Retrograde Ejaculation: Preserving All Aspects of Sexual Function with BPH Surgeries

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 answer a detailed listener question about retrograde ejaculation: "Good afternoon...I live in Seattle. I'm a growing fan of the Armor Men's Health Hour. I also suffer from BPH. I received your email address from one of your colleagues. I understand the retrograde ejaculation is a common and often irreversible complication from Terp, Greenlight, PVP, HoLEP, etc., and other non MIST BPH surgeries. What causes RE in such surgeries? Is it purposeful resection, vaporization ablation of, or damage to the 1) bladder, neck, smooth muscles, namely the internal sphincter, internal sphincter. And/or 2) ejaculatory ducks and atypical tissue in around, and beneath the same as a follow-up question. Why don't more urologist offer ejaculation preserving options across such more invasive surgeries, particularly those for patients who are poised to quote unquote trade-offs some BPH, LUTs efficacy for antegrade preservation?" Dr. Mistry goes into detail explaining each of these surgical options and the reasons why many men are distressed by the lack of "show" after orgasm. If you or a loved one has BPH and is interested in avoiding retrograde ejaculation, please call us today and we'll take care of you!

This episode was previously aired on Nov. 14, 2020. 

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.

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Transcript

Speaker 1: Welcome back 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 cohost, Donna Lee.
Donna Lee: That's right! Hello. You sound especially silky today.
Dr. Mistry: I do like to hear to my voice on the radio. I'm a board certified urologist, and this is a men's health show. This show is brought to you by NAU Urology Specialists, the urology group that I started in 2007, and now have grown to the second largest urology group in Austin.
Donna Lee: We try a little harder. We do a little better. We're a little cuter.
Dr. Mistry: That's right. We did try a little harder. We have four offices throughout Austin. We have four physician partners. We have five mid-level providers. We have two physical therapists, a sex therapist, and overwhelmingly a commitment to your global health.
Donna Lee: That's right. Even during a pandemic. Pandemic or not, we're here for you!
Dr. Mistry: That's right. We are seeing patients. We are trying our best to see patients in a safe way. We will see you by telemedicine, even if you're a new patient. We will try to handle your lab reviews and other things like that remotely, and try to use electronic communication to the best of our abilities.
Donna Lee: Can you figure that out?
Dr. Mistry: Yeah, we're trying.
Donna Lee: Can you figure out the Zoom?
Dr. Mistry: We're trying. We're trying. We have to use a medically confidential compliant system to do our telemedicine, but we also do them over the phone. We clean the office down hourly in the waiting room, and after every patient in the rooms. We have mask wearing that we require here in the office , uh, as required by the Texas medical board. And I think that we can see you safely and we look forward to helping take care of your urologic issues.
Donna Lee: You know, I went to HEB the other day, the grocery store and the guy I brought my own bags. Because I think it's time to bring back your own recyclable bags. Right? The little cashier guy was upset. I mean the bagger, he was like, "I don't want to touch these bags." And I thought, "Have you seen the stuff that people are touching in the store that you're touching when you put it in the plastic bag? It's time to move forward." Is that not medically sound advice?
Dr. Mistry: I don't think so.
Donna Lee: Bring your own bags. It's ok.
Dr. Mistry: Oh my goodness. This week I had a wonderful ego boost, which was nice.
Donna Lee: Ooh, tell me, tell me.
Dr. Mistry: One of the other urologists in town, who's not a part of our group came to tell me that one of her patients said , "Have you heard this guy on the radio? He's a genius."
Donna Lee: And his co-host is pretty funny.
Dr. Mistry: She did not mean it like a compliment.
Donna Lee: That's funny.
Dr. Mistry: She goes, "You take care of him!" I was like, "Oh, I'm happy to. Send me his name." She gave me the name. I'll take care of...
Donna Lee: Did that person tell you, was it a funny story for that urologist?
Dr. Mistry: A funny story for her? No, it's not. She felt like she didn't want to be told what to do, how to do her job.
Donna Lee: Oh, "Dr. Mistry said I need to do this. So prescribe that!"
Dr. Mistry: Well thank you so much, and for those of you out there that can do that again, please. It does help my ego.
Donna Lee: Can we make a T-shirt that says,"Dr. Mistry said...!"
Dr. Mistry: Better than "Dr. Donna said...!"
Donna Lee: I am a doctor on the radio.
Dr. Mistry: I thought you'd like that one.
Donna Lee: Dr. Donna on the radio show.
Dr. Mistry: Well, it's your questions that keep this show going. We try to circulate what kind of topics we're talking about, but you know, we do see a general theme in a lot of the questions that we get asked. And it really helps drive a little bit of questioning and answering that we do with our own patients when we see unique questions. Donna has anybody have any questions for us?
Donna Lee: Yes. You know , we've had somebody reach out from Florida, somebody reached out from Seattle. So this particular one, I thought was super intriguing. We've discussed so many different options, but he kind of put it all in one big question: "Good afternoon. My name is Boop and I live in Seattle." So hello Boop from Seattle! "I'm a growing fan of the Armor Men's Health Hour. I also suffer from BPH . I received your email address from one of your colleagues." So that's interesting suggested podcast question slash topic. He would like to know. He says, "I understand the retrograde is a common and often irreversible complication from Terp, Greenlight, PVP, HoLEP, et cetera, and other non MIST BPH surgeries. What causes RE in such surgeries? Is it purposeful resection, vaporization ablation of, or damage to the 1) bladder, neck, smooth muscles, namely the internal sphincter, internal sphincter, sorry. And or 2) ejaculatory ducts and a typical tissue in around, and beneath the same as a follow-up question. Why don't more urologist offer ejaculation preserving options across such more invasive surgeries, particularly those for patients who are poised to quote unquote trade-offs some BPH, L UTs efficacy for antegrade preservation."
