Episodes
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As over-the-counter continuous glucose monitors (CGMs) become more common, clinician guidance matters more than ever. In this episode of BackTable Women’s Health, Dr. Nicole Faulkner welcomes Dr. Nicholas Canelo, a family medicine physician and founder of the Perlman Wellness CGM program, to discuss how to effectively guide CGM use in OBGYN practice, from preconception and PCOS to pregnancy and perimenopause. They highlight the importance of interpreting data trends, setting realistic glucose targets, and supporting patients through the practical and emotional challenges of CGM use.
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Timestamps
00:00 - Introduction04:58 - CGMs in Women’s Health07:33 - OTC Data Sharing Issues09:52 - Pregnancy Glucose Targets16:20 - Accuracy and Variability20:10 - Anxiety and Eating Disorders24:41 - Counseling and Follow-Up28:29 - Prescription and OTC CGM Picks37:24 - False Lows and Sensor Errors41:23 - Alarm Settings and Logging44:06 - Interpreting Metrics and Limits46:44 - Provider Dashboards 48:42 - Final Thoughts
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More about this episode
Given the lack of well-established blood glucose targets outside of type 1 diabetes, Dr. Canelo reviews commonly used ranges for individuals without diabetes, those with prediabetes, and pregnant patients with type 1 or 2 diabetes. He explains how to interpret CGM data, including the time in tight range, coefficient of variation, and the importance of focusing on overall trends rather than isolated glucose spikes. They also discuss the potential drawbacks associated with CGM use, including anxiety and eating-disorder risks. Practical considerations include sensor inaccuracies, false lows readings, and optimizing alarm settings. Dr. Canelo emphasizes the importance of having patients log meals and other events while wearing the sensor and scheduling follow-up after the initial 15-day wear period to ensure accurate interpretation and effective counseling. Finally, they compare OTC and prescription CGM options, including costs, clinician access to patient data, and insertion tips.
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Resources
Stelo - Over the Counter CGM Optionhttps://www.stelo.com/en-us
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BackTable Women's Health 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.
► https://www.backtable.com/app -
Are you building a business that can thrive without you, or just creating a job you can never leave? In this episode of BackTable Women’s Health, host Dr. Karen Toubi sits down with Dr. Nneka Una (Unachukwu), a board-certified pediatrician, founder of Ivy League Pediatrics, and creator of EntreMD, to discuss the mindset and skills needed to build a truly sustainable medical practice. The conversation explores why physician entrepreneurship is essential in today’s evolving healthcare landscape, the difference between building yourself a job and building a resilient business, and practical strategies for long-term growth.
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Timestamps
00:00 - Introduction04:47 - From Employee to Owner05:53 - Skills That Changed Everything07:35 - The Wake Up Call10:44 - Why Doctors Resist Business15:06 - Profit as Patient Care18:20 - Job vs. Business Entity21:13 - CEO Hat and Team Systems25:14 - Exit Value and Sellability29:00 - More Profit: More Time Off30:24 - Fear Before Breakthrough35:32 - Choose Service Over Perfection39:11 - Invest in Your Potential46:26 - MEAT Week Priorities48:40 - Three-Part Daily Rhythm55:02 - Advice for Burned-Out Docs59:29 - Wrap Up
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More about this episode
Dr. Una shares how doctors can overcome resistance to “business,” why every practice needs a strong business engine, and how to balance profitability with ethical, people-centered care. She explains how to shift from employee to physician-CEO, tackle imposter syndrome, and develop systems that give your practice true staying power. The discussion provides actionable advice on hiring, team management, building exit value, and creating the freedom to take more time off without sacrificing patient care or financial stability.
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Resources
EntreMD https://entremd.com/about-us/
The Profitable Private Practice Playbook https://entremd.com/method-book/
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BackTable Women's Health 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.
► https://www.backtable.com/app -
Missing episodes?
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Lower C-section rates, faster deliveries, and less physician burnout: could the OB hospitalist model deliver all three? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Maliha Sayla, a board-certified OBGYN and medical director of labor and delivery at Northwestern Medicine Delnor Hospital, to explore how the OB hospitalist model is reshaping care for physicians, patients, and healthcare systems.
