The Armor Men's Health Show

EP 654: Dr. Mistry on Rezum, Axonics, and other Treatments for Enlarged Prostate

• Dr. Sandeep Mistry and Donna Lee

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In this episode, Dr. Mistry and Donna Lee answer listener questions about enlarged prostates, including the benefits of the Rezum, Axonics, and other treatments for BPH. If you have an enlarged prostate and are experiencing urinary symptoms, or are dissatisfied with the results of your recent BPH treatment, listen in! Dr. Mistry explains how different prostate treatments work, the likely side effects of each, and which is the best option for surgically reducing your enlarged prostate. Tune in to learn what slow flow, dribbling urine, and urgency/frequency may signify and the difference between obstructive and irritative urinary symptoms. Call us or go online today to schedule your consultation today!

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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Speaker 1:

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

Speaker 2:

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist, joined by my co-host the amazing Donna Lee. That's

Speaker 3:

Right. Welcome to the show everybody. I'm a board certified co-host

Speaker 2:

Board certifiable. Mm-hmm .

Speaker 3:

<affirmative> ,

Speaker 2:

You know, a lot of our listeners and a lot of our patients in the clinic think that you're the real star of the show, Donna. I

Speaker 3:

I do too. I do as well. <laugh> . That's so funny. We all have so much in common.

Speaker 2:

For the last three years, we've been able to give information related to men's health. A lot of it is based between the nipples and the knees. Given that I'm a board certified urologist, this show is brought to you by N a u Urology specialist. The urology group that I started in 2007. Donna, tell people about our practice.

Speaker 3:

You know, before I do that, I saw that some ob gyn in Austin as a podcast, and I think hers is like, like ours is nipples to the knees. Hers was like head to the hoo hoo , like <laugh> . It was interesting. Like she covered that part.

Speaker 2:

It, it is a , uh, she does and toes. There

Speaker 3:

We go. Ted and toes. to toes.

Speaker 2:

It's, it's Dr. McKayla Rush who, who sends us patients.

Speaker 3:

Oh, okay.

Speaker 2:

And she's , she's a friend of mine. She's been in practice also since 2007. She's an OG like me,

Speaker 3:

to toes. Not she

Speaker 2:

Does it . Oo , she does it. She does it with a podiatrist. Yeah,

Speaker 3:

That's right. Yes.

Speaker 2:

Okay.

Speaker 3:

We should have them on the show. It's

Speaker 2:

Really just and toes.

Speaker 3:

and toes. Yeah . I don't think to the toes.

Speaker 2:

Yeah , I think, well , I don't know if they do knees.

Speaker 3:

Oh, we , we cover the nipples to the knees. <laugh> , but not the head to the H

Speaker 2:

But not the nip, not the actual.

Speaker 3:

But if you have actual questions for us, you can reach out to our website, which is armor men's health.com and you can submit your questions there and we have a little backlog of questions, so we can certainly answer those as quickly as possible. Anonymously, of course, on the show, our clinic locations include Round Rock, north Austin, south Austin, and Dripping Springs, Texas. Our phone number during the week, (512) 238-0762 . Again our website, armor men's health.com. I want to thank the listeners though, so thank you all for listening and sharing our little podcast. So if you have questions though, please send them in. We do have a bunch of questions. Dr. Mystery ,

Speaker 2:

Let's go with the first one.

Speaker 3:

Alright . The first one came in a couple of weeks ago, so we will get caught up as we can. Hello, Dr. Mr . Nali . Hopefully this is my last question. He's asked a question or two before. A very nice man , uh, concerning in large prostate. Let's see, he said, failed resume procedure and a gloriously successful terp . So that's good news. During my journey, I noted to my urologist my fatigue, muscle weakness, lack of libido, and the loss of my armpit hair, chest hair and abdomen, hair. He did T levels and I was found to have a testosterone of about 200 or lower. I'm 75 and now using topical tert testosterone gel my levels . Now, after a year in the four 50 range in the morning, my urologist and myself think out of vidart . Am I saying that right? Okay .

