EP 588: Prostates, Young and Old

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee explain all about the prostate, including the impact of prostate problems on male fertility. Not sure what your seminal vesicles do (or even whether you have them)? Peeing too much, too little, or too slow? 

If you enjoyed this episode, don't forget to like, subscribe, and share us with a friend. As always, be well!

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

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Transcript

Speaker 1 0:07

Welcome to the armor. Men's health hour with Dr. Mystery and Donna Lee.

Speaker 2 0:13

Hello and welcome to the armor. Men's health hour. I'm Dr. Mystery, your host. I'm a board certified urologist. This is a men's health show. I'm joined by my co-host the effervescent incredibly entertaining. Donna Lee.

Speaker 3 0:25

That's right. I am entertaining effervescent and I'm a board certified cohost

Speaker 2 0:28

<laugh> she's certifiable. This is a show that's brought to you by N AAU urology specialist. That's the practice started by me in 2007. We've grown to four physician providers. We have four mid-level providers that are, those are PAs and nurse practitioners. We have two pelvic floor, physical therapists. We have sex therapy on site, really dedicated to a mission of treating the whole person. Even though urology may seem like a really limited field mm-hmm<affirmative>, but everything affects everything.

Speaker 3 0:55

That's right. Everything affects the nipples to the knees,

Speaker 2 0:58

The nipples to the knees. A lot of times people ask me, what does a urologist do? Donna, if somebody asked you, what would you say?

Speaker 3 1:04

That's funny. I just went through that question with my mother who's in Thailand, she's Thai and stuck in Thailand, and she's always asking me what we do. And I say, it's everything in the middle. It's like the, the, the whohoo and the, the pee pee parts. And I think she understood finally,

Speaker 2 1:17

You know, I would've expected nothing better from you

Speaker 3 1:19

<laugh> there were Wiener schnitzels and the, the pink cakes. I don't know. I don't know. I just made that

Speaker 2 1:27

Happen anyways. So for those of you out there, wondering what a urologist does is, um, what we deal with all of the organs and processes that deal with the Gena urinary system. So we start with the kidneys and then we work on kidney tumors and kidney masses. We worry about the tubes that come from the, uh, the kidneys down to the bladder. When the urine leaves the bladder, uh, it goes through the urethra in a woman is generally a shorter urethra. And some men, luckily it's a little longer, it goes past a prostate. And although not my husband, it may seem like a lot of, it's a really kind of inert system. Mm-hmm, there's all sorts of things that happens at every little step, because the body's an incredibly magical and wonderful thing. And, uh, then we have part of the genitor urinary. So that's the testicles theist, the VAs Rines, all of them come together with the prostate

Speaker 3 2:12

Gland. That's why men are so complicated.

Speaker 2 2:14

Like, like in some ways the prostate may be the center of the body. You think? Well, at least in a man.

Speaker 3 2:19

Yeah. Maybe not the woman who doesn't have one. Yes. I love it. When patients call and they're like, I got prorate problems

Speaker 2 2:24

And it's a woman.

Speaker 3 2:24

No, it's a man, but they always have the prostate problems. I'm like, are you standing upright, sir? Is that what you mean? You mean prostate a

Speaker 2 2:31

Prostate prostate. Sometimes I say prostate. So I seem like, you know,

Speaker 3 2:35

Don't do that. Okay. Neurologist,

Speaker 2 2:37

But the prostate being the center of the universe universe, the man's as it were, I thought maybe we could talk about what that is, what that organ is. We talk about it all the time and mm-hmm,<affirmative>, it amazes me the stuff that I kind of gloss over. And then I look back and I go, there's no way that electrical engineer understood anything. I just said the

Speaker 3 2:55

Plumber's like, wait, I'm a two, wait, I'm a plumber. Wait, different kind of are

Speaker 2 2:58

Plumber, are you sure? I probably should have used smaller words. So, uh, the prostate gland is a normal organ. It, um,

Speaker 3 3:03

How big is it on if on a healthy patient,

Speaker 2 3:06

It's about the size of a Walnut we say, but I've seen walnuts and I've seen prostates when you're like, wow. And prostates are a little bigger than a Walnut.

Speaker 3 3:13

Oh really? Yeah. Cause a walnut's a pretty big size Nu go

Speaker 2 3:17

You're you're the biggest nut<laugh> so we, um, uh, the, the prostate measures about 30 milliliters, uh, or cubic centimeters, which is just a little bit bigger. I think it's probably as big as one of those red noses that, uh, a clown wears

Speaker 3 3:31

Like at the Walgreens.

