https://www.backtable.com/shows/obgyn/podcasts/2/surgeon-ergonomics

In this BackTable OBGYN Brief, Dr. Mark Hoffman and Dr. Ted Lee discuss the clinical approach to diagnosing endometriosis through physical exam and imaging, and the collaborative surgical approach to treating it. 

Dr. Lee explains the importance of detailed patient history and various examination techniques, including palpation and rectovaginal exams, to identify potential signs of endometriosis. He emphasizes the specificity of these exams in differentiating endometriosis pain from other causes. The discussion also covers the role of imaging, such as MRI, particularly in advanced cases, and the collaborative approach with colorectal surgeons for bowel-related complications. Dr. Lee shares insights on the use of physical therapy and managing musculoskeletal pain related to endometriosis, highlighting the importance of multi-disciplinary care for optimal patient outcomes.

TIMESTAMPS

00:00 - Introduction

00:15 - Initial Patient Assessment for Endometriosis

01:00 - Detailed Physical Exam Techniques

07:00 - Imaging and Further Diagnostic Steps

10:55 - Collaborative Surgical Approach

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep. 30: Ambulatory Workup of Endometriosis Patients

https://www.backtable.com/shows/obgyn/podcasts/30/ambulatory-workup-of-endometriosis-patients

In this episode of the BackTable OBGYN podcast, host Dr. Mark Hoffman is joined by MIGS specialist Dr. Uchenna Acholonu to discuss the intricacies of complex gynecologic surgeries, focusing particularly on handling large uteruses during total laparoscopic hysterectomy (TLH).

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SYNPOSIS

The discussion begins with talk of the doctors’ practices and friendship. They then cover comprehensive patient evaluations and various surgical techniques, including skeletonizing the uterines, colpotomy tricks, uterine manipulators, and morcellation. Dr. Acholonu also shares his personal routines and preferences, including the use of a flexible scope to get around the big uterus. The duo exchange insights on surgical techniques, patient-centered care, and the continuous learning necessary in the medical field. They emphasize the significance of safety, adequate planning, and the benefits of engaging in community networks for better surgical outcomes. The conversation concludes with a light-hearted note on their shared experiences and camaraderie, offering both educational value and a glimpse into the dynamic relationship between two seasoned professionals.

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TIMESTAMPS

00:00 - Introduction

04:01 - Building a Subspecialty Practice

07:34 - Patient Referrals

12:41 - Surgical Approach

16:06- The Big Uterus

28:36 - Surgical Steps in TLH, Skeletonizing the Uterines

32:56 - Challenges and Solutions

36:49 - Energy Sources and Surgical Tools

42:34 - Colpotomy

44:43 - Tissue Extraction and Morcellation

50:27 - Closing and Post-Operative Care

52:05 - Use of Lupron

53:16 - Final Thoughts

In this BackTable OBGYN Brief, host Dr. Mark Hoffman interviews Dr. Jan Baekelandt from Belgium about vNOTES (vaginal natural orifice transluminal endoscopic surgery) incision placement to allow future vaginal deliveries and prevent dyspareunia. 

First, Dr. Hoffman discusses the nuances of laparoscopy, particularly the preference for smaller incisions to reduce hernia rates and postoperative pain. The conversation covers the specifics of performing colpotomy and the risks associated with different types of incisions, including vaginal and abdominal. Dr. Baekelandt emphasizes the importance of proper training and starting with simpler cases when introducing new surgical techniques like vNOTES.

TIMESTAMPS

00:00 - Introduction

00:32 - Concerns About Hernia Rates and Incisions

01:05 - Vaginal Incisions and Their Implications

02:35 - Vaginal Deliveries After vNOTES

03:55 - Dyspareunia After vNOTES

04:13 - Technical Details on Incision Placement

05:53 - Closing Techniques

06:45 - Advice for Surgeons Introducing vNOTES

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep 31: The vNOTES Procedure

https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

In this BackTable OBGYN Brief, host Dr. Mark Hoffman speaks with Dr. Jan Baekelandt about the specific challenges and complications associated with vNOTES, as well as contraindications to be mindful of.

They discuss the nuances of uterine artery management and the benefits and risks of the Alexis ring, especially for hemostasis. The doctors go on to discuss contraindications for vNOTES, including complex endometriosis and pelvic scarring. Dr. Baekelandt also shares insights on avoiding ureteric and bladder injuries and future direction of vNOTES.

TIMESTAMPS

00:00 - Introduction

00:14 - Understanding vNOTES Complications

00:50 - Techniques for Uterine Artery Management

02:13 - Hemostasis

03:24 - Challenges with Ureter and Bladder Management

09:44 - Contraindications to vNOTES

12:07 - Future Directions

CHECK OUT THE FULL EPISODE

BackTable OBGYN Ep 31: The vNOTES Procedure

https://www.backtable.com/shows/obgyn/podcasts/31/the-vnotes-procedure

Gynecologic oncology experts Dr. Matthew Powell from Washington University School of Medicine and Dr. Amanda Fader from Johns Hopkins Hospital discuss the increasing rates of endometrial cancer along with future directions of treatments and screenings.

