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July 18, 2020

Treating Your BPH: Dr. Mistry and Dr. Jacomides Discuss Pros/Cons of Treatments for Enlarged Prostate

Speaker 1: 

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 with my cohost, the professional comedienne and effervescent office manager, Donna Lee.

Donna Lee: 

Also professional office manager.

Dr. Mistry: 

You know, Donna Lee, people call here asking for you for some reason.

Donna Lee: 

Because I’m awesome!

Dr. Mistry: 

Well, there you are. I’m a board certified urologist. This is a men’s health show. This show is brought to you by NAU Urology Specialists. We are experts in the field of male and female urologic health, which can include kidney stones, kidney cancer, bladder cancer, bladder stones, prostate cancer, prostate stones. I guess it’s kind of a theme.

Donna Lee: 

You’ve said that before. I can tell you’ve practiced.

Dr. Mistry: 

We also do a number of things that are really specific for men’s health, like testosterone replacement therapy, erectile dysfunction. We also do advanced surgery for erectile dysfunction, including the infamous FLP.

Donna Lee: 

Funny looking pee-pee.

Dr. Mistry: 

FLP doesn’t work when you say ding-a-ling. We have quite a large practice, although we started in 2007 with just one physician provider–little old me–and then we are now up to seven physician providers, four PA and nurse practitioners, we have inhouse sex therapy, in house nutrition counseling, in house pelvic floor physical therapy, in house sleep apnea testing, and what I think is a really holistic whole-person approach to male health.

Donna Lee: 

One day, though, we’re going to talk about female health.

Dr. Mistry: 

We talk about it all the time.

Donna Lee: 

Not enough.

Dr. Mistry: 

That’s right. Yes. Women know how to hurt us, so we have to talk about their health, too. Today, we are joined by one of our partners here, Dr. Lucas Jacomides. Hello, Lucas.

Dr. Jacomides: 

Hello. Thank you. Thank you, everybody. I appreciate the love.

Dr. Mistry: 

I will tell you that no other person demonstrates the impact that a microphone will have on your voice more than Dr. Jacomides.

Dr. Jacomides: 

Why thank you so much. Very kind.

Dr. Mistry: 

When you come to see him as a patient, you will find him to be very similar in voice to a 16 year old prepubescent boy. But somehow here he has become very white.

Dr. Jacomides: 

This is where I grew up. This is where I, where I dropped the octaves down. And I’m normally at a Mariah Carey level.

Dr. Mistry: 

Lucas, you trained at UT Southwestern.

Dr. Jacomides: 

Correct.

Dr. Mistry: 

I trained at Baylor of course–College of Medicine in Houston, if you haven’t heard of it.

Dr. Jacomides: 

I grew up there.

Dr. Mistry: 

It’s the finest medical institution ever.

Dr. Jacomides: 

Spent some time there–great place.

Dr. Mistry: 

That’s right. That’s right. They let you in? That’s weird. But…

Dr. Jacomides: 

Research.

Dr. Mistry: 

We both trained in urologic surgery. We have quite a bit of experience. I think between the two of us, we probably have nearly 30 years of urologic experience.

Dr. Jacomides: 

God. When you put it that way, I just want to get into my wheelchair and move over. I don’t know. It’s just unbelievable, really.

Dr. Mistry: 

It’s unbelievable. And just the number of things that we’ve learned and how much has changed just in urology in our short time, really, on this urologic earth has been amazing. And really no field has altered more than that for the treatment of an enlarged prostate.

Dr. Jacomides: 

I think you said it well. I was thinking about all the things that I do now, how few I actually did in residency. I mean, I do kidney stones the same, but prostates? I mean, there were almost nothing that I do now. Actually, nothing I do now I did in residency

Dr. Mistry: 

It’s fascinating. Because you know, when you’re in training, you think that you’re going to come out fully formed, like a completely made nice cake. When in fact you’re just, you know, jello going into the refrigerator–it’s time to harden up over time and learn more of your skills. You learn the analogies later and you get better and better at making examples of how you’re going to develop as an individual. When it comes to BPH surgery, on the radio, I feel like it’s always been a mantra of ours, that this is kind of the longest time you’re going to get with a urologist, you know, this one hour you get a week. How do you describe what BPH is to a patient, and when do you try to convince a patient that surgical intervention is going to be superior to medical intervention?

Dr. Jacomides: 

You know, I trained under the great Claus Roehrborn born in Dallas, who’s probably one of the world’s most famous benign prostatic hyperplasia or BPH experts. And if you really want to know, nobody cares if you’re a famous urologist, you know, you’re still just a urologist. But for those out there who know in the community, and it was always fascinating to see how Claus would talk to people. I think BPH of all the things that we do single handedly exemplifies why I think a lot of us went into urology. Because, you know, we give people options. You say, “Look, we can try this medication, you can be on this for the rest of your life, if you don’t mind, if you don’t want surgery, if you don’t want procedures. Or, you know, we can go straight to an operation or when go somewhere in between.” So just giving people the opportunity to have lots of choices. And I think it’s just empowering them with knowledge. And even the things I’ve learned about trying to decide when is the time to do one or the other.

