EP 662: Stinky Semen? Pungent Pee? Dr. Mistry Sniffs Out the Source of Foul Odors, Frequent/Urgent Urination, and Prostate Problems

In this segment, Dr. Mistry and Donna Lee answer listeners' questions about seriously smelly urine/semen, symptoms of urinary urgency/frequency, and the role of the prostate in both. The first listener is afraid his doctor will dismiss his pungent problem or worse--diagnose him with something serious. Another listener enquires about the prostate artery embolization (PAE) procedure for her husband, an octogenarian who is fed up with his frequent and urgent urination. Dr. Mistry explains several factors that could be causing either/both of these issues and reiterates the importance of trust and open communication between patients and their doctors. If you or someone you love needs a second (or first) opinion about any urologic concern, contact NAU Urology Specialists today to schedule your consultation!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 3: 0:15

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery . Your host joined us always by my , uh, indispensable co-host, Donnel Lee .

Speaker 4: 0:24

Ooh , indispensable. I like that. That's better than , um, technologically unsavvy.

Speaker 3: 0:29

Yes. I think that after speaking to our listeners who many of whom are our patients , uh, I realize that you're the more popular one.

Speaker 4: 0:35

That's right. I'd like to give a shout out to Janet. She's an avid listener every week, and she's adorable.

Speaker 3: 0:40

I do love how, you know, the majority of our listeners may be women. In

Speaker 4: 0:44

Fact, you know, it's weird. We get a lot of female questions and people reaching out to us at the office, and it's a lot of times female patients or prospective patients. We

Speaker 3: 0:53

Love it. And , uh, this show is brought to you by NAU Urology Specialist, the urology , uh, specialty clinic that I started in 2007. We definitely see women, about 40% of our patients are women. We will take care of urinary incontinence, recurrent urinary tract infections , uh, urgency, frequency, and then of course, women also get kidney cancer and bladder cancer and other problems like that. So , uh, we would love to take care of you if you have any urologic issues, whether you're a man or a woman, or identify as, you know,

Speaker 4: 1:21

As either as either

Speaker 3: 1:22

Mm-Hmm, <affirmative> . So we would , uh, love to see you in our clinic. And Donna, how do people make appointments or ask us questions?

Speaker 4: 1:28

You can make an appointment by calling one of our amazing patient care coordinators at 5 1 2 2 3 8 0 7 6 2. Apparently our wait time is still about 90 seconds, so if you call, we are sure to answer very soon. Um , we are located in Round Rock in North Austin, south Austin, and the lovely, lovely dripping Springs, Texas. We are available by website as well, so you can submit your questions that will answer anonymously to armor men's health.com. And again, that's armor men's health.com.

Speaker 3: 1:55

Uh, Donna, do you have a question for us?

Speaker 4: 1:57

I do. I have a very intriguing question, a little backlog of questions, so we'll hopefully get to these as soon as possible. This one says, hello, Dr . Misre . Hi. I'm 43 years old. I turned 44 it soon in January. For the past year, I've been dealing with having to pee more urgently and notice that my pee smells, I can only describe it as dirty. And when I have sex with my wife, my semen has been making my wife smell. I know there's something wrong. I'm just scared to go to the doctor. Oh ,

Speaker 3: 2:24

Well, that's , uh, very interesting because we, we often get questions about , um, the smell that urine has, the smell that semen has color consistency, and I think a lot of men just don't know , uh, what they can do to improve these things, or what kind of doctor to go to. Mm-Hmm. <affirmative> . And I'll say that many urologists really are not interested in kind of exploring this issue.

Speaker 4: 2:48

I wonder why

Speaker 3: 2:49

<laugh> ? Because it's , um, it's one that is multifactorial and not life-threatening. So oftentimes , you know, doctors, when it's not a life-threatening condition, they don't know how to handle it, kind of don't wanna deal with it.

Speaker 4: 3:01

Is this like an infection thing?

Speaker 3: 3:02

So let's talk about it. So the prostate is the common thing between urinating and. So the urine has to go past the prostate, and the prostate makes semen. Mm-Hmm, <affirmative> . So , uh, let's start with the most likely scenario. The most likely scenario is a change in diet or hydration that's changing the concentration of the urine and the concentration of the semen. That's the most likely scenario.

Speaker 4: 3:29

That's a big diet change.