Speaker 2 3:32

Yes. They have those. I just had a kid wear one of those to a birthday party.

Speaker 3 3:36

And he was like 25.

Speaker 2 3:38

He was, he was older than he should have been wearing clown noses. And, and, and I, uh, and I, and I, I was like, you know, that's the perfect size prostate,

Speaker 3 3:45

Really?

Speaker 2 3:46

So, so maybe it is a it's somewhere be between a Walnut and

Speaker 3 3:51

A red

Speaker 2 3:51

Clowns, clown nose. Um,

Speaker 3 3:53

I don't think that's gonna catch on, but God red clown knows size prostate.

Speaker 2 3:57

I've been working so hard to get viral about something<laugh> except for herpes.

Speaker 3 4:01

Well, yeah.

Speaker 2 4:02

<laugh> so, so the prostate gland is, uh, a normal part of the urinary system. Mm-hmm<affirmative> it? Because it's the hub of both where you, the, it surrounds the urethra. So it's, it's the hub of kind of how we're peeing mm-hmm<affirmative>, but it's also the hub of a lot of, um, problems that are, uh, fertility related. Mm. So although we think of prostate related problems being only an old man's problem, right? There are a number of conditions that we have to come across where young men, we deal with their prostate.

Speaker 3 4:34

I did not ever connect that fertility and prostrate prostrate, prostate, prostate

Speaker 2 4:38

<laugh>. So if you have prostate infections, mm-hmm<affirmative> or prostatitis, you can have fertility problems because the inflammation can, can close off the tubes or infection or inflammation in the prostate gland can kill the sperm as it's going through the prostate gland. Oh. Or getting fed by the prostate. Did not know that. And the prostate's purpose is truly just a, a reproductive one. It makes semen mm-hmm<affirmative> that makes the, uh, that, that feeds and makes the sperm healthy. Mm-hmm<affirmative> so that the sperm which are produced by the testicles can survive for the days that it has to inside the uterus and the fallopian tube. So it feeds them. Okay. Gives'em what they need.

Speaker 3 5:23

Wow.

Speaker 2 5:24

And so if that fluid is not normal, mm-hmm<affirmative>, then that sperm won't be normal. And as men age, the prostate starts becoming more and more of a diseased organ mm-hmm<affirmative>, which is one big contributor to why older men have trouble having children compared to younger men. Okay. Because the sperm gets produced every 90 days. So that's like fresh and new. And like that sperm coming outta the testicles is great. Mm-hmm<affirmative>, but the more it sits in the system and has to go through this diseased prostate and come out, you can start having fertility problems when, um, that, you know, as you're getting older.

Speaker 3 6:02

Hmm. Okay. So super healthy older guy with no prostate problems is more likely to impregnate his 25 year old wife,

Speaker 2 6:08

Second

Speaker 3 6:09

Wife, second, third wife, third

Speaker 2 6:10

Wife.<laugh> who's trying to compete with the first two wife. Mm-hmm<affirmative>. So the, um, the organ that, that, that, that actually, um, uh, squeezes to get the out of you mm-hmm<affirmative> is the seminal vesicle. So if, if you're wondering, like, you know, people, men, men, men, some of them think that, that when you all that fluid comes right from the testicle. Right. And I try to remind them if that's the case, your testicles would be big and then you'd orgasm, and then they'd be small

Speaker 3 6:42

<laugh>. Yeah. Right. It would be

Speaker 2 6:43

Like draining and that's, and that's not what happens. Right. So the sperm March up, the vast deference they'd go into the prostate gland. And then they hide out in the seminal vesicles where they get joined by fluid that the prostate makes mm-hmm<affirmative> and that's, and then it's just sitting there waiting for you.

Speaker 3 6:58

Hmm. Interesting. Waiting for you. Science is so interesting. Seminal VE what'd

Speaker 2 7:03

You say? Vesicles. Okay. Seminal vesicles

Speaker 3 7:05

Sounds like a college football team.<laugh> there come the seminal vesicles<laugh> I guess worst

Speaker 2 7:13

In essence, worst mascot ever.

Speaker 3 7:15

<laugh>

Speaker 2 7:17

The flying prostates.

