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March 14, 2020

Pointing You in the Right Direction: Donna Lee gets answers to listener questions about phimosis and Peyronie’s disease

Speaker 1: 

Welcome back to the Armour men’s health hour with dr mystery and Donna Lee. Hello and welcome to the young men’s health out. I’m dr mystery, your host here with my cohost Donna Lee. Hi. Do

Speaker 2: 

you know Donna? Happy day. It’s a, it’s a, uh, it’s, it’s really been an absolute pleasure to be able to provide, um, what I think is top notch cutting edge information on men’s health, getting so population here in Austin and all over the world now through our podcast. That’s right. And we’re voted the most amazing men’s wellness program in the entire world. I say that during one of our vitals by you. In fact, many people, Oh my God. For me and my, could you imagine if there really was a winner and they’d be like, yeah, there will be. It’s the law of attraction. We brought this show into our universe as we will with the award that we win. Sometimes you have to fake it to make it, they say that’s right because we’re the second largest urology group, which means what? We try harder.

Speaker 2: 

That’s right. We’re a little prettier on Saturdays. Joining me. One of our newest partners, Dr. Lucas Shagun media is thanks a lot for joining and say, Lucas, I am so happy to be here. You know how I know that we’re popular because we have a new doctor and because people actually listen to this show in their car, then go home, remember the email address, right, and send us questions. Sometimes days later. The engagement that that suggests is amazing. Well, where are they going to send their emails next time they’re going to email us at Armour men’s health@gmail.com Armour men’s health@gmail.com are there apostrophes and standard spellings case. The armor is spelled a R M O R though. Right? But I secured the a M O U R a. R M. O. U. R. a. R M. O. R. army cured the other one. So we get a lot of emails there too. So spell it however you want. [inaudible] man, no apostrophe. Apostrophe Donna. We have questions.

Speaker 2: 

We do. We have one email that was just very specific and he said, I have phimosis Lucas, you and I both see a lot of FA Moses. What is Moses for Moses, for all the young boys and girls listening out there with their parents is a tight for skin that makes it very difficult to retract and you can’t see the head. It’s hard to urinate and a lot of times I could lead to infections, inflammation and just a difficult time urinating. So you know, if you didn’t have a circumcision as a young boy, um, perhaps that’s the time to come in and have us evaluate you. I usually divide it by Moses into three different categories. The first category is the child who comes in, usually their parents never got into the habit of retracting the foreskin. It’s very painful and the kid cries. Those patients we can usually treat with topical creams and gentle retraction that we teach the parent in the, in the, in the office you have a child and you are not routinely bring the skin back and need some instruction on that.

Speaker 2: 

That’s something that we’re happy to help you with. And usually a a steroid cream will help you be able to expand that skin and bring it back. The second group of patients are going to be, I would say between the age of 30 and 50 that come in where everything was fine in their younger life and now they can’t peel the skin back. There’s usually a discoloration over the end of the four skin. They can’t peel the skin back or it tears or bleeds during intercourse. Now two things. One is the creams don’t usually work in that patient. And number two, an underlying diagnosis of diabetes is very common. Just this week I had a 32 year old guy come in with exactly those symptoms and his hemoglobin a one C was 7.7 that’s making him a diabetic, so he was an undiagnosed diabetic. So having difficulty with your four skin could be an early sign of diabetes.

Speaker 2: 

If that’s the case, then retracting your four skin is going to be the least of your problems. Now you’re going to have to worry about erectile dysfunction, let later complications of diabetes. And then the third category of patient is going to be like that 65 to 75 year old patient who has a condition called [inaudible], balanitis erotica, obliterans, a reddish discoloration of the head of the penis and of the four skin very tender to to bring the skin back and maybe a loss of the, the anatomy, just the head of the penis doesn’t look normal anymore. Now interestingly, that doesn’t respond well to um, to creams usually an either. But we usually try them and all three of those conditions, all three of those patients will respond to a circumcision that may not be what you want to hear. A little, a little tip clip. Uh, it’s certainly something that is well tolerated, done very frequently and extremely successful.

Speaker 2: 

One thing on the back. So patients of course, they may have an even more underlying problem with urination despite the circumcision. So they may have a, a scarring process that can actually give them more difficulty going. I was going to ask you to doctor miss dream. The people have really big concerns about their sexuality, their sensation after a circumcision, that, that, do you ever hear that from patients afterwards? As far as for sure. And I think that it is a, it is a legitimate concern. You know, if you, if your four skin normally comes back during intercourse, then you may not experience that much of a difference. The head of your penis is used to being exposed. It’s used to, you know, friction. Usually after a small adjustment period, you’re okay. But if you’ve never had it exposed, I get a lot of men from South Asia.