Speaker 3: 3:30

In , in that, in that case, we do recommend things that , uh, improve hydration , uh, and de diminish inflammatory markers. So this is going to be a reduction in sugar and some other things that our health coach will teach you , including the use of supplements that can reduce inflammation. Now, these are not supplements that will, you know, change the smell of your urine or semen necessarily. Right . Uh, but there are certain , uh, foods, you know, asparagus would be like the , the most, the most poignant one that can change the smell of the urine. Mm-Hmm. <affirmative> . And let's say you changed your diet. Maybe you decided to go on a, on a ketone diet, or maybe you decided to eliminate something. So certainly changes in your, you know, the way that your body is processing waste , uh, which is what urine, you know, is right. Um , or , uh, how it's producing fluid in your prostate could have some impact. Hmm . Uh, then let's talk about infections. So there are infections. Um , bacterial vaginosis or BV would be an example of one that can cause , um, the vagina to have kind of a poor odor. And there are certainly instances in which couples pass this BV back to one another. Mm-Hmm. <affirmative> , uh, especially in uncircumcised men , uh, will notice that, you know, perhaps a little bit more regularly. Uh, the key there is to diagnose it and then treat both partners for bacterial , uh, vaginosis. Uh, it's a simple antibiotic and that usually will resolve that issue. If that's the issue. There can be age related changes , uh, that can cause the prostate to change the way that fluid is made. But in this particular listener, mm-Hmm . <affirmative> , he also reports urgency and the change in smell. And so prostatitis or a prostate type infection is probably one that , uh, we could certainly test for. There's a simple urine test that can find prostatitis, which is an infection of the prostate gland. Mm-Hmm. <affirmative> . And there are more complicated tests. Uh, we will do what's called an expressed prostatic secretions test. That's where you get a prostate exam. Mm-Hmm. <affirmative> , and then you pee. So sometimes it's hard to envision that in the office. You have to come to the office and pee into a cup. Mm-Hmm . <affirmative> . And then you get a prostate exam, and then you have to pee again. And , uh, it's that second p the EPS that will look specifically for bacteria that we can kind of get out of the prostate gland. And if that doesn't show anything, then we'll often do another test called A PCR. And that PCR test looks for the DNA of bacteria that may be very small in quantity. And that is a specialized test that many urologists offer. We certainly offer that in our office for the right type of patient, oftentimes covered by insurance, especially in somebody who's symptomatic, but they have a negative plain old urine culture. Mm-Hmm . Which is a relatively easy thing to do as well. By getting this information , uh, then we can , uh, treat you in a targeted way with antibiotics, not for too long , uh, usually about a couple of weeks, maybe up to 30 days. And this will usually resolve both the urinary symptoms as well as the change in smell.

Speaker 4: 6:25

What about pain? Is there pain if something smells that bad or does , is it sometimes just that it smells bad?

Speaker 3: 6:31

I think just smelling bad is probably, you know, what you're gonna see more often than not. Yeah. Uh , but you , it's important that when you come and talk about this, that you don't in your head immediately assume that you have an infection because oh , as the patient, if you, if you come in with a certain bias, you're not gonna be forthcoming with all the other things. I need to know what medicines you're on. I need to know how many of them are generic. I need to know if you've changed medicines or changed pharmacies, because the use of different medications can change the consistency and smell of your urine and your , um, and your prostate. I need to know about your diet. I need to know activity changes. These are the things that are really gonna get to the heart of it. Uh, because an infection, although , uh, very possible , uh, is simply not the most likely.

Speaker 4: 7:18

Is every doctor gonna ask if when they're , if , if the patient presents with this, is every doctor going to ask , um, talk to me about your diet changes? Or do you think that's just, they just al always talk about medicine changes?

Speaker 3: 7:28

I think that my guess is going to be that most are going to assume there's an infection Mm-Hmm. <affirmative> , and then kind of throw antibiotics at you until you go away. Mm . And that's an unfortunate, you know, scenario. Yeah . But , um, if, if, you know, for those listeners that are out there, if you're not getting the answer from the doctor that you think, or the evaluation that you think, then you might need to find another one. Right. And so probably 40% of the patients that I see are second opinion. So almost all of them, you know, a , a very good number of patients that I see , uh, have a another or had seen another urologist and didn't get to the bottom of what they needed. Yeah. And so, understanding what the patient's needs are, what your main concern is. This listener's concerned that he's infecting his wife with something Yeah. And is scared to go to the doctor because either being judged or, you know, is afraid that there's something really wrong. Right. There's nothing really wrong. Uh , it's not prostate cancer that's gonna lead to a foul smell in the, in the semen or urine. Mm-Hmm. <affirmative> an infection, especially with the onset of urgency, is probably a lot more likely. Uh, and the tests are simple. The treatment is simple, and, you know, the outcome can be very good for you

Speaker 4: 8:35

And kind of quick. Right. Absolutely. So when I started working for you , um, seven years ago, I remember at the Round Rock location, we had these two hallways that are parallel. And I walked down one hallway, this is like my first week working there. I walked down one hallway where we keep the microscope for semen analysis. And there was a pungent smell so bad that it almost knocked me on my butt, and I had to turn around and walk away. And I thought, I don't know if I want to work here anymore. <laugh>. I was like, that is crazy.