Speaker 2:

Do

Speaker 3:

You know what that is? Yeah. May have been the cause of the testosterone issue. I feel great hair return , muscle weakness gone. Libido's back. Viagra started to be effective again. Two questions. Is there any concern that my prostate will enlarge again, due to testosterone supplement and I think of my future years. How long is it reasonable to supplement with testosterone? Should I reduce the dose over the next few years as my body would've done naturally? My urologist is adamant about six month blood levels and hematocrit on a sidebar. After six months of testosterone, my fasting blood sugar dropped to 94 and my L D L dropped to 80. I did not change my lifestyle other than testosterone supplementation. What's up with that Dr . Mystery ? And then he said, Donnel Lee, keep those men laughing at themselves.

Speaker 2:

<laugh>. I love it. <laugh> . Well, what a great question and a great kind of overview of how testosterone supplementation improved the lifestyle and the status of this 75 year old man. Now, not all people benefit in the same way. Uh, and these kinds of questions that he has are very common. So let's start first with what do you do if you've had something done for your prostate and it's failed? And , uh, on this show, I say often that what treatment you get for your medical condition has a lot to do with how your doctor trained and what they feel comfortable with. Mm-hmm.

Speaker 3:

<affirmative> .

Speaker 2:

So don't assume that all doctors are the same. And certainly when it comes to a medical condition that's bothering you, if you're not getting the answer that you want from the doctor that you're seeing, you shouldn't just feel like the community has failed you. You just need to find a different doctor. And so mm-hmm. <affirmative>

Speaker 3:

It ,

Speaker 2:

This patient had a resume procedure, which is a procedure that we do in the office. It's one of our many things that we offer to make America pee. Again, our mapa program, the Zum procedure uses steam, so it's just water that's heated up right to the boiling point, becomes steam, and that steam is injected via a needle into the prostate gland. Mm-hmm.

Speaker 3:

<affirmative> .

Speaker 2:

Now the, the , the steam causes apoptosis or death of the cells and that the prostate kind of involutes or gets smaller and, and , and , and gets out of the way of the urinary tract so you can pee better. What's awesome about rezum is it's done in the office. It , uh, takes literally like a few minutes. Like a minute. Like the entire treatment is , is 30 is is 60 seconds long, and if you do it in our office, you get a little bit of a sedative. So you don't feel anything during the procedure. Mm-hmm.

Speaker 3:

<affirmative> , uh,

Speaker 2:

The downsides are that , uh, the prostate will regrow if given enough time. Uh, and you do have to wear a catheter in our clinic or , uh, when you get treated by me, you wear a catheter for seven days afterwards and it takes a little bit of time for the, for the prostate to kind of go down. Mm-hmm.

Speaker 3:

<affirmative> , if

Speaker 2:

It doesn't go down enough, either not enough steam got injected or your prostate didn't die because of the steam and that, that that's the case. Not all tissues from individual to individual are the same, so they're not gonna necessarily die. Mm-hmm. <affirmative> . So then he had a more definitive operation, which opens up the channel and allows you to pee. That's the terp procedure. And so , uh, that's what ultimately allowed this patient to have better urination. And so then you have the fact that he continued his care with his urologist and he was put on a topical testosterone. Mm-hmm.

Speaker 3:

<affirmative> ,

Speaker 2:

One of the conclusions that this patient reached is that the avodart that he started or ide

Speaker 3:

What's avodart ?

Speaker 2:

Dutasteride is another way. Another medicine besides alpha blocker therapy , alpha blockers are gonna be drugs like Tamsulosin, also known as Flomax or Fussin , uh, also known as Oxytrol . And these medicines relax the muscles of the prostate and allow you to pee and do ide and finasteride , uh, are medicines that block some of the hormones in the prostate. They also help with hair growth . Oh. I don't use those medicines very often because that hormone manipulation that's happening to help you pee better can also affect you sexually. But Oh , but that's for just for the knowledge of this particular patient and for people out there, if anything, these medicines should increase your testosterone, not decrease it because of how they work. But the increase in testosterone, oftentimes people don't feel mm-hmm .