Dr. Mistry: It's fascinating to me.
Donna Lee: Did I say every word right?
Dr. Mistry: I'll tell you, watching you...
Donna Lee: Try to read the words?
Dr. Mistry: You really...it was nice to see you work so hard.
Donna Lee: I had to go into my...
Dr. Mistry: It's almost like seeing somebody do squats.
Donna Lee: It was like Lockhart High School, public school. I've catered down to that. I channeled it.
Dr. Mistry: What a great question. And , and you know why it's fascinating?
Donna Lee: Because h is words were so big?
Dr. Mistry: Because retrograde ejaculation, for urologists, like when you're learning how to be a urologist, it never even occurs to you that patients are going to care. It never even occurs to you.
Donna Lee: Until you're in practice?
Dr. Mistry: You're in practice and patients complain about it all the time. And when I was early in my career, I thought it was that it was not the fact that they couldn't see fluid coming out when they it or orgasm, I thought it was because they were having a stunted or stilted orgasm or a hypoorgasmia, which is something that we treat here. We've discussed it on previous topics. And if you suffer from that, we would love to help you take care of it because we have medicines and other things that we can do for it. But now I realize there are some guys that really, really, really find it off putting to have an orgasm and an ejaculate and no show.
Donna Lee: See, I'm okay with that.
Dr. Mistry: Well, I understand.
Donna Lee: It's less to clean.
Dr. Mistry: I think it's less to clean up. But when it comes to retrograde ejaculation, why does that happen after prostate surgery? It also happens after medications for an enlarged prostate. So the classic ones are Tamsulosin or Flomax, and also Silodosin or Rapaflo frequently cause retrograde ejcaultaion. And it is because of the relaxation of the bladder neck, which is a little circular sphincter. And we call it internal sphincter that lives above where the prostate is. And so when the fluid is emitted from the prostate, the bladder neck closes and because the bladder neck closes, the fluid only has one way out and that's the out the end of the penis. And that's, you know, it's important because that's how we have kids. That's what the prostate's there for, to help us reproduce and t o, you know, I guess, make people happy about their ejaculation. And so when you do a prostate surgery in which the bladder neck itself is disrupted, and that happens with Terp or the rotor Rooter, where we actually cut the bladder neck a s part of that procedure, it also happens with laser surgery. And it also happens in a surgery that I perform a lot in young men called the TWIP or trans urethral incision of the prostate. And it's not generally because of ejaculatory duct resection because we traditionally salvage or save the ejaculatory ducts when we operate. And we do that because that's t he, that's a landmark for where the urinary sphincter isn't because we don't want to make men incontinent after that surgery. We salvage that area and stay far away from that sphincter. So there are preserving procedures. The most classic one is the Urolift. In Urolift, we move the lateral lobes of the prostate out of the way of the prostate of the urethra. It allows you to urinate with more force, but it's not as effective as a Terp for some patients, but this is a great, you know, middle of the road solution for people that want to retain their antegrade ejaculate while having a reduction in their urinary symptoms. Another common procedure that is ejaculation sparing would be the resume procedure, Rezum. That's the, that's the steam vapor therapy where we use a little needle to inject into the prostate. And we do it quite a few here because we are very comfortable with in-office sedation.
Donna Lee: In the office, not KLBJ.
Dr. Mistry: Yeah, we don't do it at the radio station. And so , by using that steam therapy, it's also ejaculation sparing . And another one that we do very often in our practice is prostate artery embolization, something to getting increasing interest . We do regular webinars, so if you're interested in learning about prostate artery embolization, this is a procedure where we utilize the services of an interventional radiologist and they actually cut off the blood supply to the prostate by going through an artery, either in the arm or in the groin. Very commonly performed here in our area because of just kind of the interest that men have for not having anything put in their penis or not having any catheters and trying to preserve their ejaculation. It takes about an hour and a half for the procedure. The results are about 80% effective as a Rotor Rooter or Terp, but really only appropriate for larger prostates over 40 grams. Normal prostates a re about 30 grams.
Donna Lee: And that's a walnut?
Dr. Mistry: That's a walnut, or, you know, what's ever bigger than a walnut?
Donna Lee: A tennis ball?
Dr. Mistry: A tennis ball. No , it's too big.
Donna Lee: That's too big.
Dr. Mistry: But prostate or embolization really does work well in those tennis ball size or softball size prostates as well. So those are three options you have for ejaculation sparing treatments for BPH. What a wonderful question. And if you're out there wondering how we can have the least impact on your sexual function while treating your enlarged prostate, it's absolutely a topic that we take very seriously in our practice. And if you have those concerns , we'd love to take care of you.
Donna Lee: Right? And guess I was thinking, you know who would, who wished he would have had retrograde ejaculation?
Dr. Mistry: Who's that?
Donna Lee: President Clinton, right? You can call us during the week at (512) 238-0762 . You didn't expect that, did you?
Dr. Mistry: No I did not.
Donna Lee: You can email us, you can email us at armormenshealth@gmail.com. Our website is armormenshealth.com. Oh my goodness. We're in Round Rock, North Austin, South Austin, and Dripping Springs. That was fun. Thank you for that question.
Dr. Mistry: If you are , if you are calling us from far away and you want some advice , we do, you know , provide advice and telehealth services. So please feel free to call us for any such advice.
Donna Lee: Listen to our podcasts! Thank you.
Speaker 1: The Armor Men's Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.