NAU's COVID-19 Policy
March 28, 2020

Enlarging Your Options: Dr. Mistry Discusses Medicinal vs. Surgical Treatments for an Enlarged Prostate (BPH)

Donna Lee: 

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762 or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.

Speaker 2: 

Welcome 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’m Dr. Mistry, your host, here under strict quarantine guidance with my cohost, Donna Lee.

Donna Lee: 

Hi everybody. I hope you’re well and not going crazy and filing for divorce.

Dr. Mistry: 

We sure are learning a lot about our spouses, aren’t we?

Donna Lee: 

Yes, we are.

Dr. Mistry: 

And our children, which is a awesome. It is a wonderful time to reflect on so many things that we have in terms of blessings in our life. I hope that everyone out there is staying safe. We are still gladly and happily trying to provide you information on men’s health and other issues that affect men. Obviously, the coronavirus is a huge consideration on lots of our minds trying to stay healthy and safe. I will say that social distancing and staying at home has been for some people a negative thing when it comes to their health. A lot of eating, a lot of poor physical activity decisions.

Donna Lee: 

I have a confession.

Dr. Mistry: 

Ut oh.

Donna Lee: 

I made sweet potato french fries, and we never make those at home because they’re carbs, bad carbs. And my husband and my son left to go check a job site out and then they came back and they found me on the couch with a bag of potato chips. It was awful and delicious.

Dr. Mistry: 

Well, I think that the 2 week health vacation that we took probably needs to end and I would encourage people to try to find ways to limit calorie intake, really figure out if fasting is the right diet for you. Although the social distancing issues remain in effect, trying to find ways to get some physical activity I think is real important. This is a men’s health show. I’m a board certified urologist. What we are going to do on today’s show is catch up on questions.

Donna Lee: 

Oh, that’s right. We got a lot of questions. And you can not see us in Round Rock, North Austin, South Austin, and Dripping Springs, but maybe in a couple of weeks you can.

Dr. Mistry: 

Our urology practice, NAU Urology Specialists is still seeing patients. We are considered an essential need. If you have a urologic issue that that is urgent, we will see you in person. And if it’s not so urgent than we can do a telemedicine appointment via the telephone. We can handle so many issues including basic urinary issues, ED issues, a number of things including male fertility, we’re handling over the phone. If you have a urgency, and we want to keep you out of the emergency room to maintain that capacity–if you have a kidney stone, you see blood in the urine, extreme flank pain, things like that, please let us know and we’ll try to get you accommodated as soon as possible.

Donna Lee: 

That’s right. And because the have been lifted a little bit, we can see new patients by Telemed.

: 

That’s right. So even if you’re not a patient of ours, we would be happy to establish that relationship via the telephone. Donna, why don’t we go through some questions.

Donna Lee: 

Let’s go through this very important question. We had a patient reach out, and of course I answer these with you anonymously, but this person we’ve delayed a little bit, so I wanted to apologize to him and thank him for his patience. But his question is the following: “I have BPH, have had it for years and been on different medications. Currently on Finasteride and Alfuzosin.”

Dr. Mistry: 

That’s right.

Donna Lee: 

Okay. “All taken at night. Recently I had a microwave prostate treatment, tube in the penis and a heated plug in the rectum. The results were 12 days of having a catheter due to urinary retention. Right now. My stream is about what it was before the procedure a few weeks prior. My question is, I wanted this to be done to get off the meds and hopefully have normal ejaculations again. Apparently one side effect is of the medications that can cause zero ejaculation fluid along with a weak climax sensation. Once my stream is better and I’m off meds, do you think my ejaculations will be normal again?” And he did have a vasectomy a few years ago. He heard about our program, has been listening and understands there’s different treatments, but his urologist did not mention other treatments.

Dr. Mistry: 

