Phone: 512-238-0762

Fax: 512-341-7370

October 31, 2020

Dr. Mistry Answers Listener Questions on Prostate Artery Embolization + Ejaculate Quantity/Quality

Speaker 1: 

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

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I am Dr . Mistry, your host, here with my co-host and partner in crime over here, Donna Lee.

Donna Lee: 

That’s right. I’m a bad girl.

Dr. Mistry: 

I’m a board certified urologist, maybe looking for a new partner in crime here shortly if she can’t clean up her mouth, and this is a men’s health show. This show is brought to you by the urology practice that I started in 2007, NAU Urology Specialists and have proudly grown to include some amazing practitioners. We have Dr. Christopher Yang, a board certified prosthetics expert in male erectile dysfunction. We have Dr. Lucas Jacomides, who spent many years, one of the head honchos over at Baylor Scott & White, exceptional at integrative care, and knows a lot about all the different areas of urology. Dr. Stacy Ong–she was for almost a decade the only urologist at Breckenridge. So she knows about trauma and sick patients and really, really terrible disease. And she is just an amazing practitioner, wonderful background to her as well as a wonderful disposition. Then my own practice. I am certified in robotics. I do quite a bit of advanced fertility. We have been doing amazing work when it comes to hormone replacement therapy. We do women’s issues when it is related to sexuality, urinary leakage, kidney stones, prostate cancer, on and on and on and on. And it’s the kind of thing when it comes to your specialty men’s health needs, but really all urologic needs, we’re here to take great care of you.

Donna Lee: 

Yeah, that’s right. We can handle it. What’d you say, from the nipples down?

Dr. Mistry: 

That’s right. Nipples to the knees.

Donna Lee: 

Nipples to the knees.

Dr. Mistry: 

Nipples to the knees. We have an amazing integrative health practitioner. Her name is Shefaly Ravula. She used to be at Austin gastro. She’s a firm believer in food as medicine, and she really walks the walk and, you know , not just talks the talk. She’s an amazing practitioner who’s going to help integrate dietary and supplement kind of trends along with the medicine and surgery that we perform to optimize your health. We have Dustin Fontenot, who’s an amazing physician assistant when it comes to your hormonal health. Leonora Brown, she is a little mini me, a doppelganger of mine. She’s been , she’s been with me for 10 years.

Donna Lee: 

She does not look like you.

Dr. Mistry: 

She doesn’t look like me, but she treats patients like me. And I love that. I love, I love reading her notes and seeing how she’s treating people. And she has smaller hands than I do, so a lot of, a lot of my old timey patients prefer their prostate exam with her. And then we have Jason Ramsdell, he does a lot of work down South. He’s a former 20 year in the coast guard kind of character. He’s been a PA in urology for many, many years, and just the most amazing wheel disposition.

Donna Lee: 

And a big ol’ beard.

Dr. Mistry: 

And a big old beard. And one of our news additions, so we have Heather L enz. She has experience in family practice, a wonderful disposition, and also small fingers.

Donna Lee: 

We talk a lot about small fingers, big fingers.

Dr. Mistry: 

I’ll tell you, it’s funny, it’s funny when people think is important. Yeah. And your questions and your participation with our practice and your coming in to see us are really, really important drivers of what makes this show happen and our practice happened. So , Donna, how do people get ahold of us? And let’s go to some questions.

Donna Lee: 

Sure. You can call us during the week at (512) 238-0762. Our website’s armormenshealth.com and our email address is armormenshealth@gmail.com. First question, discussing prostate artery embolization, also known as PAE. “Dr. Mistry, I’m having PAE by Dr. McWilliams at UCLA. Should I be concerned that my prostate at 160 has a median lobe protruding into the bladder?”

Dr. Mistry: 

What a great question. And so prostate artery embolization is a fairly new, unique, and often underutilized procedure for an enlarged prostate where an interventional radiologist will go into the arteries that feed your prostate and then send little, little beads that will cut off the blood flow. It will shrink, shrink the prostate and it works wonderfully for these humongous prostates . 160 gram prostate is five times larger than a normal prostate.

Donna Lee: 

What’s, what’s the size? Like a walnut?

Dr. Mistry: 