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SYNPOSIS

First, the physicians discuss trends in endometrial cancer rates and delve into the factors driving these trends, such as the obesity epidemic and aging population. They explore the differences between endometrioid and non-endometrioid cancers, along with the impact of racial and geographic disparities. The conversation also covers advances in diagnostics and treatments—including immunotherapy and targeted therapies—and the critical need for better awareness, screening practices, and research funding to combat this public health threat.

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TIMESTAMPS

00:00 - Introduction

03:11 - Types of Endometrial Cancer

04:44 - Rising Rates and Risk Factors

08:03 - Disparities in Endometrial Cancer Care

10:37 - Symptoms and Diagnosis

13:52 - Ultrasound vs. Biopsy

16:17 - Challenges in Biopsies

20:58 - Management/Treatment Approaches

23:03 - Geographic Disparities/Access to Care

26:07 - Vaginal Brachytherapy

32:11 - Innovations in Treatment and Research

40:34 - Future Directions: Endometrial Screening

43:54 - AI in Gynecologic Oncology

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RESOURCES

Beavis, A. L., Blechter, B., Najjar, O., Fader, A. N., Katebi Kashi, P., & Rositch, A. F. (2023). Identifying women 45 years and younger at elevated risk for endometrial hyperplasia or cancer. Gynecologic Oncology, 174, 98–105. https://doi.org/10.1016/j.ygyno.2023.04.019

Mirza, M. R., Sharma, S., Roed, H., Landrum, L. M., Gilbert, L., Gold, M. A., Novák, Z., Edelson, M., Meirovitz, M., Diaz, J. P., Huygh, G., Buscema, J., Pothuri, B., Eshed, H. D., Coleman, R. L., Slomovitz, B. M., Kostadinov, R., Stevens, S., Ronzino, G., & Powell, M. A. (2024). Post hoc analysis of progression-free survival (PFS) and overall survival (OS) by mechanism of mismatch repair (MMR) protein loss in patients with endometrial cancer (EC) treated with Dostarlimab plus chemotherapy in the ruby trial. Journal of Clinical Oncology, 42(16_suppl), 5606–5606. https://doi.org/10.1200/jco.2024.42.16_suppl.5606

Society of Gynecologic Oncology (SGO):

https://www.sgo.org/

Dr. Aditya Bagrodia sits down with Elie Toubiana, founder and CEO of ScribeMD.ai, to discuss the transformative potential of artificial intelligence (AI) in medical documentation.

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SYNPOSIS

Their conversation covers the capabilities and benefits of using an AI-driven medical scribe that ensures HIPAA compliance, reduces physician burnout, and enhances patient interactions. Elie also shares his insights about the technology’s adaptability across various medical fields. Finally, Dr. Bagrodia and Elie discuss ethical considerations surrounding applications of AI in other aspects of healthcare, such as medical workup and diagnosis.

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TIMESTAMPS

00:00 - Introduction

06:00 - How ScribeMD AI Works

14:14 - Integration with EMR

20:31 - Legal Considerations with AI Technology

26:34 - Cost Implications of AI Scribes

38:46 - Future of AI in Medical Diagnosis

41:45 - Conclusion and Final Thoughts

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RESOURCES

ScribeMD.ai

https://www.scribemd.ai/

Hosts Dr. Mark Hoffman and Dr. Amy Park invite Dr. Vadim Morozov, a minimally invasive gynecologic surgeon at MedStar Washington Hospital Center, to discuss the applications and implications of artificial intelligence (AI) in gynecologic surgery both currently and in the future.

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SYNPOSIS

Dr. Morozov shares his insights on the basics of AI as well as how it is currently being used in medicine and research. He shares his experiences working with AI to develop algorithms for robotic gynecologic procedures. Furthermore, he predicts the direction AI is going in medicine and highlights the complexities and ethical considerations of integrating AI into medical practice. The conversation delves into the advancements, potentials, and concerns surrounding AI, addressing its impact on surgery, privacy, and the future of medical practice.

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TIMESTAMPS

00:00 - Introduction

03:52 - AI in Gynecologic Surgery

06:10 - Understanding AI Basics

13:24 - AI in Medical Applications

17:09 - Future of AI in Medicine

33:24 - AI in Surgery

45:10 - Data and Privacy Concerns

57:35 - Call to Action: Get Involved

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RESOURCES

BUMP Study:

Goodday, S.M., Karlin, E., Brooks, A. et al. Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. npj Digit. Med. 5, 40 (2022). https://doi.org/10.1038/s41746-022-00579-9