Oh, that’s a great question. There’s so much in there that I’d like to unpack. This week alone, I was sent a patient who had an enlarged prostate and urgency symptoms for many years and he was on 4 medications. That just seems like a real unfortunate kind of sequence of things where somebody, you know, who was taking care of the patient, maybe multiple doctors, start adding another medicine for one more stage of the problem, when in fact sometimes a simple surgical procedure could eliminate the issue and take him off all 4 meds. And as you get older all of these medicines have different side effects. Medicines like Finasteride can cause you to have a orgasmic, ejaculatory, as well as libido problems. The medicines like Alfuzosin or Tamsulosin can have impacts on blood pressure, cause you to get dizzy when you stand, cause a kind of chronic fatigue kind of syndrome because of the low blood pressure, and also lead to ejaculatory and orgasmic difficulties. If you have urgency/frequency, medicines like Oxybutynin can lead to dry mouth, constipation, dizziness, they can even affect your cognitive function. I mean these medicines are widely used. They’re inexpensive but they have some negative potential side effects. Whenever I see somebody that’s on maximum medication therapy, I really try to talk to them about minimally invasive and even some more invasive procedures that sometimes we have to do for enlarged prostate. Clearly this patient who had microwave was talked into something that was minimally invasive. The microwave is done in the office. You see you don’t have to go to sleep when it happens. It’s a catheter with a radio frequency antenna on it that heats up the prostate and shrinks it, and it’s a great procedure for the right patient. If your prostate’s too big or too small, it doesn’t work. If your symptoms are too far gone, it doesn’t work. It’s not, it may not be a great option and clearly you had a long recovery period that required a prolonged catheterization. So the fact that your urinary symptoms haven’t improved is not that surprising. If there is going to be any improvement, it may take up to 8 to 12 weeks to see that improvement. And people choose different treatments for different reasons. If your primary motivation is you want to maintain your ejaculation and that’s the feeling and sight of seeing semen come out of your penis when you orgasm. Then there are really just a couple of options. One of them is called Urolift, in which we use these self retaining kind of clips that pull the prostate lobes aside, and it opens up the urinary channel. That procedure does not tend to affect orgasmic or ejaculatory function. And there’s a procedure called Rezum in which hot steam is used to kill the obstructing prostate tissue. Both of those procedures can be done in the office. Both of them don’t take very long to do, have pretty high success rates, and both of them don’t necessarily lead to a substantial orgasmic or ejaculatory complications. But you know, that being said, in a guy who already had one of those kind of minimally invasive procedures like a microwave therapy without improvement, sometimes it’s better just to go ahead and do, you know, a more invasive procedure like a trans-urethral resection of the prostate, or a holmium laser enucleation of the prostate? [inaudible] We perform both of those procedures. Some are done with laser, some are done with more traditional technology, and some are done with even more cutting edge bipolar technology. What we’re doing in those procedures is actually removing that obstructive prostate tissue, allowing you to urinate with much more force. The success rate for those are very high, although they do lead to the symptom of retrograde ejaculation. And that’s where when you ejaculate, no semen comes out of you. And, some guys, it bothers them, you know, that they want to see that ejaculate. But for most men, when I assure them that their orgasm’s going to feel normal, there just won’t be any ejaculate that’s going outside of their penis, they usually are okay with it and are willing to accept that. So, it really comes down to a risk/reward, which is a lot of urologic procedures. What’s gonna work for you? What side effects are you willing to tolerate? But don’t assume that the medicines you’re taking are necessarily good and safe that you can take for the longterm. And if we can get you out of one of those meds, that’s something certainly we want to consider.

Donna Lee: 

That’s a lot of medication information.

Dr. Mistry: 

It was a real mouthful.

Donna Lee: 

Oh. Yes. Yes it was. So what do you think though about the, when we see a patient say, “My urologist only offered me one thing?” Let’s revisit that discussion.

Dr. Mistry: 

That’s a great point there. You know, all of us as urologists trained at different places, trained with different technologies that have different skill sets. And although I think that you as a patient can naturally assume that your urologist or your surgeon or your physician is going to treat you in a safe way, remember that they’re also thinking, how can they treat you in the way that they can deliver the care, the safest way?

Donna Lee: 

Their training and they’re comfort level.

Dr. Mistry: 

…what their training can do. And if you have somebody that trained 40 years ago as opposed somebody to train 10 years ago or 2 years ago, they’re going to have been exposed to different technology and different techniques in their training. So, you know…

Donna Lee: 

Because you all can’t possibly know every procedure and every option like you do.

Dr. Mistry: 

Well, there you go.

Donna Lee: 

You gave me that look like, “You better fix that!”

Dr. Mistry: 

At the very least, if I can’t do something, I’m going to tell you what it is. And what the benefits are and send you to either one of my partners or someone else that does them really well. Dr. Yang in our practice does really, really good greenlight lasers. Dr. Jacomides in our practice has a really, really nice Urolift. I do a lot of Rezums. I mean, they’re going to be different things that each of us has a particular take on. And so, you should all know, and I’ve said it over and over again on this show, you get a second opinion before somebody puts a knife to your skin, because you need to make sure that you’re comfortable with the surgeon, with the options presented to you, and then once you feel really sure you’re willing to take the good and the bad of whatever happens from that outcome. And, remember that although your doctor is probably well-trained, not all training is considered the same. I mean, I talk about going to Baylor all the time because it’s, you know, it’s, it’s the best. You know, we had spectacular training, spectacular professors, and something that I can tout as being very proud of.

Donna Lee: 

And you sure to talk about a lot.

Dr. Mistry: 

I do. Why don’t you tell people how to get ahold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. Please keep these questions coming. It’s armormenshealth@gmail.com and we will be right back.

: 

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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