A walnut would be a normal prostate. And this is like a tennis ball. It’s a pretty big prostate. Now in our practice with me, if you were getting treated by me surgically, I would do something called a laparoscopic robotic simple prostatectomy, which is a procedure done through small incisions in your abdomen to go and kind of core out your prostate. It’s a wonderful procedure. I love doing it. It works really well for men. But sometimes men don’t want to go through something as invasive as that and want to try something a little less invasive and a prostate artery embolization is a perfectly acceptable option if you are not in urinary retention or having recurrent urinary tract infections, but just are bothered by symptoms of an enlarged prostate. The procedure takes about a couple of hours. If you don’t want to travel all the way to UCLA , we have exceptional experience, prostate artery embolists here. We use Dr. Howard Sill, Dr. David Wood at Advantage IR. They’re our partners, and we have worked together to really promote this technology. In terms of the anatomic considerations you have, it is virtually very uncommon, virtually impossible to have 160 gram prostate without having a large median lobe protruding into the bladder. It’s, they go hand in hand. So it is the case that men with larger median lobes, which is like kind of a tongue of the prostate going into the bladder that can act like a ball valve on the opening of the prostate–those men don’t do as well with prostate artery embolization, but I’ve had excellent experience in patients whether they have the median lobe or not. Usually when I see a large median lobe and the patient is highly symptomatic, I will encourage them to have that simple prostatectomy procedure performed. It is not like the same surgery that you do for prostate cancer, so does not cause incontinence and impotence and all those things that you’re concerned about. It’s a different procedure, even though some of the words may sound like the prostate cancer procedure. And if you’re out there interested in either prostate artery embolization, or management of especially large prostates, we’d encourage you to give us a call.

Donna Lee: 

That’s right. That was an amazing section on prostate artery embolization. I’m sure people are seeing the commercials too, because I see them on KVUE.

Dr. Mistry: 

Yeah. And we’re going to do webinars about once a month. So for those of you that can visit our site , we’re going to be having information on it. And if you’re interested in just sending us an email, we’ll definitely include you if you’re interested in our next webinar.

Donna Lee: 

Gotcha. We have enough time for another question. “Dr. Mistry, how can I increase the volume of my ejaculate? I’m a 71 years old, fairly fit male.”

Dr. Mistry: 

That’s great. There was another question too, right?

Donna Lee: 

Mhmmm. You want me to get to that, too? Or you’re making me find it?

Dr. Mistry: 

I think they kind of relate to each other.

Donna Lee: 

Ejaculate volume: “Doctor, how can I increase the volume of my ejaculate?”

Dr. Mistry: 

Well, I think that’s the exact same question. There was another question that somebody had, which was a patient with a dry ejaculate.

Donna Lee: 

Oh I’m sorry, yes.

Dr. Mistry: 

And so , just kind of putting all those volume questions together. Let me just say that although a lot of men and a lot of physicians might discount a man’s concern, men come to me every day, concerned about the quality quantity of their evacuation. And when they’re complaining about dry ejaculate, I always worry that people are worried, I was worried that the person’s really concerned about having a poor orgasm. So when you come and see us for these kinds of concerns, we certainly have medications that can increase your ejaculate volume. We can give you explanations of what could be happening medically that could be changing your ejaculate consistency. If you have a dry ejaculate, it could be due to medications, or prior surgery, or a condition called retrograde ejaculation, which happens in response to neurologic issue, injury or issues, prior surgery. It can happen due to medication side effects. So if you’re out there on medicine for your prostate and you have a dry ejaculate, 9 times out of 10, it’s your prostate medicine. So those are some kinds of different interventions that we’re going to take. Medicines that we use traditionally to increase ejaculate volume, we’ve found that HCG has a pretty good impact. Then we look at your medicines and see if you’re on any kind of drying agents. Are you o n oxybutynin? Are you on any medicines that we think might dry up your fluid secretions?

Donna Lee: 

Hmm, never thought about that.

Dr. Mistry: 

And so then we can reverse that. Well, I mean, that’s how you got to think about it. I mean, when somebody comes up, comes to complain about it, the first thing you need to remember is that it used to be different for that guy. And you know, he may not be performing on camera, but for whatever reason, having an adequate ejaculate volume, and they also look at that exactly consistency as a sign, as a sign of prostate health. So if it becomes overly, some men complain about it being overly watery, some people complain about it being changed in color, some people about it being overly thick. And the semen is a product of the prostate. So as the prostate either gets injured or old, or it gets treated with medicine, it can change the product that it’s putting out. And that product is putting out is semen , which has a primary purpose of helping to nourish sperm. Just this week, I had a patient 59 years old, who was very concerned about their ejaculate volume, but also has a severely enlarged prostate that needs to get treated. And unfortunately, a lot of times the treatments that we do for an enlarged prostate are going to affect the ejaculate volume. So whereas in some men, we pick and choose which options are least likely to cause him side effects with, and compare them to the ones most likely to improve his overall urinary complaints, we made his treatment algorithm entirely based on the likelihood of affecting his ejaculate volume. And I think we’re going to make him happy.

Donna Lee: 

Well, I hope so because that’s a really sensitive discussion.

Dr. Mistry: 

It is.

Donna Lee: 

Because you know, women are running away from the ejaculate, but you guys are trying to improve it…

Dr. Mistry: 

Only you, Donna. Oh my lord.

Donna Lee: 

You guys are mind you improve it. Stop that. You can call during the week at (512) 238-0762 , send us these questions. We’ll get them answered right away, or as soon as possible. Armormenshealth@gmail.com. And you can hear our podcast all over the world, Dr. Mistry, for free! And our website is armormenshealth.com, where you can see Dr. Mistry’s smiling, happy face!

: 

Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour

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