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April 18, 2020

When You Gotta Go -Dr. Mistry and Donna Lee Discuss Options for Treating Post-Prostatectomy Urinary Incontinence

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 as always with my effervescent cohost, Donna Lee.

Donna Lee: 

Mmm, I like that–effervescent. I sound like an Alka seltzer.

Dr. Mistry: 

That’s right, nice and fizzy. I’m a board certified urologist. The show is brought to you by NAU Urology Specialists, which is the urology practice that I started and founded in 2007. What we like to do is deliver a variety of men’s health topics, a lot of them based around urology, but really expanding the entire breadth of what can affect a man’s health. And then every so often a little extra tidbit on things about your ladies.

Donna Lee: 

Oh, that’s right. And we have segments called “That’s What She Said” because that is, in fact, what she said.

Dr. Mistry: 

That’s right. Just to help us understand our spouses and partners. You can catch this show on the radio, but you can also catch this show on podcast. Donna, have you figured out how to get the podcast yet?

Donna Lee: 

I think I just type in “podcast help,” and I Google it, and then all these directions come up. But you can also type into your Google–the Google, like the Walmart or the Target–you can type in Armor Men’s Health Hour and whatever topic you’re looking for, whether it’s erectile dysfunction, or Peyronie’s, or low testosterone, and just a plethora of our podcasts pop-up.

Dr. Mistry: 

That’s right. So if you’re out there suffering, especially from Peyronie’s disease, which tends to make up half of our questions…

Donna Lee: 

I know, it’s amazing.

Dr. Mistry: 

…we would love to have you catch up on some old podcasts. You’ll get some extremely valuable information. And then of course we love having your questions sent to us. Donna, why don’t you tell people about our practice?

Donna Lee: 

Yeah. Before that, I want to give a shout out to friend by Facebook, because I’ve promoted our show and I put in, because we can only say certain words on Facebook, I said, “We’ll talk about FLP’s,” and she reached out to me by private messenger. She was like, “Hey Donna, what’s an FLP?” So…

Dr. Mistry: 

Very good. You’ll have to catch that on a previous podcast.

Donna Lee: 

That’s right. So we’ll talk about the FLP here in a little bit. Our locations are Round Rock, North Austin, South Austin, and Dripping Springs–very cute out there. Our phone number during the week is (512) 238-0762. You can listen to our podcasts, like we said, anywhere you listen to podcasts. They are free and super valuable. So it’s like having an office visit with a doctor.

Dr. Mistry: 

You know it’s going to be maybe the longest time you spend with a urologist. And we love your questions and…

Donna Lee: 

That’s right, and you can send them to armormenshealth@gmail.com.

Dr. Mistry: 

And for those of you listening now, of course you’re well aware of the Coronavirus quarantine that all of us are under. If you are hearing this on podcast, and this may be just a walk down memory lane. But we still are seeing some patients, those of higher acuity. We’re doing a lot of telemedicine visits and if you have a urologic condition, please call us for an appointment. Either we’ll talk to you even something that you think would traditionally require a physical exam. A lot of times we can walk you through a lot of the basic steps on the phone. And if you need need to come in, we’ve heavily spaced out the clinic traffic. We thoroughly clean down the entire office, we make sure that nobody’s really in the waiting room, everybody’s wearing masks–it’s a very safe place to be. So don’t feel like you have to put off medical matters that you would like to take this time to deal with. We’re limited on what kind of procedures we can do on patients. We can’t do any elective surgeries, but absolutely, we are in a position to help take care of your urologic issues.

Donna Lee: 

Right. And insurance plans are covering the telemedicine or over the phone visits. So that’s been nice.

Dr. Mistry: 

That’s right. I think that’s going to be hard to go back to the old way, given so many people can make their doctor’s appointment in their underwear.

Donna Lee: 

I have a feeling a lot of patients are going to be like, “Nope!” That’s right. I want to zoom appointment with you, Dr. Mistry, and you will do my surgery by zoom.

Dr. Mistry: 

We’ve had a wonderful week of patients. One of the things that’s happened as a result is how much more time we have right now to talk to patients. I mean, the average patient visit now lasts half an hour because you’re just, you’re just so wanting somebody’s attention, and just some ability to connect with people. We had a very interesting and prolonged conversation with a patient this week when it came to complications after a prostate surgery. And so this particular patient had their surgery done at a very prestigious university in Houston.

Donna Lee: 

You’re not going to name it, are you?

Dr. Mistry: 

No. But he mentioned something really interesting. He is now suffering from severe urinary incontinence, which happens in a percentage of patients who’ve had their prostate removed. I’ve had patients like this all the time. I know exactly what he sounds like. He comes into your office, you tell him he has a diagnosis of prostate cancer, and come hell or high water, he wants his prostate out. He just is hell bent on that treatment choice.

Donna Lee: 

Because that’s all he’s ever heard of, is that what you’re saying?

Dr. Mistry: 

Or because he just is scared of radiation, doesn’t want chemotherapy, and doesn’t want that cancer growing inside him.

Donna Lee: 

Right.

Dr. Mistry: 

Because a lot of prostate cancers can be managed expectantly. So I understand that mindset from the patient, and we see it, and we operate on them. Unfortunately though, there are complications or side effects of surgery, and I think that if you don’t spend enough time really couching what the patient should expect after their prostate’s removed, they get really disappointed, and really disappointed in the whole experience, even if you make them cancer-free. Unlike a lot of the organs that we operate on where you remove it, there may be a small functional loss, but largely you’re living a normal life, when it comes to prostate surgery, you can end up impotent or incontinent. And although we talk about post-prostatectomy impotence on this show quite a bit, we don’t talk a lot about post-prostatectomy incontinence. And what I thought I would do is kind of go through the kind of discussion that I would have with a patient. So, Donna Lee, maybe you were just diagnosed with prostate cancer?