Speaker 3:

<affirmative> and

Speaker 2:

It can decrease your free testosterone , uh, which is a calculation that's done that's like a numeric calculation that oftentimes many people don't get done. But, but if anything, it's gonna decrease your free testosterone, but it could increase your total testosterone In this particular patient. I think his testosterone went down because he's 75 years old and that just happens. He mentioned some things that are very fascinating. He had fatigue. Mm-hmm.

Speaker 3:

<affirmative> , he

Speaker 2:

Had some changes in his hair growth patterns, but the most interesting one that he mentioned was that the Viagra was no longer working for his erections. And we see that often about 60% of men who have low testosterone and the Viagra used to work but doesn't work anymore. About 60% of them, we can salvage Viagra or any oral medicine for erections by supplementing their testosterone.

Speaker 3:

Okay .

Speaker 2:

Uh, and so if you are in that category, we would encourage you to come in so we could help supplement your testosterone. Uh, this particular urologist used topical agents. Uh, in our clinic we use injections more commonly than topical agents because the topicals have to be delivered daily. Mm-hmm.

Speaker 3:

<affirmative> ,

Speaker 2:

Not everybody absorbs them as well. Uh , this , the

Speaker 3:

Transference,

Speaker 2:

The transference issue , uh, to, you know, small children or to your partner if you're , if, if it touches them mm-hmm. <affirmative>

Speaker 3:

For , uh,

Speaker 2:

And, and oftentimes it can be expensive, but the fact that it worked in this patient is excellent or this, this lister is excellent. Um, he got up to a level of four 20 from under 200. That's excellent. Also, it's

Speaker 3:

Pretty good for 75, huh?

Speaker 2:

And it's pretty good for the topicals. Um , yeah . Uh , we will goal oftentimes for the six hundreds, but our goal, you know, is really based upon your symptomatic improvement, the fact that he's doing so much better. Mm-hmm.

Speaker 3:

<affirmative> ,

Speaker 2:

I think the likelihood for his prostate to grow

Speaker 3:

Mm-hmm . <affirmative> , uh,

Speaker 2:

Is pretty low, but TURPs in general last about 20 years. Oh.

Speaker 3:

So ,

Speaker 2:

Uh, hopefully he sees 95. That would be awesome,

Speaker 3:

Right.

Speaker 2:

If , if he needs another TURP one day, that that's , that's good . That's a good thing. It means that he live long enough

Speaker 3:

And the TURP is the, what they call a roto-Rooter.

Speaker 2:

The Roto-Rooter, which a lot of men don't like. I don't

Speaker 3:

That like the

Speaker 2:

Idea. Uh , and I think it , I think that if you've actually worked for a living and know what a rotor rooter is, then you don't like it <laugh> . But if you're like me and, you know, it's just a , like a theoretical concept, you're like, Hey, I'll use whatever word . Oh, that's funny. Uh, so it probably says more about , uh, kind of where you're coming from <laugh> . So , um, uh, should he continue it? I would say that the fact that his lipids got better, his cholesterol got better, his blood sugar ter means that he needs that medicine. Right. Right . I wouldn't stop taking it ever. Sounds very interesting . So , uh, just , uh, he's doing great. I think that your doctor's insistence that you get your labs checked every six month is, is , is on point . Mm-hmm.

Speaker 3:

<affirmative> , the

Speaker 2:

Only thing that I would change about that plan would , I would add an estradiol level to your levels every six month . A lot of times testosterone supplementation, they don't include that number. And we do it routinely. And , uh, it , it makes me happy to get a report from a listener that's getting treated, you know, in, in every way that I think that , you know , it's , it's awesome. It's awesome out there. So I , so I love it. Uh, so , uh, secretly

Speaker 3:

He's your patient though . <laugh>. <laugh> .

