Dr. Mistry: 0:00
Hello and welcome to the Armor Men’s Health Hour. I am Dr. Mistry, your host. Happy Sunday to everyone. I’m joined by my cohost, Donna Lee.
Donna Lee: 0:08
Happy Sunday. Everybody. It is Sunday and I always get sad because the show means it’s nighttime on a Sunday and we have to go to work on Monday.
Dr. Mistry: 0:16
This year, this little time of year between Thanksgiving and Christmas is so short. We’re trying to get so many things in work at the office, getting patients through.
Donna Lee: 0:26
Why do the patients wait til the last moment? I guess, I know it’s the deductible thing, but they’re killing us. They’re killing us.
Dr. Mistry: 0:31
We’re really enjoying kind of operating quite a bit, seeing quite a few patients in the office. We’re doing tons of vasectomies. We probably have a couple spots left…
Donna Lee: 0:40
No, I mean, yeah, I’m supposed to say yes.
Dr. Mistry: 0:42
Listen, if you need a vasectomy, you email email@example.com.
Donna Lee: 0:45
We have a thousand spots left in 2020 how about that?
Dr. Mistry: 0:51
If you need a vasectomy before the end of the year and you want a no scalpel, IV sedation vasectomy, no clip–don’t give me that look.
Donna Lee: 0:59
…begging you please.
Dr. Mistry: 1:00
I will make a spot for you. Email me directly and I’ll make sure if I have to work on a Saturday to get people in, I’ll do it.
Donna Lee: 1:08
I’ll train to be a medical assistant.
…and I bet in March madness is a popular time for that.
Dr. Mistry: 1:13
Well, actually we can’t say that because there’s another group in town who will go unnamed and they won’t let me advertise vasectomies anymore. Yeah, he sent me a cease and desist letter.
Donna Lee: 1:23
No he did not, you didn’t tell me this. Is that real? Can we call it what we called it before?
Dr. Mistry: 1:28
I’m telling you that they have a lot of what we call envy when you see something larger and more popular. What’d we call that? I’m not sure. That other voice was our special guest.
Donna Lee: 1:39
Oh, that’s right. We have to welcome him. He came from very far away. He claims from South, but we know you’re from up North.
Dr. Mistry: 1:44
That’s right. Dr. Richard Levin. Welcome. Thanks for joining us.
Dr. Levin: 1:48
Thank you for having me.
Dr. Mistry: 1:50
He is a unique guest on our show. He is actually a board certified urologist…
Donna Lee: 1:54
Whoa, and there’s two of you!
Dr. Mistry: 1:56
…and I will tell you that my ego will not usually allow another urologist on the show.
Dr. Levin: 2:00
Well I’m very humbled by you letting me be here today.
Dr. Mistry: 2:04
So, when it comes to size envy, I have tremendous size envy when it comes to two things with you. Number 1 is you come from 150 group, man group, person group, practice, and you have amazing hair which will be on our Facebook page.
Dr. Levin: 2:16
Well thank you. It’s good to be here. Glad we can talk about some minimally invasive treatments for enlarged prostate.
Dr. Mistry: 2:22
So those of you that listen to the show or big fans of Donna and I, you know that we had the “Make America Pee Again” event in November. What we really talked about were the different and varying technologies that are available today for men with urinary symptoms and BPH specifically. And one of the therapies that we highlighted that event and in our practice is called “Rezum”. Dr Levin here is someone who performs a tremendous number of Rezums. He’s here in town to help our practice improve the way that we are both educating patients and performing the treatment. Maybe you could talk a little bit about what is that technology and what role did it fill in kind of treating men with an enlarged prostate?
Dr. Levin: 3:01
You know, a lot of men as they get older are experiencing problems with urination from an enlarged prostate. It’s a very common problem. As you know, 50% of men over the age of 60 are starting to have some problems. And, and I think men today are smarter. They’re more, better educated and on the internet and seeing that there are less invasive treatments out there than there were 10, 20 years ago. Everybody’s interested in a treatment that’s going to improve their symptoms and allow them to get back to their normal activity, whether it’s exercise or work, in a quicker amount of time with the least amount of side effects
Dr. Mistry: 3:36
And in the old days–by old days, I mean like 10 years ago–you would see the majority of patients getting a “TERP” or traditionally the “Roto-Rooter,” right?
Dr. Levin: 3:44
Right. So it’s a very good procedure that works well and gives men a lot of improvement in their symptoms. But however, it’s, it is a little bit more invasive than what’s available today. What’s available today can be done under local anesthesia. So in other words, a quicker recovery time and less of the side effects, primarily the sexual side effects that affect a lot of men. And I think Sunny, a lot of men today, you know, in, in the past we’ve been very free with writing a lot of medical, medication prescriptions for patients. You know, we write a prescription and they do okay for a number of years, essentially. We’re not really treating the problem are we, we’re just kind of covering it up with a bandaid. So to speak. And so I think nowadays men want a little bit more of a longer lasting treatment and not just taking a pill every day.
