BackTable Women's Health

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.

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SHOW NOTES

00:00 - Introduction

03:09 - Understanding RhoGAM: Origin and Development

06:06 - The Science Behind RhoGAM and Its Role in Pregnancy

08:13 - The Controversy and Debate Around RhoGAM Usage

11:52 - The Impact of RhoGAM on Public Health and Medical Practice

15:25 - The Future of RhoGAM: Perspectives and Predictions

29:24 - Closing Thoughts and Further Resources

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RESOURCES

Horvath, 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.2022.07.002

Horvath 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

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)