Speaker 2:

Kidding . Wouldn't that be funny? It's , it is . Like when I scope a person that I did a TURP on and I'm like, man, somebody did a really good job who did his turp ? And I'm like, oh, I did it. Perfect. <laugh> . Well, Donna , uh, what a great question. Uh , how do people ask more? You

Speaker 3:

Can reach out to us through our website, armor men's health.com, and you can also call during the week (512) 238-0762 .

Speaker 2:

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host joined by my co-host Donna Lee.

Speaker 3:

Hello everybody. Happy day.

Speaker 2:

Happy day. I am a board certified urologist. This is a men's health show, although we do talk a lot about women's issues sometimes, don't we?

Speaker 3:

Mm-hmm. <affirmative>? We do. We do. We need to do it more. We

Speaker 2:

Need to do a little segment on That's what she said again. That's

Speaker 3:

Right.

Speaker 2:

We'll put that on. Um, I, I'm a board certified urologist. This show is brought to you by N a U urology specialist. That's the urology practice started in 2007. We have four physician providers. We have what, five or six nurse practitioner and PAs. We have . It's

Speaker 3:

25 nurse practitioner .

Speaker 2:

We have <laugh> , we have , uh, um, uh, four offices. We have two pelvic floor physical therapists. We have in-house health coaching with a focus on nutrition and a really holistic approach to your healthcare . Something that's gonna be unique, comprehensive, and I hope extremely successful in dealing with your urologic needs. That's

Speaker 3:

Right . Don't forget we have sex therapy on site and sleep therapy.

Speaker 2:

That's right. Because , uh, and this comes from a, a , an understanding of mine from very early on that urology is not the center of the universe. It's weird. It's weird. I feel

Speaker 3:

Like it is,

Speaker 2:

But, but if you don't have a healthy heart, you won't pump any blood to your penis. Help me . That doesn't help me . Me at all . So , uh, how do people get ahold of us and send us question?

Speaker 3:

You can reach out to us through the website, armor men's health.com com. You could submit your questions there at the little link at the top right. And we'll answer them anonymously maybe a week or two later. But we'll get to those we promise. And you can find us in Round Rock, north Austin. South Austin Dripping Springs. And before I forget, Amy, our in-house sleep coordinator manager. Yes.

Speaker 2:

She was

Speaker 3:

Asking me if my husband, Michael, was using his C P A P the other day and I said no. And you know what she said to me? What she said that can add seven years to his life. Why aren't you making him use his C P A P ? And then I felt horrible. I didn't know it was seven years. <laugh> . That's a long time.

Speaker 2:

It's a long time. And you just want his money, so I make sure you're in the will and we can kill him off earlier. <laugh> . So

Speaker 3:

For those of you listening, there's a new way to get money out of your,

Speaker 2:

Can you make sure I can have the car <laugh>?

Speaker 3:

Yes . So we talked about Rezum and some other prostate issues in the previous segment. And I have another resume question for you. Go

Speaker 2:

For

Speaker 3:

It. This particular person sent in Dr. Mystery . I had a resume procedure done in March, and it appears that it was successful because according to the scope, the prostate has significantly reduced. But I'm still having issues with urinating. My urologist thinks it's a bladder issue and suggested that I might try the axonics procedure. What say you

Speaker 2:

I think that's great. So what this listener is saying is that they have some degree of urinary complaints and when somebody comes to see me , uh, a man in particular, let's to say what , when I'm kind of , uh, listing out what urinary complaints they have, I separate them into two categories. And if you can think of kind of your urethra and your urinary system, like just a , you know, a garden hose with a reservoir behind it,

Speaker 3:

A wizard wire ,

Speaker 2:

A reservoir, <laugh> , the , the flow can be low.

Speaker 3:

Okay .

Speaker 2:

Out the end of the hose. Mm-hmm.

Speaker 3:

<affirmative> ,

Speaker 2:

That can be either because the bladder is weak Okay . Or there's a blockage. Right. Then you can have a list of symptoms that are, because the system is irritated and not working well, we call those irritative symptoms. So there's obstructive symptoms and irritative symptoms. Mm-hmm. <affirmative> , so obstructive symptoms would be difficulty getting the urine flow started. I include dribbling when you're done peeing also in that obstructive category.