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Timestamps
00:00 - Introduction 03:27 - Why Hospitalists Matter05:33 - How Their Model Works07:15 - Managing Pushback10:18 - Measuring Better Outcomes15:58 - Drills and Emergencies19:50 - Staffing and Transition24:33 - ROI and OB-ED26:33 - Residents and Teaching30:52 - Future Flexible OB Careers34:14 - Patient Acceptance of Model36:47 - Collaboration and Lifestyle Balance40:00 - Conclusion
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More about this episode
Dr. Sayla shares her journey from traditional private practice to full-time OB hospitalist work, explaining how this model reduces physician burnout by making labor and delivery a dedicated role rather than one juggled alongside clinic visits, surgeries, and administrative responsibilities. She details her institution’s staffing structure, where hospitalists provide continuous labor and delivery coverage, allowing generalist OBGYNs to focus on outpatient care. Dr. Sayla highlights the benefits of having dedicated physicians available for bedside counseling, fetal monitoring, and real-time decision-making. The episode explores improvements in communication, collaboration, and patient outcomes, including lower NTSV (Nulliparous, Term, Singleton, Vertex) cesarean rates and shorter induction-to-delivery times after adopting the hospitalist model. Additionally, she discusses the hospitalist role in obstetric emergency preparedness and interdisciplinary collaboration, patient perspectives, and the potential of hospitalist programs to address OBGYN workforce shortages.
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BackTable Women's Health 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.
► https://www.backtable.com/app -
Get an inside look at prolapse surgery, from technique to training to team-based care. In this episode of BackTable Women’s Health, Dr. Amy Park talks with Mayo Clinic urogynecologist and pelvic reconstructive surgeon Dr. John Occhino about the art and strategy behind prolapse repair. They explore why Dr. Occhino favors vaginal approaches, when robotics come into play, and how he frames staged treatment strategies, particularly for younger patients at risk of recurrence.
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Timestamps00:00 - Introduction02:09 - Choosing Vaginal vs. Robotic Approach10:24 - Why Vaginal Skills Declined13:20 - OR Setup and Positioning16:32 - Anterior Entry Technique20:05 - Ureter Safety and Suspension28:14 - Robotic Hysteropexy Considerations31:47 - Collaborative Training Culture35:41 - Beyond See One Do One46:13 - Anatomy Keeps You Safe49:46 - Leadership Authenticity53:45 - Team Support and Wrap Up
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More about this episodeThe conversation covers how to counsel patients about prolapse as a dynamic condition, the trade-offs between durability and mesh aversion, and the importance of prioritizing symptoms and quality of life in decision-making. They share practical tips on vaginal hysterectomy technique and ergonomics, discuss why vaginal surgery skills are declining, and highlight best practices in surgical education, including apprenticeship-style training, promoting psychological safety, setting targeted goals, fostering collaboration among program directors, and grounding surgical judgment in anatomy and authenticity in leadership.
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BackTable Women's Health 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.► https://www.backtable.com/app -
Can a “normal” pelvic exam mask life-altering pain? On this episode of BackTable Women’s Health, host Dr. Karen Toubi interviews board-certified OBGYN Dr. Chailee Moss about why common vulvovaginal pain and skin conditions are frequently missed or dismissed as “normal” exams. Dr. Moss explores how gaps between gynecology and dermatology, limited training, and the under-recognition of non-life-threatening but highly morbid pain contribute to these diagnostic challenges, including mental health impact and even suicidality in some cases.
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Timestamps
00:00 - Introduction03:56 - Why Pain Gets Missed08:58 - Building Trust With Time10:51 - Vulvodynia Workup Basics16:02 - Hormonal Vestibulodynia Clues21:21 - New Treatments On Horizon23:07 - Lichen Steroid Maintenance26:25 - Biopsy Decisions And Mimics30:30 - Multimodal Treatment Planning33:00 - Pelvic Floor PT Done Right35:55 - When To Consider Surgery37:33 - Clinical Trials Ketotifen Botox40:40 - Conclusion and Resources
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More about this episode
They discuss rebuilding trust through time, attentive listening, and clear communication, along with a detailed evaluation process that includes medication review, targeted symptom questions, Q-tip mapping, vulvoscopy, cultures, and selective biopsy. The approach informs an individualized, multimodal treatment plan. Additional topics include lichen steroid counseling,differentiating mimickers like yeast and irritant dermatitis, and connecting patients to resources such as ISSWSH, ISSVD, and support groups.
