Episode 12.2 Cuff Dehiscence and Classic Papers

Howard Herrell and Stuart Winkler question long-standing OB-GYN habits that feel “routine” but do not add value, then replace them with evidence and practical decision-making. We move from hysterectomy follow-up and cuff dehiscence management to the data behind cesarean sutures, endometrial cancer evaluation in postmenopausal bleeding, and the ongoing shift to HPV-based cervical cancer screening. 
• why routine 6 to 8 week vaginal cuff exams after hysterectomy may not prevent or predict dehiscence 
• how telehealth post-op care can improve access while keeping symptom-driven safety nets 
• four tips for evaluating and managing vaginal cuff dehiscence, including when laparoscopy matters 
• what Ethicon discontinuing chromic and plain gut could mean for cesarean technique choices 
• how the CORONIS trial informs chromic vs Vicryl decisions and why transfusion risk is part of the conversation 
• where the 4 mm endometrial stripe rule came from and why it can fail in real-world care 
• why persistent postmenopausal bleeding still warrants endometrial biopsy despite reassuring ultrasound 
• how race, tumor subtype, and fibroids affect endometrial cancer detection and counseling 
• the arc from Pap smear cytology to HPV DNA testing, vaccines, and primary HPV screening 
• why self-collected HPV testing may raise screening uptake for patients avoiding speculum exams 

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0:00 Welcome And Today’s Game Plan

0:35 Rethinking The Six-Week Pelvic Exam

13:25 Four Practical Tips For Cuff Dehiscence

24:42 Chromic Gut Is Disappearing

35:40 CORONIS Trial And Cesarean Sutures

42:22 Postmenopausal Bleeding And The 4 mm Rule

53:12 HPV Testing Takes Over Screening

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