Speaker 3:

Okay.

Speaker 2:

And a slow flow, obviously what I would call as irritative symptoms would be frequently getting up at night, having urgency, frequency, or leaking some urine before you get to the bathroom. So that's how I separate them. If you have obstructive symptoms, that's slow flow, difficult , getting the urine flow started and dribbling in our clinic, the most common reasons are going to be an enlarged prostate, which is more likely if these symptoms are evolving over time and you're in your late fifties, sixties and seventies, then there is the possibility that your pelvic floor or the muscles of the sphincter are not relaxing all the way. They can cause very similar symptoms. That's gonna be more common in the younger guys. So that's, we're gonna see in like our twenties and 30 year olds mm-hmm. <affirmative> , they don't have an enlarged prostate, they have something else going on.

Speaker 3:

Right. We

Speaker 2:

See it in truck drivers, police officers, people that sit for long times and had drive quite a bit. Mm-hmm. <affirmative> people with lower back issues like , um, spinal issues and things of that nature. So those are gonna be some examples of where somebody that would have a spinal or, or, or a sphincter issue. Then you have people that have a stricture or a narrowing of the actual tube that's from scar tissue. That's gonna be more common in people who have a prior history of an accident, like a motorcycle accident or a pelvic fracture or something like that. Mm-hmm .

Speaker 3:

But

Speaker 2:

It can happen even in people , uh, who don't have that. And that usually causes a very low slow flow that's consistently slow. It doesn't get better or worse. Mm-hmm.

Speaker 3:

<affirmative> , uh,

Speaker 2:

And they usually don't have a lot of urgency or frequency and it can be repaired fairly quickly and easily in the operating room. Then separate from that, you have people with irritative symptoms now in a man in their sixties or seventies or late fifties, if you fix the obstruction, if you make the tube bigger mm-hmm .

Speaker 3:

<affirmative> ,

Speaker 2:

You fix their irritative symptoms 80% of the time. So if you come to me and you're 65 and you're complaining of getting up a lot at night and having a lot of urgency and frequency, and I think you have an enlarged prostate, then we'll do something for the prostate. This patient had a resume procedure. We can do terps, we can do laser procedures, we can do UroLifts, we can do prostate artery embolization. A plug for the fact that we are the only urology group probably in all the entire state of Texas that offers in-house prostate artery embolization. Certainly the only one in Austin. And so , uh, that uses the blood flow restriction to shrink your prostate. The rezum is an excellent option if you're looking for an office-based procedure that removes some tissue. Once again, it uses hot steam that's injected into the prostate lobes that shrinks the prostate.

Speaker 3:

The prostate spa,

Speaker 2:

It's a prostate spa. We've said that before. That's funny. <laugh> . Uh, so about 20% of the time though, it doesn't fix the urgency, frequency, and nighttime pain .

Speaker 3:

Mm-hmm .

Speaker 2:

So if you still have a slow flow after a procedure, then that means you're still obstructed, meaning you're still blocked. Mm-hmm . Even if it looks okay.

Speaker 3:

How, how soon though after the procedure should they not have a slow flow?

Speaker 2:

You should certainly be better. I mean, this, this , this particular listener seems like they're almost 10 months out from their procedure. So I would say the longest you really have to give it , it's , it's about 12 weeks to six months mm-hmm.

Speaker 3:

<affirmative> where

Speaker 2:

The shrinkage happens and their irritated symptoms should get better. So if you're still getting up at night all the time or having urgency and leakage before you get to the bathroom 10 months after your procedure, then you're way too long. Mm-hmm .

Speaker 3:

<affirmative> .