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Resources
Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833711
ISSWSH
https://www.isswsh.org/
Pudendal Hope
https://www.pudendalhope.info/
Tight Lipped
https://www.tightlipped.org/
The National Vulvodynia Association
https://www.nva.org/
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BackTable Women's Health 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.
► https://www.backtable.com/app -
How do you decide which noninvasive prenatal testing option is best for your patient, and when should you reach for single-gene NIPT? In this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews maternal-fetal medicine specialist Dr. Andrei Rebarber to break down the evolving world of prenatal genetic testing. They discuss the importance of pan-ethnic carrier screening, the clinical scenarios where single-gene NIPT is most useful, and how to navigate counseling and follow-up for a wide range of patients.
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This podcast is supported by
Naterahttps://www.natera.com/info/fetal-focus
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Timestamps
00:00 - Introduction04:43 - Prenatal Genetic Testing Basics07:10 - Larger Panel Screening Benefits10:49 - Defining Single-Gene NIPT14:51 - Counseling and Invasive Options18:26 - Accuracy Data and No Call Rate22:03 - Patient Acceptance of Test24:18 - When to Test and Screen26:13 - Counseling Carrier Results30:12 - In Utero Treatment 32:36 - Workflow for Generalists35:33 - How to Interpret Literature40:08 - Closing Remarks
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More about this episode
Dr. Rebarber shares how witnessing in-utero transfusions for severe Rh disease inspired his career in OBGYN and maternal-fetal medicine, highlighting the importance of treating the fetus as a patient and the rapid growth of fetal therapy. The episode reviews ACOG-guided carrier screening for conditions like cystic fibrosis and hemoglobinopathies, the trend toward larger, pan-ethnic screening panels, and why carrier findings are common but true “double-carrier” couples are relatively rare. Dr. Rebarber also discusses the clinical utility of single-gene NIPT—a cell-free placental DNA test for select recessive conditions—especially when partner testing isn’t possible or when patients wish to avoid invasive procedures. The conversation compares screening and diagnostic strategies, including CVS and amniocentesis, and provides practical insight into interpreting test performance and emerging research.
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Resources
EXpanding Prenatal Cell Free DNA Screening Across moNogenic Disorders (EXPAND) https://clinicaltrials.gov/study/NCT06808880?tab=study
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BackTable Women's Health 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.
► https://www.backtable.com/app -
Osteoporosis may present after menopause, but prevention starts decades earlier. In this episode of BackTable Women’s Health, Dr. Carla Gunn, guest host and OBGYN, interviews Dr. Pooja Luthra, an endocrinologist at UConn Health, about osteopenia, osteoporosis, and practical strategies for lifelong bone health.
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Timestamps
00:00 - Introduction03:28 - Why Bone Health Matters Early05:23 - Bone as a Vital Sign08:02 - Amenorrhea and Early Screening09:51 - Calcium, Vitamin D, and Protein15:11 - Menopause Bone Biology Explained21:58 - Metabolic Diseases and Bone Risk25:58 - Early Screening Red Flags27:53 - Hormone Therapy Bone Benefits30:59 - Reading DEXA Scores33:42 - FRAX Scores35:09 - Modern Treatment Sequencing38:02 - Bisphosphonates Mechanism and Concerns41:16 - Secondary Labs and Referrals44:23 - Closing Thoughts
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More about this episode
Dr. Luthra explains how peak bone mass is largely established by early adulthood, followed by accelerated loss during the perimenopausal/menopausal transition due to estrogen decline, inflammatory cytokines, altered calcium absorption, and increased bone resorption. She reviews prevention strategies, including adequate calcium, vitamin D, and protein intake, resistance training, and avoiding smoking and excess alcohol use. The discussion also covers high-risk conditions that can negatively impact bone health, including amenorrhea, premature ovarian insufficiency, hyperthyroidism, diabetes, and chronic kidney disease, along with considerations for earlier screening in these patients. Dr. Luthra walks through DEXA interpretation, including T-scores, Z-scores, trabecular bone score (TBS), and FRAX assessment. She closes the conversation by outlining treatment sequencing with anabolic agents before antiresorptives, bisphosphonate safety, alternative therapies, and secondary osteoporosis workup labs.