Dr. Mistry: 4:27
We talk about that a lot on the show and I personally believe that longterm use of alpha blocker therapy or medicines like Tamsulosin or Alfuzosin or Silodosin or Rapaflo, I think longterm use can cause fatigue. I personally don’t like to give it in patients that are getting older. So looking at therapies that will give you longterm improvement like a surgical procedure or a minimally invasive procedure are things that a lot of our patients are getting kind of encouraged to do. Rezum is one of the latest types of technology. It’s something that’s, you know, when I heard the concept of I thought it was an amazing thing. Maybe you could talk about what goes behind Rezum technology.
Dr. Levin: 5:03
Sure, sure. But, I 100% agree with you in terms of the side effects with the alpha blockers. And also there’s a lot of new information out there that the alpha blockers really are allowing the bladder muscle to decompensate over time. And so actually, we’re really, these patients are suffering because of that. So Rezum, the unique thing about Rezum is that it’s a treatment that is really treating the problem. The problem is that the prostate is enlarging and it’s blocking the flow of urine. So you want to get rid of that blockage. There are some treatments out there now that don’t essentially treat the problem. They just kind of push the tissue out of the way, whereas Rezum, by using something very natural water in the form of steam can heat the cells and kill the cells and allow the body’s natural mechanisms to get rid of dead tissue, resorb that tissue in a very natural way and allow the urine to flow out in a much more efficient manner.
Dr. Mistry: 5:54
Well, what I find interesting when I’m explaining Rezum to is when I’m taught describing other therapies like the TERP, they all ask what happened to the urethra because you know, they know that the prostate surrounds the urethra and to remove that prostate tissue we have to cut through the urethra. But with Rezum, you know, kind of when you’re looking at it visually and kind of dealing with it, the urethra itself kind of stays intact and you’re just kind of treating the prostate beyond it.
Dr. Levin: 6:20
Exactly. And that’s a, that’s a good point. And a lot of our more well educated patients understand that, that the urethra is not affected with the Rezum treatment because you’re just putting a needle, a small needle, through the urethra into the actual prostate tissue and delivering the steam to the prostate. And so it’s not affecting the channel that the urine actually flows through. It’s just affecting the amount of pressure that’s on that channel and allowing the urine to flow through easier. It’s a very minimally invasive treatment that literally takes three to five minutes to do. It’s a very novel, interesting option that we have for our patients and a lot of, a lot of my patients now that had been on medication for years because they really didn’t want quote “surgery,” now that they have this available to them, it opens up a whole new option for these patients.
Dr. Mistry: 7:06
So when you’re thinking about it visually, what happens to you during this procedure is you come into the office. In our office, we sedate you. Not all offices do that. I think you do a very aggressive local type anesthesia. We give you an IV sedative in our office. The camera and the equipment goes through the penis to the prostate and a small needle is then projected through the urethra into the prostate and steam is inserted into the prostate, right?
Dr. Levin: 7:34
Correct. So it’s actually a very small amount. It’s only 0.4 milliliters of steam, and that spreads out into an area about 1.5 centimeters, so about a half an inch. And you treat different areas of the prostate where the prostate is causing the blockage. Each treatment last nine seconds. And so most people get anywhere from 4 to 8 treatments. So the whole treatment takes a couple of minutes.
Dr. Levin: 8:00
What’s great about it is that a treat, small and large prostates and even very low prostates in the right hands. And so that means that kind of the stable of patients that are appropriate for this treatment can be quite, quite big.
Dr. Levin: 8:15
Correct. Correct. And it also, the advantage is that can treat a lot of different sizes, excuse me, shapes of prostates as well. Some patients have what’s called a middle lobe of the prostate, which some treatments don’t take care of, whereas the steam can treat this as well.
Dr. Mistry: 8:31
So the natural process of the tissue dying, the natural process is that as the, the cells are injured by the steam, the body then goes through and removes these, this dead tissue. But it takes some time for this to happen.
Dr. Levin: 8:43
Correct? Correct. So, you know, the improvements are not immediate. As with some treatments, it takes several weeks, even several months for the body to reabsorb this tissue to have the improvement in your symptoms.
Dr. Mistry: 8:56
But you’re probably going to get a much longer term improvement because this tissue is gone.
Dr. Levin: 9:02
Well, theoretically, yes. So I was involved in the original clinical trial, which got it FDA approved about 6 years ago. And so we have 5 year data now and the data looks very good that there’s a very small percentage, about 5% of people that need to have something else done at 5 years. So we’re projecting that at 10 years, only a small amount of patients will need another procedure done.
Dr. Mistry: 9:25
Well, Richard, thanks a lot for giving us that information on Rezum. If you’re interested in pursuing that type of treatment with us at NAU Urology Specialists, that’s the name of our urology practice. And we would love for you to email us at–how can they get ahold of us, Donna Lee?
Donna Lee: 9:45
Armormenshealth@gmail.com. Leave that to me because I’ve got that memorized. Armormenshealth@gmail.com. Send us an inquiry, we’ll answer it right away.
Dr. Mistry: 9:53
And if you want have a vasectomy before the end of the year…
Donna Lee: 9:55
…call us for 2020.
Dr. Mistry: 9:58
You do it. You do it.
Donna Lee: 9:58
Alright, we’ll be right back.
Speaker 3: 9:59
Dr. Mistry wants to hear from you. Email questions to firstname.lastname@example.org. We’ll be right back with the Armor Men’s Health Hour.