Speaker 2: 

I mean the, the Indian man to come see me, that has Phi. Moses’s almost a template around here. Those men there, Heather penis is so sensitive because it never sees the light of day that they have a big change in their sensitivity sensation and how much intercourse hurts, especially for the first 12 to 16 weeks after surgery. So for those patients that have that problem, we have a, a numbing cream that we can, we can apply, especially when they start wearing underwear or having their, um, their newly circumcised, uh, glands exposed. And we also have them alter some aspects of sexual intercourse. But definitely it’s something that I, you know, I’m very sensitive to when patients are concerned about six months after surgery, almost everybody’s back to normal. Yeah, exactly. That’s fascinating. I never about that. You shouldn’t, you shouldn’t. You should. You should. You should.

Speaker 2: 

All right. What’s the next question? So we talked a lot about Peyronie’s. This listeners knew and said, are there any new treatments or nonsurgical procedures for a severe curvature of the penis, which is also Peyronie’s. I’ve had this condition for almost 10 years and I’ve tried several treatments, including Xiaflex injections with no success. Well, thanks to that listener, I think that because of people’s interest in treatment for Peyronie’s disease, we’re going to have to make that a weekly topic. [inaudible] I think so we get a question at least a couple of times a month. So, so I would say that if a Xiaflex didn’t work, then you’re probably in line for surgery.

Speaker 3: 

I think Lucas, yeah, I think to answer the question, yes there are treatments, but my uh, there’s an adage a if there’s about 30 different options for you, it’s because none of them really work that well. Xiaflex is of course the first thing I thought of because that has been the one true savior for those who did not want to do surgery. But I think the, the question is at this point, if it’s bothering you and you’d say painful intercourse and to the point where you’re not even having it, then it’s probably time to come in and talk surgical options.

Speaker 2: 

Those listeners that don’t know Xiaflex is a, is a, is a medication that’s, that has been derived from a certain bacteria, the medication or the enzymes called [inaudible] and it’s specifically designed to eat or break down scar tissue or collagen deposition that Xiaflex is injected right into this scar band that leads to penile curvature. And about 60% of patients will have a, you know, satisfactory relief of a curvature. If it’s 30 degrees or more. It’s something that’s paid for by insurance. It works well and we combine it with vacuum erection therapy. If you have Peyronie’s disease and you have not been offered Xiaflex or you’re interested in it, we would love to see you and to treat it. Uh, but if Cy flex didn’t work, then you’re probably a candidate for surgery. If you’re that bothered by either the look or the feel, then surgical correction of the curvature is certainly possible.

Speaker 2: 

If it’s a mild curvature, we do something called up placation the case takes maybe half an hour. The, we put in some stitches that straighten you up. Uh, I would say overwhelmingly men wish they had had that surgery done sooner. It’s covered by insurance and has a very high satisfaction rate. If your curvature is over 30 or 45 degrees and you can’t have intercourse, then that plications may not work. And we have to do something called a patch graft phalloplasty. That’s where we actually cut the, cut that scar tissue, make your penis straight, and then put a graft of artificial tissue down to give you a full length of your, of, uh, of your, uh, of your penis. Uh, we’ve had spectacular success with that surgery. One of our partners here, Dr. Christopher Yang, spent a year doing advanced erectile dysfunction fellowship in, uh, in Florida and, um, uh, between all the expertise here in our practice, I think that we can give you a satisfactory straight penis, um, makes sure that we maximize your sexual experience and you know, give you back something that you think you may have lost.

Speaker 2: 

Wow, that’s a lot. I feel bad for the guys now. You do. Yeah. You used to make banana jokes and now, now that doesn’t work. How many options? I mean, there’s so many options for patients, so get seen by urologist. If it’s not us, get seen and don’t forget it should be us. That the advice that you’re going to get is going to be largely limited by the expertise of your urologist. If you see somebody that doesn’t do advanced penile reconstruction, guess what? You’re not going to get offered advanced me and I’ll reconstruction and uh, you know, you don’t go to a wallpaper store looking for paint. Um, because I don’t know, was that a bad analogy? But yeah, the results would be they’d probably sell painted a wallpaper store. Well, if you go to [inaudible] and you as the patient, you’re going to assume that everyone has the same expertise level.

Speaker 2: 

That is not true. You need to look for someone that specializes in the condition that you have. So if you want a robotic surgeon, make sure that that person does robotics. If you have a penile curvature issue, go to someone specially trained in, uh, erect erectile dysfunction and Peroni’s disease. And it’s in the group too. I think that’s what we provide, right? You’re always talking about dr dating and his specialty, so we know we’re going to point you in the right direction. No one intended. Oh, nice. All right, Donna, how do people get ahold of us during the week at five? One, two, two three eight zero seven six two armor men’s health@gmail.com please eat those armor men’s health@gmail.com

Speaker 1: 

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