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Resources
FRAX Tool:https://www.fraxplus.org/calculation-tool
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BackTable Women's Health 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.
► https://www.backtable.com/app -
"The treatment of cervical cancer is definitely a team sport." Hear how recent radiation advancements are impacting gynecologic cancer care, and how to partner with your radiation oncologist to tailor therapy. This BackTable Women’s Health / Tumor Board episode features hosts Dr. Mona Guo and Dr. Marcia Ciccone joined by USC radiation oncologist and brachytherapy director Dr. Andrew Lim discussing modern radiation techniques, indications for definitive/adjuvant therapy, and toxicity management in gynecologic cancers.
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Timestamps
00:00 - Introduction02:39 - Modern External Beam IMRT05:47 - Planning With CT And AI08:14 - Daily Setup Imaging Workflow13:30 - Dose and Fractionation Basics18:50 - HDR Image Guided Brachy21:50 - Brachy Vs External Boost Evidence24:54 - Managing Side Effects and Menopause28:49 - Hormone Therapy Benefits30:37 - Dilators and Pelvic Rehab33:12 - Long Term Radiation Effects38:14 - Spacers and Prolapse Planning41:42 - Reirradiation and Plan Review44:05 - Palliative Radiation Choices46:50 - Gamma Knife Explained50:16 - Conclusion
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More about this episode
Dr. Lim contrasts historical four-field box radiation with contemporary IMRT, CT-based planning, daily cone-beam verification, and AI-assisted contouring with dosimetrist support. They review pelvic radiation treatment timelines, emerging hypofractionation data, and the essential role of image-guided brachytherapy for cervical cancer, including outpatient workflows and improved tumor coverage with reduced bladder/rectum dose. The group covers patient counseling on expected side effects, radiation-induced menopause, fertility, sexual health, vaginal stenosis prevention with dilators/pelvic floor therapy, late effects, re-irradiation considerations, spacers, palliative regimens, and stereotactic radiosurgery/Gamma Knife for brain metastases.
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BackTable Women's Health 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.
► https://www.backtable.com/app -
What happens when maternity care deserts stop being just a “rural problem” and start impacting your own labor and delivery unit? On this episode of BackTable Women’s Health, host Dr. Nicole Faulkner interviews Dr. Yamicia Connor about the evolving “birth worker crisis.” Dr. Connor reframes the issue as a long-standing structural collapse accelerated by deliberate policy decisions, not simply sudden burnout.
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Timestamps
00:00 - Introduction03:30 - Structural Collapse Explained05:41 - What Providers Can Do09:40 - Data On Care Deserts14:24 - COVID Like System Failure19:50 - Limits Of Telehealth20:57 - Think Systemwide Care23:52 - Insurance Access Shifts25:04 - Support Midlevel Workforce27:06 - Build Future Infrastructure29:39 - Burnout Is System Failure31:02 - Defunding Surveillance Risks32:51 - Stop Calling It Burnout34:35 - Conclusion
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More about this episode
Dr. Connor describes how the systematic decoupling of clinical science from federal and state infrastructure has shifted legal and operational risk onto individual physicians, leading to illogical practice patterns and confusion about the standard of care, especially in settings like emergency departments. A review of the 2024 March of Dimes data showing over 35% of U.S. counties are now maternity care deserts, and JAMA-tracked data in states like Idaho, where nearly a third of OBs left between 2022 and 2024. She warns that as more rural units close, regional and academic hospitals will absorb sicker and less managed patients, straining L&D units, NICUs, staffing, and training pipelines. To address this crisis, Dr. Connor calls for system-level coordination, stronger leadership from professional societies, improved care navigation, expanded mid-level support, and enhanced telehealth infrastructure to extend obstetric expertise.
