Phone: 512-238-0762

Fax: 512-341-7370

March 7, 2020

Dr. Mistry and Donna Lee Answer a Listener’s Questions About Peyronie’s Disease and “FLP,” or “Funny Looking Penis”

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back. I’m Dr. Mistry, your host.

Donna Lee: 

That’s your name.

Dr. Mistry: 

That is my name.

Donna Lee: 

How do you spell that?

Dr. Mistry: 

I’m also with Donna Lee. Miss interrupter over there.

Donna Lee: 

You told me to interrupt you more, so I am.

Dr. Mistry: 

That’s right.

Donna Lee: 

Mystery.

Dr. Mistry: 

I told you what Brian Sellers, my good friend from Round Rock wanted…

Donna Lee: 

More Donna.

Dr. Mistry: 

More Donna.

Donna Lee: 

That’s right, as every smart man should.

Dr. Mistry: 

He said I was boring.

Donna Lee: 

You just talk a lot, and I don’t want to interrupt you. But I will.

Dr. Mistry: 

Well, it’s time.

Donna Lee: 

M-I-S-T-R-Y.

Dr. Mistry: 

I’m a board certified urologist. A urologist is a surgeon that is trained in…

Donna Lee: 

Surgery?

Dr. Mistry: 

…disease management of the genitourinary treatment. For those of you that don’t know, we deal with problems like kidney stones, kidney cancer, problems with the transport of urine down from the kidney to the bladder, some of that which can be affected by tumors or other problems within the abdomen. A lot of our work is between the bladder, the prostate, the penis, and the outside world. We also treat women. Women will get kidney stones, kidney cancer, bladder cancer, a number of other things.

Donna Lee: 

Lots of UTI’s.

Dr. Mistry: 

We also deal with urinary incontinence. I think we have a great program for chronic urinary tract infections in postmenopausal women. We also deal with sexual dysfunction in women, although we don’t talk about it a lot on this show. We have had a advanced sexual dysfunction clinic for women for many years. We have a pelvic floor physical therapist. We have an amazing vaginal rejuvenation program. We have a sex therapist. And a real area of interest that we take pride in is the treatment of women after breast cancer and breast cancer treatment and helping them deal with regaining their sexuality. So if you’re a man out there and your spouse or girlfriend was diagnosed with breast cancer, and whether they’ve gone through treatment or not, this is a great opportunity to bring up these issues of sexuality and how to regain sexual function, because the chemotherapy, the radiation, the surgery, all of those things can have an impact. So…

Donna Lee: 

And you should also Google our “That’s what she said” segments.

Dr. Mistry: 

That’s right.

Donna Lee: 

Because those are amazing.

Dr. Mistry: 

That’s right.

Donna Lee: 

It’s the provider or the doctor telling you guys exactly what to expect for when your women are going through certain issues.

Dr. Mistry: 

That’s right. And you can Google it or you can just search the podcast, which is what you’re supposed to do, Miss. I don’t know even know if we’re on the Google.

Donna Lee: 

The Google? Is that like the Walmart?

Dr. Mistry: 

Or the Twitter.

Donna Lee: 

The Target.

Dr. Mistry: 

We don’t know what we’re doing. In any case. We do absolutely love to help you address any number of different topics or issues that you may have that come up. Sometimes we direct the topics, we’ve decided to kind of help answer questions that you’ve had.

Donna Lee: 

Because there’s so many!

Dr. Mistry: 

And, this, I think, upcoming question is something that we get virtually every week. We could spend 15 minutes on Peyronie’s disease every week…

Donna Lee: 

We could.

Dr. Mistry: 

…and we would have interested listeners. Let’s hear the question and then I really want to go through the psychology of Peyronie’s disease a little bit.

Donna Lee: 

Okay. And this gentleman used your famous “FLP,” which is “funny looking penis.”

Dr. Mistry: 

That’s right.

Donna Lee: 

So this was in the question. I was impressed. This is for you, Dr. Mistry. “I have a few questions about Peyronie’s disease,” this person sends in. “Do you typically have success reversing the effect [sic] of this condition,” and he put in parentheses “FLP.” Number 2, “Does Medicare cover the office visits? If not, what would the expected expense be?” And number 3, “Is there a specific clinic location that treats this condition?”

Dr. Mistry: 

Well? That’s a great question. So when it comes to Peyronie’s disease, specifically, what we’re talking about is the deposition of scar along the erectile bodies of the penis. That generally leads to an abnormal curvature with an erection. A good proportion of patients will have pain when they have this thing first start, but then eventually the pain will go away. The curvature can be an upward, downward, right, left curvature. It can also be a twist. And probably one of the hardest to deal with medically and psychologically is going to be the kind of Peyronie’s that leads to like an hourglass deformity. And it looks like one part of your penis when erect is just thinner than the rest of it. And it gives you the impression that you’re not getting blood flow to the end of the penis because sensation is different and the penile or the erectile kind of hardness is not going to be there. First I want to talk about the psychology. I think the reason why we get so many questions about it is because it’s so off-putting to have something that you’ve had forever, your erections, and then wake up one day and it just look funny and not function right. And it literally can happen overnight. You can wake up, something that you’ve relied on night after night, day after day…

Donna Lee: 

Oh my.