Speaker 3: 9:03

It , it , it's probably this adverse response to the smell of semen that really has limited your love life <laugh> . Not just, not just your professional life , just in general. That's correct. Well,

Speaker 4: 9:12

You know, women don't like the smell of semen. I don't know. I don't , I mean , but this was a particularly bad one. It was like an infection that had gone awry, that had gone bad.

Speaker 3: 9:20

I think none of those things are true. It is true. I think that you just have ,

Speaker 4: 9:22

You think it was just a normal semen. That's correct. And I just freaked out and ran the other way. That's correct. That's at home. I did , I did that at home, not at the doctor's office. Right . I work , but it was frightening.

Speaker 3: 9:32

And we do see an analysis for fertility and post vasectomy, so Bye to Bing . Oh

Speaker 4: 9:36

My goodness.

Speaker 3: 9:37

How do people get ahold of us, Donna, and ask more questions?

Speaker 4: 9:39

You can reach out to us at 5 1 2 2 3 8 0 7 6 2, and then you can make an appointment there as well. One of our patient care coordinators can help you very quickly. Our website is armor men's health.com where you can submit your question that will answer anonymously just like this one. And remember, we're in Round Rock, north Austin, south Austin, and Dripping Springs, Texas. Thanks so much, Dr. Mystery .

Speaker 3: 10:00

Hello and welcome back to the Arm Men's Health Show. This is Dr. Mystery , your host joined as always by my co-host Donnel Lee . Hey

Speaker 4: 10:06

Everybody. Welcome to the show.

Speaker 3: 10:08

Donnel Lee is a professional comedian and , uh, our business development manager at our practice. Uh, this show is brought to you by NAU urology specialist. That is the group of urologists that we put together starting in 2007. We are now up to six urologists. Mm-Hmm . <affirmative> . We have a , uh, interventional radiologists that works for us that does prostate artery embolization. We have six advanced practice providers, two pelvic floor physical therapists, a sex therapist, a health coach, and a strong commitment to taking care of the whole person.

Speaker 4: 10:35

Yep . We're a big medical clinic. That's what you're trying to say.

Speaker 3: 10:37

Yeah. Second biggest in Austin

Speaker 4: 10:39

<laugh> . Still the second biggest <laugh>

Speaker 3: 10:40

Still the second biggest. We have a long way to go. We do. We have a long way to go, but , uh, we, we love our position , uh, in this community and we love your questions. Uh , Donna, how do we get more patients and get more busy?

Speaker 4: 10:51

You know, I think people like an underdog. I think that we're just that kind of group that people are like, let's go to second largest in town, but if you'd like to call us, it's the second largest in town, but still the first and most amazing. It's 5 1 2 2 3 8 0 7 6 2. Our website is armor men's health.com. You can see our shining smiling faces there. And submit your question in a little box, obviously noted as submit your question here, and then you can call us (512) 238-0762 . You can ask for me or leave me a message at extension 2, 2 0, Dr . Mr . We talked about the prostate and it's interesting in fabulous functions and sometimes smelly in the previous segment. I have another prostate question for you. Let's do it. Dr . Mystery , I just happened to hear on the radio show that you talk about outpatient procedures to cut off blood flow to the prostate so it shrinks and improves urine flow and decreases frequency. My husband is 88 and has to urinate multiple times a night. We live in Katy, Texas. You are from Katy, Texas.

Speaker 3: 11:45

I'm from Houston. Well, Houston,

Speaker 4: 11:47

Katy

Speaker 3: 11:47

Sugarman.

Speaker 4: 11:48

Oh, Sugarland, Katy , whatever. Is there a doctor in this area who performs a procedure? I thought, how interesting is that because we Sure. Like talking about prostates and PAE and prostate artery embolization around here. Well,

Speaker 3: 11:59

It's a good question. So , um, first of all, I train down at , uh, at Baylor in Houston. Mm-Hmm. <affirmative> . And every time I meet my colleagues from school , uh, and my old professors, I try to convince them that they need to start a prostate artery embolization program. Mm . Uh, but it , it is the case that not many urology groups offer prostate artery embolization within their practice. And so, Mm-Hmm , <affirmative> , let's start with what, what it is. Okay. How it works, and then why, and why and why urologists may or may not want to integrate it into their practice. Years ago, we would do prostate artery embolization for patients who had severe bleeding from their prostate and were not good surgical candidates

Speaker 4: 12:41

Years ago, meaning like decades ago or just a couple of years ago?

