Phone: 512-238-0762

Fax: 512-341-7370

July 18, 2020

Can PAE Help You PEE?: Dr. Mistry and Dr. Howard Sill Discuss Prostate Artery Embolization For BPH

Speaker 1: 

Welcome back to the Armour men’s health hour with dr. Mystery and Donna Lee. Hello,

Speaker 2: 

Come to the women’s health hour. I’m dr. Mystery, your host here as always with my cohost, the effervescent and indispensable.

Speaker 1: 

That’s right. Try not to wrap it up at the beginning.

Speaker 2: 

That’s right. Fabulous show. We’ve been doing the radio for a little while now. So we have, we know all of these radio terms, wrap it up. What was the other one? I guess the one you use the most banter shut up, shut up and useless conversation. Well, very good. So we’re getting this radio thing down.

Speaker 1: 

We are, we’ve got all sorts of people listening in it’s crazy.

Speaker 2: 

I’m dr. Mystery, M I S T R Y. That is my real name. And this is the armor men’s health show. This is brought to you by NAU urology specialists. Our urology practice in founded in 2007.

Speaker 1: 

You’ve been around a long time and old man. They got the gray on hair.

Speaker 2: 

I still think I still consider myself a young buck in this down, but I don’t know.

Speaker 1: 

I think I’m looking at it otherwise. You’re making me old. It’s all the stress like control

Speaker 2: 

Boy. Donald Lee is our office manager here. We have grown this practice from a single solo practitioner to one that has four physicians for PA and nurse practitioners. We have a in house, pelvic floor, physical therapy. We have a in house, nutritional counseling in house sex therapy in house, sleep, apnea testing, and really a practice focused on you as the whole person. This show gives us the opportunity

Speaker 1: 

That’s right, and all the options, all the options, which is going to bring us to our special guest in a minute. Totally.

Speaker 2: 

You want to tell people about our practice.

Speaker 1: 

You can call us at (512) 238-0762. During the week, you can reach out, reach out to us through Armour men’s health.com. That’s our website. You can send an inquiry through that website, or you can email me directly at Armour men’s health@gmail.com. And we will respond to the emails. We will answer the questions anonymously on air and you know, Donna, you know why I became a urologist,

Speaker 2: 

The jokes, they were number one, but number two was to save people’s lives. The surgery, the surgery you went, when you go through medical school, you sit in a big room. You self-select which tables you sit in the cafeteria. You know what I’m saying? Radiologists, sit at their own table. The internist is on the table. That’s right. Alright. Dermatology OB-GYNs and dermatologists at another table, the fancier table and the surgeons all sit in the same table, make farting noises. And the, I mean, it’s a very, it’s a lot of fun to compare hand sizes. That’s correct. That’s right. Eight and a half. I’m larger than most men. I tell people the, um, the act of becoming a surgeon or being able to function as when it was one of the biggest reasons that I became a urologist. Sometimes people are surprised when we offer treatments for things that are either nonsurgical or differently surgical. And I thought that would be a great lead in to our special guest today. Dr. Howard sill from advantage. I R thanks a lot for joining us today, Howard. Oh, I really appreciate

Speaker 3: 

The opportunity. Thank you so much.

Speaker 2: 

We’re gonna discuss and talk about a treatment for enlarged prostate today that a lot of our listeners may never have heard of called prostate artery embolization or P a E. How long have you been doing PE? This is not new.

Speaker 3: 

Actually the, uh, the first prostate artery embolization was done in 1976. Believe it or not, it was actually done for a patient with prostate cancer that had severe bleeding. Interventional radiology is a field that most people haven’t heard of, but it’s been around since, uh, 1964, when we performed the first angioplasty in the leg, unlike your table of surgeons, interventional radiologists take pride in not making big incisions

Speaker 2: 

And that’s right. Minimally invasive surgery. Yeah.

Speaker 3: 

And so we’ve invented things, it’s all over the body to avoid surgery.

Speaker 2: 

You know, we say it’s not the size of the incision. It’s the size of the surgeon.

Speaker 3: 

So we like to say how far you can go with your wire.

Speaker 2: 

I didn’t know. I didn’t know. They got a little dirty mine there though. So, um, first, just to give people a general idea about prostate problems in general, when I describe prostate problems, I describe it as an age related growth of the prostate that can affect up to 60% of men over the age of 60, that leads to slow flow, urgency and frequency, urinary retention that can sometimes lead to more significant problems. How would you describe BPH to patients?

Speaker 3: 

Very similarly, actually, I usually use 70% at 70 as my benchmark. So we’re probably on the same page with that. The debilitation that this causes for many men, where they just are running to the bathroom all the time. They, if they take a car trip and they have to stop every hour or two, or they have accidents, it creates a lot of effect on their life that we can help with our procedures.

Speaker 2: 

You know, as a urologist, we come across these patients, they come to us with these problems. Sometimes we try meds in our field. We’ve come up with this plethora of different BPH type procedures. We can do rotor, Rooter, TURPs. We can use lasers, we can use steam, we can use clips like the Euro lift. And so it just seems like increasingly we’ve come up with better and better technologies, but you know what? One of the, one of the commonalities is something’s probably going to go on your penis.