Dr. Mistry: 

One of the interesting differences between what it’s like to practice as a doctor and what it was like to educate as a doctor is that when you’re learning about medicine, every patient is just kind of the same. “Patient A is a 55 year old man who has slow flow urgency and enlarged prostate. What do you do?” And the answer is, “medicine.” But in real life, it’s different. Every man’s different. Some guys don’t tolerate the medicine well. Not everybody responds to the medicine that well. Some guys are gung ho to [inaudible] to operate right away. Some guys are very, very averse to operating. Some people are based upon people’s, their neighbor’s experience or their father’s experience. Some people just want to avoid medication at all at all costs. And fortunately, today, now we can really kind of tailor your approach for BPH to really exactly what you want.

Dr. Jacomides: 

Right. And I think it’s reading the patient in front of you. I was thinking about a patient when you said that I saw yesterday, who really should not be playing around with medications anymore. This man has had kidney failure has had catheters, multiple times said hospitalizations for infections. It’s time to get to work on this guy. Or he could potentially could end up…you know, we call it benign prostatic hyperplasia versus malignant and cancer, but benign prostatic hyperplasia can have serious side effects of kidney failure. Not just one kidney, but you killed both kidneys if you don’t empty your bladder well. So I think, you know, telling people, “No it’s time to do something more about this and not everybody fits in that perfect box. You know, you need something done.”

Dr. Mistry: 

And the number of people that are on medications like Flomax, or also known as Tamsulosin for BPH and are really not completely satisfied with their treatment is staggeringly high. It’s probably the minority of patient that comes in and says, “No, no, that medicine works perfect. I don’t want anything else.”

Dr. Jacomides: 

My dad is very much, he’s on your Uroxatral. And I said, well, he’s miserable. And he says, “What can I do, son?” And I was like, “Well, you need to go see about getting a surgery.” “I don’t want to do surgery.” “Well, then stick with your meds.” “Well, I don’t want to do meds.” You know, and this just kind of goes back and forth. And he’s in Greece right now, so he can’t hear this podcast I don’t think, so we can make fun of him all we want. No, I love you daddy, but…

Dr. Mistry: 

There’s no internet in Greece?

Dr. Jacomides: 

No, that’s, it’s a very, very poor, very poor country. Covid is really hitting it, but seriously, I think, yes, there’s no reason to be a martyr and suffer if the pills aren’t doing it for you. Or even why bother starting with med sometimes? You know, that’s, that’s certainly a switch that I’ve made over the years.

Dr. Mistry: 

We’ve talked about several different treatments on the show before. And if you get ahold of the podcast or ever want to come talk to us for a second opinion, we do Greenlight laser, standard TURP. We do vaporization of the prostate using the laser. Some of us do HoLEPs or whole gland enucleation of the prostate. We do in office procedure called Rezum, which uses hot steam therapy. Prostate artery embolization is a relatively newer addition to our armamentarium, as well as the in-office UroLift. Lucas, what kind of treatment intervention do you feel has gotten the most recent improvement in your mind, and what have you had success with?

Dr. Jacomides: 

Well, I think it’s all again about the target. I mean, I’ve had great successes with UroLifts, but even that gentleman I told you earlier, he came to me with another physician elsewhere telling him that he should have a UroLift. And I sort of thought, “No. You probably need a full resection of the prostate with a plasma button.” I’ve been very pleased with the plasma button over the last eight years or so that I’ve switched to it from the GreenLights. I think everybody’s got their own favorite arrow in their quiver. It’s just good to have options. And I think among the four of us that operate in this clinic, I think it’s good that we all have kind of a relative one that we like better than others. And then, you know, you’ve mentioned also [inaudilbe] about even robotic simple prostatectomies. We don’t do them very often, but I think honestly, that’s what a lot of people do need some time. So I’ve been very pleased with plasma button TURPs. I’ve been pleased with the Rezums. I’ve been pleased, very pleased with UroLifts. We haven’t done, I haven’t personally done any PAs or had patients with it, but I’m interested about it. So I think it’s a matter of if patients are ready to jump to a bigger procedure versus maybe do something in between, and if it doesn’t work, then do more. You can always do more. You can’t usually do less once you’ve done the bigger case.

Dr. Mistry: 

That’s right. I mean, the idea, this iterative step-wise process through, uh, you know, more and more invasive type procedures may appeal to some. “I’d like to do the least that you can, to me with the lowest complications and then proceed.” BPH surgery is very much a cost versus reward kind of a trade off. The more likely something is to work, the more likely you are to have some potential complication. But just for our listeners, none of these procedures are likely to cause impotence. None of them are really likely to cause any incontinence. They may not work, and some of them have varying levels of discomfort in terms of how long you have to wear a catheter. But if you’re interested in getting a second opinion on your BPH, if you’ve kind of been going to the same urologist for years and years or primary care doctor for years and years, and that doctor doesn’t seem to be adding anything new to your options, call us for a quick phone call. We’d love to do a telemedicine visit with you and talk to you more in depth about options for your BPH.

Dr. Jacomides: 

Yes. I think that’s a very valid point about incontinence. Too many people equate that with removal of prostate. But I have to my knowledge, nobody in continent doing a transurethral resection of the prostate or any BPH surgery. So I think that’s very important point.

Dr. Mistry: 

So Donna, how do people get ahold of us for that second opinion?

Donna Lee: 

You can call us at (512) 238-0762. You can ask for me, Dr. Donna Lee. Our website is armormenshealth.com. I’m kidding. Not a doctor, but did play one on…

Dr. Jacomides: 

The YouTube video is very self explanatory.

Donna Lee: 

You can send us email, email your questions to armormenshealth@gmail.com, that’s armormenshealth@gmail.com. Thank you guys so much.

Dr. Jacomides: 

Thank you.

Speaker 2: 

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

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