Speaker 3: 12:44

Four decades. Oh , wow . For , for decades. Oh, for decades. For decades we've been, we've, we've done that. So if you have a very badly bleeding prostate because it's too big Mm-Hmm . <affirmative> . Then by cutting off the blood flow or by severely diminishing the blood flow, you create a situation where the prostate shrinks and the bleeding is resolved. So we've known that for many years. Right. And then we notice all also that many of those patients, especially those with very large prostates, pee better . You may think that you've been told that you have a large prostate, but really the only way to know whether you have a big prostate or not is to measure it using an ultrasound. Okay. The finger is simply not a accurate representation of the size of your prostate.

Speaker 4: 13:22

Do doctors still do that? They do the rectal, the finger or digital exam and say, oh, your prostate's huge.

Speaker 3: 13:28

I think that it happens. The maj vast, vast majority of the time. Really, I think it happens 99% of that . But

Speaker 4: 13:33

You're only touching that one tiny part of the

Speaker 3: 13:35

Prostate. Uh , you're , it it is, it is an inaccurate measurement. It's just like flipping a coin based upon the size. Wow. And so, so many men are out there thinking they have a big prostate when they may not have a big prostate.

Speaker 4: 13:46

And that's nothing to brag about y'all.

Speaker 3: 13:47

I don't know . Mine's pretty big. No

Speaker 4: 13:50

<laugh> .

Speaker 3: 13:51

So , uh, if you have a a , a prostate that is over 80 grams and a normal prostate is 30 grams,

Speaker 4: 13:57

Let's talk about what that means size wise .

Speaker 3: 13:58

That is about a , a golf ball would be about 30 grams. Okay. And 80 grams, you're looking at a , uh,

Speaker 4: 14:06

Grapefruit,

Speaker 3: 14:07

What did I say? Golf ball, right? Yeah. Yeah. Maybe, I mean, 120 gram prostate, maybe you get up to a , a tennis ball because of the way geometry works, the volume <laugh> increases. <laugh> don't hurt

Speaker 4: 14:18

Yourself,

Speaker 3: 14:19

Had The cube of the radius. It , it , it doesn't matter. Okay . <laugh> . But the point is, is that it gets bigger. And so , um, when you're looking at , uh, uh, a large prostate, they tend to do better when you cut off the blood flow in terms of , uh, urinary improvement. Right. When it comes to a very big prostate, let's just say a very big prostate, we don't have great options for you that are minimally invasive. Mm-Hmm. <affirmative> . So we have , uh, a surgery that I like to do called the robotic , uh, simple prostatectomy, <laugh> . We go through your abdomen, go through your bladder, and carve out your prostate, like peeling an orange. We leave the peel behind and take the orange , uh, fruit out.

Speaker 4: 14:59

You lit up a little too much just now .

Speaker 3: 15:00

I love, I love the operation. Uh , it takes me about , uh, two and a half hours. You're in the hospital for a couple of days and you have a catheter for two weeks, but you're gonna , you pee great afterwards, I'm sure. Uh, and then , uh, uh, Dr. Uh , Jordan Krieger in our office, one of our newest , uh, additions does hoep holmium laser and nucleation of the prostate. She's a, she's a maestro at it. Mm-Hmm. <affirmative> . And that is done through the penis. So there's nothing that goes through the abdomen. And she similarly peels that orange Mm-Hmm. <affirmative> . Uh , and then she uses something called a morsel later to, to chew up the prostate tissue and take it out

Speaker 4: 15:31

A what? A morcellator morsel

Speaker 3: 15:33

Later . Wow.

Speaker 4: 15:33

Morsel later to chew up the morsels.

