Phone: 512-238-0762

Fax: 512-341-7370

June 27, 2020

Freakin’ Leakin’: Dr. Mistry Talks About HIFU and Urinary Incontinence

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’m Dr. Mistry, your host, here with my cohost Donna Lee.

Donna Lee: 

Hi, that’s me.

Dr. Mistry: 

Well, we hope that you’ve been sticking through this show today.

Donna Lee: 

I thought you were going to say something else.

Dr. Mistry: 

I’m a board certified urologist. This is a men’s health show. This show is brought to you by NAU Urology Specialists. This is the practice that we started in 2007. We have what I think is a very unique take on urologic medicine. One that is a whole body approach. One in which we really try to go that extra mile to take care of your urologic concerns. A urologist is a surgeon who is trained in surgery. My residency was six years long after a four year stint in medical school, and that’s after college–a long time. You wouldn’t think there’s so much to deal with…

Donna Lee: 

I would have missed out on so much partying.

Dr. Mistry: 

…with the yin yang and the yum yums, but, it really, it really did fill a bit of our life.

Donna Lee: 

I’d like to give a shout out to Sally, who laughs very hard every time we say yin yang, yum yums, or ding-a-ling.

Dr. Mistry: 

There you go. There are any number of short podcast series that urologists will talk about. It’s commonly, it was commonly commented on that there’s always going to be some kind of dirty part of it because we can’t really help ourselves.

Donna Lee: 

We can’t. And I’m the worst HR manager ever. So there you go.

Dr. Mistry: 

It’s why I became a urologist, really it’s for the jokes. But we do take your health very seriously. If you have a urologic condition that you want advice on–prostate cancer, chronic pain, low testosterone, chronic fatigue that you don’t know what could be causing it–these are things that we have a lot of experience with, we’ve had a lot of success with, and we have a team here that’s going to really go after making you feel better.

Donna Lee: 

We have a team dedicated to your yum yums and your yin yang.

Dr. Mistry: 

That’s right.

Donna Lee: 

New t-shirt alert!

Dr. Mistry: 

And we really are dedicated on seeing you quickly. So please call us for an appointment. We love second opinions. I absolutely thrive on seeing patients that have gone through multiple different providers and not been given a lot of success. So if you have a urologic condition…

Donna Lee: 

That’s an ego thing.

Dr. Mistry: 

I know I do like that. If you have a urologic condition and you haven’t gotten the answers that you for your condition, it definitely make an appointment with us. Email us, let us know that you’re interested in getting seen and treated. Give us the opportunity of making your life better.

Donna Lee: 

Yeah. I have a perfect example of that, by the way. We got a patient who sent an email through our website, armormenshealth.com, where you can leave inquiries. And it says: “I’m having an issue with my left testicle. Painful to walk, and I can feel a lump in it.” Those emails go directly to me. I make somebody call this person. We got him in right away.

Dr. Mistry: 

That’s right.

Donna Lee: 

So, please call us. But if you send an email, we will…

Dr. Mistry: 

If you have a lump on your yum yum, that is time to get your butt in here, and we want to take care of it.

Donna Lee: 

And if you’re having pain walking, that’s that’s a big sign. That’s a red flag, for sure.

Dr. Mistry: 

For sure. I mean, we have a few red flags in our office. Testis pain, testis lumps, fever with flank pain–those are going to be three things that we’re going to want to see you immediately for, because those are going to be signs of something that could be eminently dangerous to you. And at this time of isolation, concerns for getting ill, I want you to know that we are so committed to seeing you in a safe fashion. We can see you via telemedicine. We can see you in the office. We have very limited traffic through our waiting room, and we’re distancing everybody. Really very little waiting time around. You’re either in your car and directly in a room, or just briefly in the waiting room to fill out paperwork, and then right in the room.

Donna Lee: 

That’s right.

Dr. Mistry: 

We’re doing vasectomies, we’re doing evaluations, and of course, telemedicines are always going to be an option, even if you’re a new patient.

Donna Lee: 

Right. Especially now. So we will take care of it as quickly as we can.

Dr. Mistry: 

That’s right.

Donna Lee: 

You can call us too. If you have any questions at (512) 238-0762. Please Google us. We’re so Google-able with our free podcasts. The podcasts are free, like most of them are. We may not be Joe Rogan, but we’re heading in that direction. We’re going to be the health Joe Rogan.

Dr. Mistry: 

The health Rogan.

Donna Lee: 

Maybe a hundred dollars podcasts, but he has a hundred million dollar podcast. Eek. But you can hear our podcasts anywhere: iTunes, Alexa, SoundCloud…

Dr. Mistry: 

Don’t hurt yourself.

Donna Lee: 

Anywhere? I don’t know. Those are the three I memorized last week.