Dr. Mistry: 

…can totally feel like a betrayal to you.

Donna Lee: 

Especially when it’s looking back at you.

Dr. Mistry: 

That’s right. And then you have the embarrassment that you perceive you’re gonna experience when your partner sees that curved penis and wonders what’s wrong with it. And so I completely understand why it’s off-putting and you may not know even where to turn. And then a lot of times men with Peyronie’s will see a urologist, and they’ll get an incomplete or insufficient answer. And it’s because not all urologists are gonna deal with that condition the same. If you go to a urologist that doesn’t do penile reconstruction surgery, or doesn’t have Xiaflex as an option, or doesn’t believe in a vacuum therapy, or doesn’t have the right supplements or meds, you may not get that comprehensive kind of advice. There’s some comforting truths about Peyronie’s, and some hard truths. The comforting truths are that if you have pain, that will get better. The comforting truths are that a good number of patients who wake up with a bad curvature will have improvement in that curvature before it becomes permanent. Some less comforting things are that it can cause erectile dysfunction. It can sometimes be something that’s not going to reverse on its own, and is going to require additional treatment. So when I talk about treatment for Peyronie’s, I usually separate it: the first determining factor is how much of a curvature is it and is it preventing you from having intercourse. So generally speaking, a man with a curvature of about 30 degrees can still have intercourse. If the curvature is more than that, then it can make it difficult to penetrate. You’re invariably going to have some degree of penile shortening, which also has a psychological impact. And then there can be pain. If there’s pain for the most part, our practice and me, we don’t do much. We will try Colchicine, which is an oral medication. We will do vacuum therapy and in some cases we’ll do injections of medicine into the plaque or into the hardness that you feel with Peyronie’s to help break it up. But for most people, I usually don’t try to do any injections while you’re in the painful stage, also known as the acute stage of Peyronie’s. After that resolves, then we have a lot more options on the table. Generally, oral medications don’t have a lot of effectiveness. Some people think it does have effectiveness, but those are people who probably would have gotten better on their own. Two therapies that work the best: the first one is called Xiaflex. It’s a special enzyme that was derived from bacteria that break down scar collagen. And it’s injected right into the plaque. It’s called Xiaflex, X-I-A-F-L-E-X. If you have not been advised on the potential benefit of Xiaflex, or if you were diagnosed with Peyronie’s, let’s say 7 years ago, before the medicine was available, you may not have been counseled on it and we would encourage you to come in and hear more about it. It is covered by many insurances. If you’re a Medicare patient, it’s covered in a special way and we might have to find a special way to get it to you. But generally, these medicines are covered. But if the curvature is really severe, you might need surgery. And although that sounds scary, oftentimes surgery can be the best solution. When in a 45 minute procedure we can straighten you up and make you feel whole again. If it’s a severe, severe curvature, like more than 60 degrees, we actually have to do something with a patch graft. But nothing that we don’t do all the time, nothing that we haven’t been trained on. Myself and my partner, Dr. Christopher Yang, have been specially trained in penile reconstructive surgery. And so you have a lot of potential people in our practice that can address it and fix it. And most importantly, everyone here is going to give it a really thorough evaluation, and deal with both the physical as well as the psychological impact that this condition is having on you. There’s a 80% concordance or overlap with low testosterone, and so we’ll check that and fix that. We’ll also make sure you’re getting rigid erections, as well as possible using other therapies. Shockwave therapy may be of some value in cases where the plaque is easily palpable, we can, and put those low intensity electro pulses right on the shock–excuse me, right on the plaque. And so a number of things that you can have at your disposal, the most important thing is going to a doctor that cares about its treatment.

Donna Lee: 

Like you.

Dr. Mistry: 

Well, thanks. Thanks Donna for letting me go on for 8 minutes.

Donna Lee: 

20 minutes? Yeah, I know, but that was a great answer. And now if you have this…like 10% of men have Peyronie’s.

Dr. Mistry: 

Why don’t you tell people what you’re most proud of in our practice?

Donna Lee: 

I am most proud of the fact that when I joined you and you’re the first surgeon I worked with, that you’re not the GoTo surgeon. Like let’s do surgery right off the bat. I was super proud to learn that about you. You’re very holistic in your approach and with sex therapy and physical therapy and all these different ancillary services, you start with that, the registered dietician, you have all these things that you would never think would be in a urology clinic, and at the very end, if surgery is the option, then you go to surgery.

Dr. Mistry: 

Even though we love it so much.

Donna Lee: 

I know you love it so much, but I was still pretty impressed.

Dr. Mistry: 

Why don’e you tell people how to get ahold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. You can also email us from wherever you are, armormenshealth@gmail.com. Listen to our podcasts. They’re amazing and they’re free and they’re award-winning. So find them on Google, on the Google, when you were shopping in the Target. Our website is armormenshealth.com. Thanks so much, Dr. Mistry.

Dr. Mistry: 

Thank you.

: 

The Armor Men’s Health Hour. We’ll be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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