Speaker 3 7:19

<laugh>

Speaker 2 7:20

When we remove the, um, the seminal vesicles, in fact, uh, although it's completely untrue, you know, mm-hmm,<affirmative> whenever we find really big ones, we, we, we think to ourselves, maybe the guy hasn't been having very much sex. Oh. And when you find really small, we're like, well, this guy got pretty, very good<laugh>. Uh, but, uh, it actually has nothing to do with its size does not matter,

Speaker 3 7:41

Doesn't matter

Speaker 2 7:41

Here when it comes to seminal Sables, at least.

Speaker 3 7:44

Mm.

Speaker 2 7:45

And so what happens to the prostate, uh, that can cause fertility problems. I mentioned prostatitis mm-hmm<affirmative> um, we very occasionally get a fascinating condition, um, called a utricle prostate uric in which the there's a cyst right. In the middle of the prostate. And it's just so perfectly and terribly placed that it blocks both VAs Derin as they come into the prostate. Cland

Speaker 3 8:07

What causes

Speaker 2 8:08

That. It's just a, it's just, it's a, it's a congenital anomaly called a prosthetic utricle mm-hmm<affirmative> and it can make you infertile.

Speaker 3 8:14

Why is it so perfectly positioned though? Like, is it

Speaker 2 8:16

Just it's right in the middle and it, and it blocks both tubes. Hmm. And it's just, it's just a way that, um, it's, uh, uh, really it's too much the, the, the, the, the genitor urinary systems of men and women, mm-hmm,<affirmative> start out identical when we're fetuses. Right. And then little chemical hormone signals get bet pushed that push us from one type of sex organs to another mm-hmm<affirmative>. And sometimes those signals don't get completely transmitted. Oh. And you get a little bit of woman in the man. Oh. And so when you get, and that utricle is very similar to the uterus. And so if, if you get that U utricle, you can become infertile and have no suburban the. So about five years ago, we had, um, uh, a patient come to us all the way from Corpus Christi because they had were infertile. And we found that utricle and opened it up oh. And were able, and they, they were able to have two kids really. And then I got to do his vasectomy. Oh,

Speaker 3 9:12

<laugh>

Speaker 2 9:14

So full circle. So I took it from no sperm to lots of sperm, to two kids, to no sperm, to no sperm, again, that's funny cycle of life.

Speaker 3 9:21

Aw<laugh>

Speaker 2 9:22

Uh, and so, um, prostate problems can lead to, uh, fertility problems. Mm-hmm<affirmative>. And, um, so that's kind of how young people can have prostate problems, but in older men, the first question that most older men ask me when I tell them that I think their prostate is the cause of their urinary issues. They go, what's that prostate for

Speaker 3 9:40

They're like, how do you get rid of the prostate problems?

Speaker 2 9:43

And, and it, because people get affected by it, when it comes to urinary habits, you're left with this impression that the prostate actually has some urinary function,

Speaker 3 9:50

Right? Like urine goes through it,

Speaker 2 9:52

Like it should be doing something to the urine, but it isn't right. It's really just meant there to make fluid, to help support sperm. So it's really only a reproductive organ. It just, in order to get the semen mm-hmm<affirmative>, which has your sperm in it, into the same tube where you pee from, there has to be a connection between your testicles and your urinary system. Like there has to be one or else we would have to have two

Speaker 3 10:15

Penises, two

Speaker 2 10:16

Penises, right? You'd have to have one that you pee from. And one that you have

Speaker 3 10:19

Sex with, it would be a terrible world.

Speaker 2 10:20

And, and luckily, you know, nature has kind of allowed us to kind of become more efficient. And so he put this wonderful play land right there in a waste management system and decided

Speaker 3 10:30

Waste management

Speaker 2 10:31

System. You know, that's what urine is. That's funny. And so by combining these two, but that's where the, the potential point of failure is when we were just cavemen and only lived to like 25. And I eaten by a saber tooth tiger or whatever our prostate didn't have this chance to outlive our reproductive years. Mm. That makes sense. But because we're living longer and longer, mm-hmm,<affirmative> this, this organ that was only meant for reproduction ends up malfunctioning,

Speaker 3 10:55

Fing up other things. Yes.