Speaker 3: 15:35

It doesn't <laugh> . Uh , and then it takes out the little pieces of prostate. And that requires a , a catheter that requires sometimes a hospital stay, although she does , uh, many of them as an outpatient. Mm-Hmm . <affirmative> . Um, and so then you have this prostate artery embolization in where the , uh, arterial flow to the prostate is cut off and it shrinks the prostate. Now, Dr. Preston Smith in our office is probably one of the nation's most experienced , uh, prostate artery embolization experts. Mm-Hmm . <affirmative> , because that's, you know , mainly what he does here. That's what he does. Uh , and , uh, we have supported his practice because I'm a strong believer that there is a place for prostate artery embolization within a good buffet of options for BPH. Mm-Hmm. <affirmative> . And as the population in this country gets older and people are wanting to keep their lifestyle intact, they're looking for options that will not put them down, will not require a catheter. You know, men often are like, I can't believe that we haven't come up with a better way to take care of this problem yet. You know? Right. And that is, and , and that is what prostate artery embolization provides the better way to take care of this particular problem. Mm-Hmm. <affirmative> , it takes about two hours in our office. It's done with a sedation, kind of like you would get during a , um, uh, a colonoscopy. Mm-Hmm. <affirmative> , uh, we do it right here at one of our offices. It , we have a , a really excellent state-of-the-art cath lab, as it were. Mm-Hmm. <affirmative> , uh, with recovery base and a , and a wonderful nurse. And it's an exceptional , uh, opportunity to do it right in the office. Mm-Hmm. <affirmative> . As a matter of fact, I don't know of , uh, any , uh, other clinics Mm-Hmm . <affirmative> in Texas that offer it. Right. Uh, although there, there certainly could be , uh, certainly none in Austin. I don't believe that there's a prostate artery embolization clinic that is a urology focused one , uh, meaning led by urologists in Houston. Mm-Hmm. <affirmative> . It's just a rare thing. And, and we get to the reason why

Speaker 4: 17:20

It's a quick , it's a quick trip to Austin . It's a quick trip.

Speaker 3: 17:22

We have patients that come from all over. That's true. The country to get hifu high intensity focused ultrasound for prostate cancer and prostate artery embolization . Yep . And we can do your consultation, you know, over the phone. There's a visit up here to measure your prostate to make sure that you're an appropriate candidate, and then you pop in and get it done and go home that same day. Mm-Hmm. <affirmative> , you can even get back to most of your normal activities within 24 to four eight hours, including power lifting and golfing.

Speaker 4: 17:47

Wow. Sounds like you've treated those particular patients before. We do. We do. So, quick question. I've heard Dr. Smith and you talk about prostate artery embolization, it cuts off the blood supply to the specific prostate organ. And then I remember asking once, well, doesn't that kind of kill the organ? But Dr. Smith said there's something called collateral blood flow.

Speaker 3: 18:05

That's correct. It's not, it's not , uh, an organ that only has two main arteries. I'm sorry , it has two main arteries, but then it has a lot of, you know, smaller arteries that , that , that , that, that keep the prostate from necrosing or completely dying off. It does not affect you sexually. Uh, most people still have fluid that comes out of them when they, so they still have antegrade . Mm-Hmm . Which is a concern for many of our patients. Yeah . Uh, and , uh, I , I would say more than half of patients tell me their erections are more robust after taking care of this. And then, oh , and then side

Speaker 4: 18:35

Effect ,

Speaker 3: 18:36

Uh , you know, I started this by saying, why don't urologists do this? Well, I have 11 things that we can do for bph h right in , in my, in my little armamentarium.

Speaker 4: 18:46

And some doctors only have one or two,

Speaker 3: 18:48

And that's fine. Okay. But if, if, if you have a lot of options for BPH and you have a patient that comes to you and you're gonna make money off of doing one of those procedures Mm-Hmm . <affirmative> , you're not gonna be as likely to send them to another type of doctor to do a procedure unless you specifically ask. Right. That, that's the, that's the simple truth of it. There's a financial disincentive to offer prostate artery embolization because it's not a urologist that does it. It's an interventional radiologist. And so, in Houston and in major cities, there are interventional radiologists that will do prostate artery embolization. I don't know of anyone specifically in Houston, but they will do it. But where you lose out is they're not in cahoots in combination with a urologist. Mm-Hmm. <affirmative>. So if you're not an appropriate candidate, trust me, that guy's still gonna do it. Mm-Hmm. <affirmative> . And so it's really the captain of the ship, being a urinary health specialist, like a urologist, really gets you a better outcome. And that's why we encourage patients. And that's the truth is patients agree and that's why they fly from all over the country to get prostate artery embolization. Dr. Smith would love to do a consultation with you if you're interested. Mm-Hmm . <affirmative> call us and we'll do that as a telehealth consultation. Right. And , uh, if you wanna learn more about it, I'll do one with you too. So, Donna , uh, how do people here are podcasts? Uh, we've talked a lot about PAE and, and make an appointment with us.

Speaker 4: 20:04

You can reach out to us at 5 1 2 2 3 8 0 7 6 2. You can even ask for me, or extension 2 2 0 to leave me a voicemail message and I'll call you back. Visit our website, armor men's health.com. You could submit your questions there. We'll answer them anonymously just like this one. And if you wanna learn more about prostate artery embolization, you can visit our website again, armor men's health.com. Thanks so much for listening to our podcast. Wherever you listen to free podcast,

Speaker 2: 20:28

The Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.