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Resources
Maternity Care Deserts Across the US https://www.marchofdimes.org/maternity-care-deserts-report
Change in Number of OB/GYN Physicians Practicing Obstetrics After the Dobbs Decision https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837058
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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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From surgery to systems to access, medicine is shaped as much by barriers to care as it is by innovation and the latest techniques. In this episode of BackTable OBGYN, Dr. Kimberly Kho, a complex benign gynecologic surgeon, joins host Dr. Amy Park to discuss her work expanding access to women’s healthcare, including building a surgical program in Hawaii, studying childcare as a barrier to care, and exploring the diagnosis and management of adenomyosis.
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Timestamps
00:00 - Introduction08:35 - Faculty Development in Hawaii12:26 - Childcare as Access Barrier16:20 - Survey and Trial Findings18:10 - Annie's Place Childcare Center24:23 - Childcare Barrier Example25:43 - Applying Community Solutions 27:04 - What Is Adenomyosis30:22 - Diagnosis Strategies Beyond Hysterectomy34:07 - Risk Factors and Age Myths36:03 - Fertility and Pregnancy Risks38:02 - Medical and Surgical Treatments41:20 - Uterine Sparing Procedures45:59 - Closing Thoughts
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More about this episode
Dr. Kho discusses her recent transition to the University of Hawaii, where she is building a complex benign gynecology program to serve patients across the state and broader Pacific region. Her work emphasizes faculty development through mentorship, strengthening research infrastructure for generalists, fostering inter-island collaboration, and implementing surgical coaching.
She then reflects on her time at Parkland, where she expanded access to minimally invasive gynecologic surgery, demonstrated by a significant reduction in open hysterectomy rates. She also shares how her team identified unmet childcare needs as a major barrier to care, leading to multiple research initiatives, a clinical trial, and ultimately the creation of a five-year, no-cost, onsite childcare center (Annie’s Place) developed through hospital and community partnerships.
The episode concludes with an in-depth discussion of adenomyosis, covering its pathophysiology, imaging-based diagnosis, common symptoms, and fertility implications. In the absence of formal guidelines or FDA-approved therapies, Dr. Kho reviews current management strategies, including medical therapy, uterine artery embolization (UAE), and endometrial ablation techniques.
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Resources
Childcare needs as a barrier to healthcare among women in a safety-net health systemhttps://pubmed.ncbi.nlm.nih.gov/38886715/
Addressing childcare as a barrier to healthcare access through community partnerships in a large public health systemhttps://pubmed.ncbi.nlm.nih.gov/36261213/
Adenomyosis Pathophysiology, Diagnostic Advances, and Therapeutic Optionshttps://pubmed.ncbi.nlm.nih.gov/41926770/
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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.► https://www.backtable.com/app -
Imaging, incisions, and Instagram: Dr. Ramirez on the cutting edge of endometriosis management. In this episode of BackTable OBGYN, host Dr. Mark Hoffman interviews Atlanta-based Complex Benign Gynecology (CBG/MIGS) surgeon Dr. Laura Ramirez about how her practice has shifted toward predominantly endometriosis care, driven in part by social media referrals bringing patients nationwide.
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Timestamps
00:57 - Introduction02:22 - Mentorship Mission and Career Focus06:13 - Social Media Referrals08:10 - What Is Endo Surgery and Targeted Excision13:27 - Multidisciplinary Care16:53 - Lesions and Adhesions Approach 22:20 - Imaging and Case Triage24:07 - Hysterectomy Expectations27:28 - Going Solo on Bowel Endo31:25 - Team Support and Mentors34:27- Residency Training Gaps40:39 - Call for Help Culture43:07 - Challenging Surgeries 48:10 - Noninvasive Tests and Therapy Limits51:26 - Conclusion
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More about this episode
Dr. Ramirez discusses why endometriosis surgery varies by patient, pathology, and surgeon experience. She emphasizes careful symptom-based assessment, recognizing atypical lesions, and setting realistic expectations. The conversation contrasts radical peritoneal stripping with her preference for targeted excision to reduce complications, highlights multidisciplinary management for central sensitization and overlapping bowel/bladder symptoms, and covers imaging triage, robotic vs. laparoscopic approaches, collaborating with colorectal specialists, and diaphragmatic endometriosis as an ongoing surgical challenge.