Speaker 2 10:56

Yeah. And it happens in women too. Right? Young women don't tend to get uterine cancer or breast cancer. Mm-hmm<affirmative>, but after you've gone past your reproductive years, that's when these reproductive organs are like, we're not gonna pay so much attention. Right. Let's pay more attention to the heart and the lungs and the brain mm-hmm<affirmative> because those are organs that are gonna keep this organism alive. And the reproductive system kind of goes to heck as men age, an enlargement of the prostate is something that, that ha in a good number of patients. And then because the prostate surrounds the urethra, it goes all the way around it. One of the ways that it can grow is that it can grow large enough where it squeezes the urethra mm-hmm<affirmative> and makes it difficult for urine to come out

Speaker 3 11:37

Side question. What's the largest prostate you've ever seen.

Speaker 2 11:40

I have seen the 700 gram prostate.

Speaker 3 11:42

And what, what is that? A like

Speaker 2 11:43

A, it would be baseball. Be 20. It was a softball. And it was 25 times larger than normal prostate. I mean, it's humongous 25. It's humongous.

Speaker 3 11:53

That's a lot of

Speaker 2 11:54

Weight. Oh yeah. And it didn't cause him any trouble. So we didn't do any with it. What? Yeah.

Speaker 3 11:58

Wait, you don't remove it. If it's that big, you just let it be. He just let it be. But then he is like super feeling heavy. Like you fat meal.

Speaker 2 12:05

He just leave that in there. Oh. And, uh, you know, you, you brought up two very interesting points. Mm-hmm,<affirmative> bigger people mm-hmm,<affirmative> tend to have bigger prostates. Okay. So, so a lot of times, you know, the 300 pounders that come in, end up having, you know, 300 pounders inside their prostate too. Oh boy. And, but not always. And most importantly, the size of the prostate has nothing to do with how much blockage there is. And that is sometimes something that's very hard for men to understand. Yeah. They'll come in and say, my doctor told me that I have an enlarged prostate after doing an exam on me. Mm-hmm<affirmative> and I will tell you I've done luckily and fortunately, tens of thousands of exams on men, tens of thousands. That's true. And the, the reliance on feeling only one part of the prostate, you're only feeling like the back part of it. Mm-hmm<affirmative> and being able to estimate the size of the whole prostate GGL right. Is something that I don't even try to do. It's a, it's a, it's, it's a dumb exercise. Okay. There's just no way. And you're wrong half the time. So you were better off guessing the size of the prostate than putting your finger in there. We put our finger in there to feel that for tumors.

Speaker 3 13:15

How do you feel for tumors, like quickly? Cuz it's like just a few seconds.

Speaker 2 13:19

I mean, I'm a very, very gifted,

Speaker 3 13:21

But are the tumors always on the finger side? Like or what about the other

Speaker 2 13:23

Side? No, that's right. That's right now most tumors. But, but, but it's because that's how we used to find tumors than anybody. Like right before we had the PSA test, the only way we found tumors was putting our finger in there. So that's kind of how we do it, but that's why now we're more sophisticated. We have MRIs to find tumors of the prostate. We have tests that are blood test related. We have biopsies like we have, you know, it's not just the finger test. Right? And for size we do something called a transrectal ultrasound where we put an ultrasound in the rectum and now I can get a true size estimate. Mm-hmm<affirmative>. Now, although I said, how big the prostate is and how many, how much symptoms you have may not have a, a correlation mm-hmm<affirmative> but how big your prostate is definitely impacts what surgery I can do to fix the problem. Mm-hmm

Speaker 3 14:05

<affirmative> that makes

Speaker 2 14:05

Sense. So the bigger you have of a prostate, I, you start eliminating some options. Mm-hmm<affirmative> the minimally invasive office based and procedures that we do for quote unquote, enlarged prostate. I think that's another confusing part is that we use the term enlarged prostate mm-hmm<affirmative>. So you think that it's bigger, but I would say almost, uh, a quarter of the prostates that I operate on mm-hmm<affirmative> are normal sized<laugh> they're just grown in a certain way that causes blockage. And that's why the patient has symptoms. And if you go to the appropriate doctor and they do the appropriate evaluation surgery to help your urinary complaints, like works like virtually every time. Right? It's just, you have to make sure that the doctor has weeded you. So if you go to a doctor that only does mm-hmm,<affirmative> a certain procedure, you're gonna get that and get, and you're gonna get that for sure. Right? Right. If you go to a popup, that's what they do. If you go to a popup clinic that pops out dense after hail damage, right? Guess what?

Speaker 3 15:03

You're not gonna get an oil change. Yes.