Dr. Mistry: 

Let’s just hope, let’s hope the listeners know what a podcast is. Your questions really kind of drive us in terms of our success in doing the show. This has been an incredible week in terms of the kinds of cases and the kinds of things that we’re doing. But I say that every week. I absolutely love what I do. A big thing that we’ve been doing a lot of second opinions for prostate cancer. In addition to doing robotic prostatectomies, in addition to doing referrals for radiation therapy when appropriate, we also perform a treatment option here called high intensity focused ultrasound or HIFU. HIFU treatment is a way of treating prostate cancer in a focal way, meaning that you don’t have to treat the whole prostate. It has a way of killing and heating the prostate cancer, especially if you can see it via MRI. We can actually fuse the MRI images with your realtime treatment. It helps us avoid incontinence, it helps us avoid radiation exposure, and it helps us avoid impotence. And so that’s really very much in line with kind of our approach here, which is kind of soft steps to not cause lots of harm or damage while still treating the underlying condition. And if you’ve been diagnosed with prostate cancer, you know, we would highly encourage you to make a second opinion appointment. We can do that on the phone, we’ll get your information. It doesn’t cost you anything, just so that you can hear about what the HIFU option is for you. We have patients that come from all over the state and now all over the country coming in to get this treatment. We’re one of very few centers that have the latest technology–it’s called the robotic focal one program, and we would just love to talk to you about it. There’s just no way on the radio to kind of address every specific situation, but we can do it individually with you. And if you have questions that you want us to share on the radio, we would highly encourage you to do that too.

Donna Lee: 

This question might be a good one for a HIFU consultation: “Dr. Mistry, my brother in law, who’s 72, had prostate surgery in August, 2019. He continues to have incontinence despite having physical therapy. His urologist told him his sphincters don’t work too well and that he can continue therapy and consider having a cup implant. My brother in law is extremely frustrated at the lack of his progress, and it is not interested in the cup idea. Are there other healthy options for him to manage the incontinence?”

Dr. Mistry: 

Sure. More than likely is being recommended to him is called the ActiCuf, which is a, essentially just a clamp that gets put on the penis, which is very uncomfortable for men if they’re having incontinence after prostate surgery.

Donna Lee: 

Its a clamp?

Dr. Mistry: 

It’s just like a rubber band. Now that’s a, it’s the right option for some people.

Donna Lee: 

A rubber band on your ding-a-ling?

Dr. Mistry: 

Yeah. But if you’ve had surgery in 2009, you’re incontinent, the physical therapy is simply not going to work. At this point, how we judge what’s the right treatment for you is based upon how much you’re leaking. So if you’ve had your prostate removed and you’re leaking and you’re soaking diapers, or more than two or three pads a day, then the right treatment option for you is called an artificial urinary sphincter. It’s a silicone device. It’s a ring that actually pumps up and squeezes the urethra and stops you from leaking. It has a very high degree of satisfaction. They work very well, even though it’s kind of a mechanical device, and it involves you having to use a pump, a small pump that is kind of hidden in your scrotum to kind of really mimic what your body does with its sphincter. Everything is inside you. Nothing is external. It works very well, it takes me about an hour to put in. I ususally keep people in the hospital overnight for an extra dose of antibiotics because it is a foreign body, but other urologists may just send you home. It is appropriate for outpatient surgery, and that is an option if you have severe incontinence. If you have less than severe incontinence, if you’re just leaking maybe a pad when you’re golfing, or maybe when you’re just getting up out of a chair, you know, one to three pads of incontinence a day, then there’s something called a male sling. It’s an actual device, it’s a, I use something by a company called Coloplast. It has four arms that are, that then spread out and cause constant tension on the urethra. It’s kind of a way to just squeeze the urethra tube and cause resistance. And you don’t have to do anything with it. You don’t have to manipulate it. And so if you have poor hand-eye dexterity, if you’re really concerned about not wanting to have something that has to be…

Donna Lee: 

To fiddle with?

Dr. Mistry: 

Yeah, fiddled with, than the sling is a wonderful option for you. And we have to go through a little bit of preparation. If somebody has been leaking for 20 years, their bladder’s smaller. You know, it just hasn’t been gotten used to holding a lot of urine. So we do go through this process of bladder retraining. We use medications and different clamps to kind of get your bladder to get bigger and bigger. And then we go ahead and pull the trigger on getting you dry with either an artificial sphincter or a male sling. And if you have incontinence and you haven’t gotten a second opinion on it, and if you’ve kind of been, you know, going along with the same provider, just try to remember that all of us are kind of subject to the capability of the provider that we’re seeing. So if your doctor doesn’t do incontinence surgery, then you’re not going to get offered incontinence surgery. If you don’t, if your doctor doesn’t do penile prosthesis, you’re probably not gonna get offered a penile prosthesis. So that’s why seeking out a second opinion is something that we think is really important so that you get kind of multiple opinions on what’s available to you because it’s 2020, you know, we can do a lot of stuff.

Donna Lee: 

That’s right. It’s been a rough year, but we’ll fix you right up.

Dr. Mistry: 

And if you’re listening in the future…

Donna Lee: 

…it was a terrible year.

Dr. Mistry: 

It’s a terrible year.

Donna Lee: 

It’s just terrible! The most normal thing was Joe Exotic on Tiger King. Geez.

Dr. Mistry: 

Tell people how to get ahold of us, Donna Lee.

: 

You can send us those questions to armormenshealth.com. We have a little inquiry there, or you can email us directly at armormenshealth@gmail.com. But why is the word “sphincter” so funny all the time? We have three boys and that word just gets kicked, a little cackle around the house. Anyway. Thanks for listening. Send us your questions. Bye!

: 

The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormen’s health ed gmail.com.

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