Speaker 3: 

Many of our procedures are done through blood vessels. We occasionally do the procedures that involve a needle going straight into an organ in the body. But for the most part, our specialty started off for the angioplasty. So we go through blood vessels. When we do this prostate artery embolization, embolization just means stopping blood flow. We go through a blood vessel to do it.

Speaker 2: 

I think cognitively people understand that if something’s too big and you can restrict the blood flow to it and make it smaller that perhaps the symptoms would get bigger, better,

Speaker 3: 

Sorry, one other commonality. I think that our specialties have is that we’re both plumbers. So we have a little bit different toolbox for our, uh, plumbing treatments and for us putting a wire into a blood vessel and then putting a catheter that we can guide to the artery that goes to the prostate gland. And there’s one on each side and most men, and then putting in small particles that block up those little blood vessels can cause the gland to shrink and decrease symptoms without cutting anything out. We don’t cut anything out. We just cut off the blood supply.

Speaker 2: 

Well, let me just first say you use the word catheter. And in this case, catheter is really just me. It meant to be a tube to access. This is not the same kind of urinary catheter that you would use for one of my procedures that I would do in the surgery, in the surgical suite. What you’re doing is going through the blood vessels, the blood vessels in the hand, or the groin, you feed it up to those blood vessels that feed to the prostate, and then you cut off that blood flow. Now, some people are worried, well, if you completely strangle off the blood flow that Oregon’s going to die. That sounds really bad. There’s more than just those two blood arteries that feed the process.

Speaker 3: 

Yeah, just about every organ in the body has what we call collateral supply. You can think of these as the, the main artery is the highway and the small collaterals as side streets. And so we go into the main artery, the main highway artery, and block that off, but it still allows a little bit of blood flow to get in through the side streets that keeps the gland alive.

Speaker 2: 

And when I describe it to patients, I tell them that there’s about a, they can expect over about the next 12 to 16 weeks, about a 40% decrease in the size of the prostate. That’s exactly what I tell them. What percentage of patients with classic BPH symptoms do you,

Speaker 3: 

Or having improvement

Speaker 2: 

As you know, after four, 12 weeks of

Speaker 3: 

For treatment over 90%, uh, well, quotas of having improvement, it can even be higher than that, but it’s more of the degree of improvement. The thing that we’ve seen with the studies that have been done is that our improvement rates that degree to which we improve things are, are really getting pretty close to a Terp to, you know, the rotor reader procedure that you do. Nothing’s going to be as good as the Terp. I’m sorry, Howard. I never going to give you that. Do you understand?

Speaker 2: 

Okay. All right. I’ll let you have second best, but second best around here is pretty good. Right? We’re the second biggest urology practice and down, uh, when it comes to prostate artery embolization, the patient does not leave the suite with a catheter it’s generally done under a sedative procedure. So you don’t have to go to sleep. There’s a lot more leeway in how sick or healthy the patient can be and tolerate the procedure. And it’s covered by insurance, which, uh, I guess I left the best for less so, and it doesn’t preclude anything that I want to do. It doesn’t work. We have all the tools still in the toolbox that we can use from a neurologic standpoint.

Speaker 3: 

That’s right. So the, the small particles that we put into block the blood vessels, they stay there, they’re permanent. They don’t move, they don’t go anywhere. And like you said, it doesn’t prevent any other procedure from being done. The only way that those little particles are going to come out as if you cut them out with a Terp,

Speaker 2: 

I guess, to kind of keep in line. What I tell patients, I tell patients that the larger your prostate is the more likely the procedure is going to work. So if you have a very small prostate, perhaps this may not be the perfect option for you, but if you even have a massive prostate this week, I saw 200 grand prostate, which is eight times normal size. Uh, I think that guy’s going to do great with it. Um, I tell people that, um, they’re, they’re,

Speaker 3: 

They’re not going to have a catheter afterwards and that they should expect improvement in about four to eight to 12 weeks. Yes. Uh, the, the blood supply as after it’s cut off allows the, uh, the prostate gland to gradually shrink over the course of weeks to months. And most people will have the maximum degree of, of improvement after a few months now, uh, many patients would never have even heard about the prostate symbolization. What, why is that? Uh, it’s because I’m an interventional radiologist and most people have never heard of that either. Um, our, uh, treatments compete with traditional surgical treatments in many cases, and many surgeons don’t offer that or mention it as a, uh, a potential treatment that is helpful. How do people get ahold of you? What is your website and your phone number? Our advantage, I, our website is advantage hyphen [inaudible] dot com.

Speaker 3: 

And through that, they can get to all of our, uh, uh, telephone numbers, you know, and at five one, two seven seven two one six seven seven is our main number here in Austin. We also have another office in El Paso. And if you call our office or email us, we’ll get them a hold of you. Uh, I would consider us one of our strongest urologic partners that advantage I R has in this town. And if you’re interested in prostate artery embolization, you should let us know and we’ll get you in contact with dr. Silly.

Speaker 1: 

That’s right. Thanks for coming in yourself. That was awesome. We have no time left the armor. Men’s huh?

Speaker 3: 

Is brought to you by urology specialists for questions, or to schedule an appointment, please call (512) 238-0762 or online at Armour men’s health.com.

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