Speaker 2 15:04

You're not getting an oil. She you're getting dense popped outta your

Speaker 3 15:07

Car.

Speaker 2 15:08

So if you go to somebody that if, if you're a patient and you don't, and you're not a medical doctor, but you heard somebody got something and then go to the doctor that does that one thing, you're probably gonna get that one thing. Right. Even if it's not appropriate to you. So, you know, making sure you go to a comprehensive specialist is really important.

Speaker 3 15:24

And second opinions are very important.

Speaker 2 15:25

I agree. I mean second opinions, which we do all the time. Mm-hmm<affirmative> are really important, making sure that you've been, you know, appropriately put into a certain category. Mm-hmm<affirmative> another question people ask, uh, or men ask, um, is why does removing the prostate, if it has no urinary function, why does removing the prostate sometimes lead to impotence? And incons

Speaker 3 15:49

Good

Speaker 2 15:50

Question. And that is because, because the prostate is the nexus, right? The center of the man's universe. Right. They put it right in the middle of like, oh, that's great. All the most important things. It's right next to the Spiner that controls your urination and keeps you from peeing on yourself. And in some quirk of fate, the nerves that protect our erections.

Speaker 3 16:13

So

Speaker 2 16:13

Scientific, I cured Coate feared to the side of the prostate for no good reason. You know, they, they could've put'em a couple inches to the right or not, and nothing would've changed.<laugh> but no, they stuck Glu

Speaker 3 16:25

Super

Speaker 2 16:26

Glue. These nerves right on the edges of the prostate.

Speaker 3 16:29

Oh, how delicate.

Speaker 2 16:30

So when I'm doing a prostate removal for cancer, mm-hmm<affirmative> we have to try to identify where those nerves are and not use any heat energy, because they're very delicate.

Speaker 3 16:39

Oh my

Speaker 2 16:40

Gosh. It's like trying to delicately take a piece of wet tissue paper. Yeah. You know, and slide it off, you know, a, a plate that's where it got stuck to it without tearing the, the toilet paper or the, you know, the tissue paper. Oh my, that was the worst

Speaker 3 16:54

Analogy. It was terrible.

Speaker 2 16:55

I really need to think of better analogies.

Speaker 3 16:57

You do. Cuz I couldn't visualize that<laugh>

Speaker 2 16:59

Yes, because maybe wet paper towels don't adhere commonly place.

Speaker 3 17:04

You just pull a wet paper, towel off a plate, maybe like a bamboo cutting board. That's a better

Speaker 2 17:09

Excellent.

Speaker 3 17:10

You cannot

Speaker 2 17:11

Maybe only in your house, but, but because of the location of the prostate mm-hmm,<affirmative> removing, it can cause nerve damage that affects your erections as well as your linter. Another part is that

Speaker 3 17:25

It's those nerves,

Speaker 2 17:26

Those nerves that

Speaker 3 17:27

Are the issue

Speaker 2 17:28

That, that, that are the issue of the prostate. And so, and then, so it's not the prostate itself losing that. And so that's why it's possible to remove your prostate and still keep your erections and keep your cotton younger.

Speaker 3 17:37

So you better have a good surgeon is what you, the

Speaker 2 17:39

Younger you are absolutely. The younger you are, the more likely you are able to keep those functions. Mm-hmm<affirmative> and if you have a really, really big prostate, like a huge roadblock inside your body, then your body got used to that huge roadblock being there. Right? So your Spiner might be lazy. It's like, well, I'm Mr. Spiner. I, I don't already work that hard. That big Boulder of a prostate's gonna slow the urine down before it gets to me. Anyway, then you remove the big Boulder and the Spiner's like, oh my God,

Speaker 3 18:03

What

Speaker 2 18:03

Do I do now? What do I do now? I gotta work.

Speaker 3 18:05

Lazy spank turned into hardworking Fier. And so that sounds like a band from the eighties.

Speaker 2 18:10

That's why lazy Fier.<laugh> it's going to join the seminal vesicles playing this Saturday at your local high school. That's right. Donna. Tell people about our practice.

Speaker 3 18:19

You can, uh, listen to our podcast wherever you listen to free podcasts and you can email us at Armour men's health@gmail.com. We are all over the place in round rock, north, south in your big Springs. We look forward to hearing from

Speaker 1 18:31

You. The armor men's health hour is brought to you by urology specialist for questions, or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at arm men's health.com.