Speaker 2:

And so this patient's urologist or this listener's urologist, has recommended that he move on to the next stage of treatment. And that is exactly right. You want to make sure that if you're that far out from your prostate procedure and you're still having irritative symptoms that we've moved you on now to what we call the overactive bladder pathway. And in our office the overactive bladder pathway begins with behavioral nutritional therapy first, along with management with one of our pelvic floor physical therapists. They will help retrain your bladder and we will use nutrition and supplements to kind of help calm your bladder down in an effort to avoid more invasive things. The second step that we will have is going to be medication therapy. There's two classes of medicine. The medicine names that we use are VETRI and Gem Tessa. These are medicines that can , um, have fewer side effects. Mm-hmm.

Speaker 3:

<affirmative> , uh,

Speaker 2:

But can be kind of expensive, but insurance covers many of them. Uh, and then we have medicines like Oxybutynin and Vasca and sen , uh, which is also known as cin . These medicines work very well for overactive bladder symptoms, but they can cause dry mouth and constipation.

Speaker 3:

Hmm .

Speaker 2:

And because of those side effects, we avoid them a little bit.

Speaker 3:

Right.

Speaker 2:

And then we have surgery because, you know, because

Speaker 3:

You like to do surgery .

Speaker 2:

I'm a surgeon. Right. <laugh> . So , uh, and so, so , uh, these surgeries are not big surgeries, but they're very effective. So one of them , do you call

Speaker 3:

'em big wax ?

Speaker 2:

Big wax . When

Speaker 3:

You say good surgery, they're

Speaker 2:

Not , they're not big wax <laugh> . They're , they're , they're very, very small.

Speaker 3:

They're small wax.

Speaker 2:

They're small wax <laugh> . And , and they can be done a lot of can be done in the office. So, so , uh, we don't do a lot of Botox in the office, but Botox can be injected into the bladder wall. It's a very simple procedure. Many urologists do it right in the office. Uh , we do it in the operating room because the Botox is very expensive and it's hard for a small practice like ours to kind of afford , uh, the Botox mm-hmm . <affirmative> , but , uh, and

Speaker 3:

It's hard when I throw my forehead underneath the Botox needle and try to get some free Botox.

Speaker 2:

That's right. Not all of it in your bladder, some into DOT's , forehead,

Speaker 3:

<laugh> . The patient's always confused when I sit up, I'm like, hello,

Speaker 2:

What are you doing down there, Donna <laugh> ,

Speaker 3:

I'm just stealing your boat .

Speaker 2:

They're excited. It's not as exciting when they find out they're just getting the Botox. So , uh, Botox is ejected into the bladder wall. Uh, we typically start with a hundred units, but can do up to two or 300 units depending on your particular bladder. It is covered by insurance, although Botox is expensive. Mm-hmm . <affirmative> , it is covered by insurance and , um, uh, very effective, but it only lasts for six months. Mm-hmm.

Speaker 3:

<affirmative> . And

Speaker 2:

Then at our clinic, we do a lot of what we call the axonics , sacral neuromodulator. Mm-hmm . <affirmative> , uh, which is a, like a pacemaker. It , uh, it , it uses a very low electrical signal. Mm-hmm . <affirmative> that calms down the bladder nerves. Right. It's very effective for overactive bladder. In our practice, we use it a lot in people who have overactive bladder from prior stroke or have other kind of neurologic issues, including our multiple sclerosis patients and patients with dementia, because using those medicines isn't always good for them. Right. So,

Speaker 3:

And there's no medicine with this

Speaker 2:

And , and , and so we reduce the medication side effects. Mm-hmm.

Speaker 3:

<affirmative> ,

Speaker 2:

It's , uh, although the, the simulator goes near your nerves, it doesn't go anywhere near your spinal cord. So there's no risk of paralysis or anything like that. It's just calms the bladder down and we do the trial for it right here in the office in many cases. So , uh, we can see if it's gonna work for you. No medication side effects. And a great way to address overactive bladder after prostate surgery. Great question. How do people ask more? Donna, you

Speaker 3:

Can visit our website, armor men's health.com and submit a question right there that will answer anonymously <laugh> . Thanks Dr. Worre .

Speaker 1:

The Armor Men's Health Show is brought to you by N a U Urology specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online@armormenshealth.com .