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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.
► https://www.backtable.com/app -
What if we trained surgeons to recover from complications, not just avoid them? In this BackTable OBGYN episode, Dr. Joseph Chen, a complex benign gynecologic surgeon at Kaiser Permanente and certified surgical coach, joins host Dr. Nicole Faulkner to explore how surgeons process and recover from complications.
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Timestamps
00:00 - Introduction01:15 - Dr. Chen’s Origin Story06:34 - Coaching Framework08:08 - Second Victim Phenomenon10:10 - Four Phases Of Stress15:07 - Managing OR Chaos19:22 - Delegation as Surgeons22:11 - Peer Review Programs25:09 - How Coaching Programs Work30:52 - Timeline After Complications33:16 - Avoiding The Advice Trap35:37 - Debriefing With Residents40:51 - Future of Coaching and AI47:13 - Resolution of Complic
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More about this episode
Dr. Chen reflects on a serious complication during his fellowship that exposed an “emotional gap” in surgical training beyond technical solutions. This experience shaped his focus on psychological safety, crisis-management frameworks, and supportive coaching. He outlines the phases following an adverse event, from the initial chaos and cognitive overload to reflection, identity challenges, and resolution. Do these factors influence whether one experiences burnout, survival or growth. This episode also recommends practical strategies such as focused breathing, effective delegation, and simulation training to improve performance under pressure. Dr. Chen discusses the “second victim” phenomenon, reviews data on surgeons’ emotional responses after complications, and emphasizes the importance of allowing time before debriefing. They advocate for peer support, non-punitive systems, and coaching programs to improve surgeon well-being, patient safety, and operating room efficiency. Finally, they explore future roles for AI and video review in surgical learning.
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Resources
Medical error: the second victim. The doctor who makes the mistake needs help toohttps://pubmed.ncbi.nlm.nih.gov/10720336/
Dare to Lead by Brené Brownhttps://brenebrown.com/book/dare-to-lead/
Atlas of the Heart by Brené Brownhttps://brenebrown.com/book/atlas-of-the-heart/
The Advice Trap by Michael Bungay Stanierhttps://www.mbs.works/advice-trap-book/#purchase-options
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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.
► https://www.backtable.com/app -
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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Timestamps
00:00 - Introduction03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline07:32 - Patient Experience with OAB11:59 - Beta-3 Agonists vs Anticholinergics15:15 - Botox Counseling and Dosing18:11 - Tibial Nerve Stimulation25:47 - Sacral Neuromodulation32:09 - Cost Burden of OAB39:38 - Evolution of OAB Care41:39 - 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 Dementiahttps://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 Registryhttps://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.