Donna Lee: 

Mmmhm, yeah. I’m an amazing human as a woman with a prostate.

Dr. Mistry: 

And you’re scared.

Donna Lee: 

I’m scared to death.

Dr. Mistry: 

Well, we’re in a genderless society now, so you never know who’s coming in with a prostate in your office, trust me.

Donna Lee: 

I do identify as “they.” Okay.

Dr. Mistry: 

So you’re scared about about this disease.

Donna Lee: 

Right, I just want it out.

Dr. Mistry: 

I mean…well yeah, I mean in your mind, you’re more focused on just getting the cancer out, and you’re almost willing to accept any side effects, any trade off. “I just want to be cancer free, I’ll live anyway.”

Donna Lee: 

Right? I don’t need to have sex. I just want the cancer to go away.

Dr. Mistry: 

Oh man.

Donna Lee: 

Oh wait, I’m acting as the man…

Dr. Mistry: 

Are you sure you didn’t already have prostate cancer?

Donna Lee: 

Poor Michael.

Dr. Mistry: 

So, but urinary incontinence occurs after the prostate is removed surgically in its entirety.

Donna Lee: 

How common is that?

Dr. Mistry: 

How common is urinary incontinence? Well, after the prostate’s removed, immediately afterwards everyone is incontinent, at least immediately…

Donna Lee: 

For a while.

Dr. Mistry: 

…and that continence can return in as early as 2 or 3 weeks, or it can return gradually over several months. But generally speaking, in the literature they’ll say however much you’re leaking at a year is how much you’re going to be leaking there on. But I think it happens sooner. I think that now with robotic technology, if you’re still having leakage when you’re coughing and sneezing or you’re getting out of a chair or riding your tractor or carrying hay bales or whatever…

Donna Lee: 

What kind of friends do you have?

Dr. Mistry: 

It’s going to cause…I mean, we’ve got a lot of ranchers.

Donna Lee: 

Country friends out there.

Dr. Mistry: 

And so, when no matter what you’re doing, if you’re losing urine and having to wear pads or diapers after a radical prostatectomy, then you’re going to feel, even though you’re cancer free, that maybe the side effect was something that you weren’t expecting or knowing how to prepare for.

Donna Lee: 

Right.

Dr. Mistry: 

We do some amazing things in our practice to try to prepare people for it. Not only am I very honest and upfront about the risks of urinary incontinence, which is generally really highly bothersome. Urinary incontinence occurs in about 4% to 7% of patients after radical prostatectomy. And we have…

Donna Lee: 

4% to 7% or 47%?

Dr. Mistry: 

4% to 7%. That reminds me of like a, like an episode of some show or something.

Donna Lee: 

The 47th episode of friends?

Dr. Mistry: 

I think it was, I think it was Mega Mind. In any case, it’s either between 4% and 7%, so not a dramatic number, but those patients are very unhappy.

Donna Lee: 

Yeah.

Dr. Mistry: 

And they’re wearing pads, they’re worried about going out, they can’t get back to physical activity.

Donna Lee: 

Right.

Dr. Mistry: 

And so, the kinds of things that we do right around the discussion time of surgery–because our patients are so focused on getting their prostate out–but we make them go see our pelvic floor physical therapist, Angela Treadway, here in our office before surgery.

Donna Lee: 

Yeah.

Dr. Mistry: 

So just like we make them see our nutritionist before surgery, because when they’re that kind of motivated to get to surgery, we want to give them the opportunity to like take a deep breath and understand what their life may be like afterwards. You start the pelvic floor exercises that helps strengthen the pelvic floor musculature to help augment the continence that the prostate also provides. If you’re 6, 9, 12 months after your radical prostatectomy and you’re still having leakage, then we have treatment options for you. I perform 2 different operations. One is called a male sling. It is a procedure done right through the perenium, or the undersurface of the scrotum. And I’ll go and place a, like a large, essentially obstructing piece of mesh tissue that will help shrink or compress the urethra and provide more resistance to urinating.

Donna Lee: 

So it’s an actual sling?

Dr. Mistry: 

It’s an actual sling.

Donna Lee: 

Wow.

Dr. Mistry: 

And what’s great about it is that it, you don’t have to do anything, there’s no manipulation of it, and you’re just better right after surgery. And that works for people with mild urinary leakage. For severe urinary leakage, we do something called the artificial urinary sphincter. It’s a 3 piece silicone device with a little pump in the scrotum, and it actually compresses the urethra just like your native urethral sphincter would do, and when you want to go pee, you pump it up and it empties and you empty out. And, I don’t quite remember exactly where that was invented…maybe a little place called Baylor College of Medicine in Houston by Russell Scott, where I trained. So…

Donna Lee: 

If you didn’t know, that’s where Dr. Mistry went.

Dr. Mistry: 

So it’s definitely something that…so, if for those of you that may be suffering from this condition, we would highly encourage you to reach out to us. And, Donna Lee, how do people reach out to us?

Donna Lee: 

They can call us during the week at (512) 238-0762. But send us an email. These emails last as through these segments and through the weeks, and we’re answering so many questions, and people are benefiting and we really appreciate it. It’s armormenshealth@gmail.com. That’s armormenshealth@gmail.com. I’ll respond to the questions, too, so you know when to listen for the answer. But, our website is armormenshealth.com. So give us a call during the week. Thanks so much.

Dr. Mistry: 

We’ll 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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