► https://www.backtable.com/app -
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 Cycleshttps://www.naturalcycles.com/
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Timestamps
01:29 - Introduction03:02 - Contraception Pain Points06:16 - Natural Cycles Origin09:46 - How The App Works12:44 - Effectiveness And Variability15:18 - Ideal Users And Red Days17:34 - Modes Beyond Birth Control19:19 - Clinical Insights From Data22:04 - Future And Privacy24:31 - Counseling And Adoption Tips27:19 - 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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Timestamps
01:17 - Introduction 03:35 - How Kaiser Works07:24 - Research Using Big Data09:19 - Changing Hysterectomy Culture13:36 - Ending Racial Disparities15:22 - Handling Large Uteri17:52 - Vaginal Hysterectomy Trends20:38 - Myomectomy Reintervention Rates24:23 - Shared Decision Making26:30 - Mini Lap Versus Robotic27:41 - Hybrid Extraction Strategy29:08 - Credentialing Robotic Myomectomy30:19 - MIG Referral Pathways32:03 - Fibroids Across Asian Subgroups34:55 - Mentoring Research Pipeline36:44 - Funding Analysts Through GME40:49 - Endometriosis Disparities Findings43:59 - 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 Systemhttps://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 - Introduction01:37 - Why Hereditary Cancer Matters04:51 - Family History Red Flags09:01 - Who Should Order Genetic Testing11:32 - Variants and Counseling Pitfalls13:30 - Access and Remote Testing Options19:27 - BRCA1 Positive Patient Walkthrough24:52 - Risk-Reducing Surgeries29:11 - Prevention and Screening Limits32:38 - Why Ovarian Cancer Is Hard34:04 - Combining Breast and Gyn Surgery35:41 - Preop Ultrasound and CA-12536:27 - BRCA Timing and HRT Nuance42:32 - Nonhormonal Menopause Options47:14 - Lynch Syndrome Screening Basics54:22 - Endometrial Biopsy Debate56:43 - Insurance and Coverage Pitfalls59:00 - Fertility Preservation and REI01:01:41 - Cascade Testing01:02:45 - 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 Reductionhttps://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 - Introduction02:18 - Dr. Ackenbom’s Journey to Urogynecology04:47 - Research on Brain Fog06:18 - Personal Support and Hobbies09:54 - Age vs Frailty in Surgery13:05 - Procedures with Perioperative Complexity16:11 - Counseling on Operative Risk20:10 - ERAS and Earlier Discharge23:35 - Patient Goals and Tradeoffs27:53 - Surgical Clearance and Preop Consults33:30 - Prehabilitation Basics36:24 - Minimally Invasive Surgery Benefits37:15 - Surgical Cognitive Complications with Age41:42 - Finding the Surgery Window46:05 - Cognitive and Frailty Screening50:01 - Guidelines for Perioperative Care52:52 - Future Research 54:07 - Conclusion
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RESOURCES
Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgeryhttps://pubmed.ncbi.nlm.nih.gov/32827107/
ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patienthttps://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 - Introduction05:40 - Multi-Compartment Prolapse & Second Opinions08:14 - Pelvic Floor Compartments Explained10:36 - When Internal Prolapse Becomes Surgical11:56 - Incomplete Emptying, Splinting, Fragmentation & Leakage16:55 - Fluoro vs MRI and When to Order It23:47 - Anorectal Manometry26:56 - Physical Therapy, Biofeedback, Meds, Injections, & Motility Workup29:08 - Robotic Mesh Repairs vs Vaginal/Perineal Approaches34:43 - When (and Why) to Consider Biologics36:46 - Resection Rectopexy38:10 - Treating Ehlers-Danlos syndromes (EDS) & Eating Disorders42:55 - Pelvic Floor PT After Surgery and Recovery Timelines47:29- Perineal Prolapse Repairs (Altemeier vs Delorme)49:53 - Symptom Improvement vs Retraining the 'New Normal'52:20 - Fecal Incontinence & Sacral Neuromodulation57:08 - Diarrhea-Driven Incontinence58:56 - Building a Multidisciplinary Pelvic Floor Program01:04:04 - 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 - Introduction05:34 - Training and Mentorship in Hysteroscopy11:21 - Dr. Salazar's Practice and Techniques14:00 - Challenges and Trends in Surgical Practices18:58 - Referral Practices and Advanced Hysteroscopy21:58 - Understanding Dysmorphic Uterine Population24:08 - T-Shaped Uteri Description26:09 - Hysteroscopic Metroplasty: Methods and Risks29:17 - Innovations in Hysteroscopy32:38 - Value of Ultrasound in Hysteroscopy36:35 - Post-Operative Management and Estrogen Therapy39:23 - Challenges and Future Directions in Hysteroscopy44:23 - 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-analyseshttps://academic.oup.com/humupd/article/31/6/588/8248883
Hysteroscopy Newsletterhttps://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 - Introduction03:41 - Residency and Early Involvement in ACOG07:29 - Advocacy and Government Affairs18:40 - Balancing Professional and Organizational Work24:28 - Listening to Members' Needs26:36 - Challenges and Value of ACOG Membership29:00 - The Importance of In-Person Meetings34:45 - ACOG's Legislative Advocacy and Future Plans35:48 - Advice for Getting Involved with ACOG40:16 - 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 - Show more
