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 are joined by NAU Urology Specialists' partner, Dr. Christopher Yang. Dr. Yang spent an entire year training to perform penile prosthesis surgery for men with severe erectile dysfunction. In this segment, Dr. Mistry and Dr. Yang answer a listener's question on switching from a rigid penile prosthesis to an inflatable one after multiple back surgeries left him impotent. Dr. Yang explains that after having any penile prosthesis put in, other ED treatments like medication won't work. However, switching from a rigid implant to a malleable penile prosthesis is entirely possible for the majority of patients. This procedure is often covered by insurance and can usually be completed in 1-2 hours, sometimes as an outpatient surgery (depending on the patient's medical history/pain tolerance). Most importantly, we want patients with ED to know there are options for everyone to achieve a more fulfilling love life! Call us today with questions about the penile prosthesis surgery and other ED treatments available at our clinic.
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!
Round Rock Office 970 Hester’s Crossing Road Suite 101 Round Rock, TX 78681
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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, the very informative technologically savvy, some days, Donna Lee.
Donna Lee:
You know, if it wasn't for me, this stuff wouldn't be produced except for Sam.
Dr. Mistry:
And Kelly, and everybody else that helps us.
Donna Lee:
OK, but I make it happen on the front end. The people just don't know the magic that I provide.
Dr. Mistry:
You provide a lot of magic.
Donna Lee:
Mhmm. You're welcome.
Dr. Mistry:
This is a men's health show. This the armor men's health hour. We've been doing this show for about two years now, happily giving information to people in the Austin area, but also worldwide.
Donna Lee:
That's right. We have Dr. Worldwide and our partner, Dr. Worldwide, other Dr. Worldwide. You can hear our podcast everywhere. So we see that people listen in Europe and Asia and other countries.
Dr. Mistry:
Even Thailand.
Donna Lee:
Even Thailand, where my mommy lives.
Dr. Mistry:
This is a show that is dedicated towards helping men understand their health, as well as the health of their family. We try to give it in a very honest, straightforward manner. We use words that we would use with our own patients in the room.
Donna Lee:
Mhmm. Like yum-yums and ding-a-lings.
Dr. Mistry:
And try to make the mysticism of healthcare a little easier to grasp and something that more men are willing and able to talk about real sensitive issues with us.
Donna Lee:
Mysticism. Is that a word?
Dr. Mistry:
Well, because I'm Mistry.
Donna Lee:
Oh, M-I-S-T-R-Y.
Dr. Mistry:
How do people get ahold of us?
Donna Lee:
You can call us at(512) 238-0762. Our website is armormenshealth.com, where you can check out our podcast. You can also listen to our podcasts wherever you listen to free podcasts, they're everywhere, and they're amazingly informative. Send your questions anonymously--they will be answered on air--to armormenshealth@gmail.com.
Dr. Mistry:
If you've been listening for some time, you would know several things. Number one is I graduated from Baylor College of Medicine, which is the finest place to educate. Number two is that my name is really Dr. Mistry. Number three is that I'm really proud of the amazing practitioners that we have in the practice. Started in 2007, grown to four offices. With us today is one of our, our earliest partners, Dr. Christopher Yang. Thanks a lot for joining us today, Chris.
Dr. Yang:
Glad to be back.
Dr. Mistry:
Chris, for our listeners trained at UTMB, went to medical school at the university of Illinois in Chicago. Did I get those right? I got them wrong. I got it wrong.
Dr. Yang:
Yeah. But that's okay.
Dr. Mistry:
Give me the order.
Dr. Yang:
Yeah. So main thing is I did a fellowship in men's health, particularly specializing in erectile dysfunction, Peyronie's disease and other, you know, andrology type issues in Tampa.
Dr. Mistry:
So people wouldn't believe that you spent a whole year on ding-a-lings. Tell me what, what motivated you to do it. And then I really wanted you to come and discuss a very interesting patient question that we had today.
Dr. Yang:
Yeah, well, I thought it was a part of urology that, you know, a lot of people want to take care of the, the cancer and, you know, the things that definitely affect patients, but, you know, I wanted to help with some of the quality of life type issues. So definitely learned a lot when I did that extra training and, you know, glad to be helping patients here in Austin.
Dr. Mistry:
Now, the penile prosthesis was invented somewhere...I don't remember what medical institution was the penile prosthesis invented in?
Dr. Yang:
Actually, there were actually two.
Dr. Mistry:
Dammit.
Dr. Yang:
There's one of them called the Small-Carrion that was invented in Miami.
Donna Lee:
Small-Carrion on?
Dr. Mistry:
But nobody wants a Small-Carrion. They want a big Baylor.
Donna Lee:
Big-Carrion.
Dr. Yang:
Yeah. So then I guess the one that you're talking about is the inflatable prosthesis, which was, you know, some, some institution in Houston. I don't remember.
Dr. Mistry:
It's called Baylor College of Medicine. It's in Houston, Texas, and it's a pioneer of prosthetic surgery.
Donna Lee:
Oh, fun fact. Didn't, y'all go to the same high school.
Dr. Mistry:
We sure did.
Donna Lee:
That's right. But different years, like 10 years.
Dr. Yang:
Yeah, Mistry was a mysterious bully.
Dr. Mistry:
Mysterious bully.
Dr. Yang:
But yeah, these, these prosthesis were actually invented in the 1970s. So they've been around for quite a little while.
Dr. Mistry:
They preceded medication. There was a time in our, in our life where a guy reached a certain point, couldn't get an erection and then really didn't have anything for him. I actually read a book from the 1960s and the very first sentence on impotence said that the majority of patients with impotence, it's psychological. And now our whole approach to impotence is so different. It's vascular and neurologic, and there's some psychology.
Dr. Yang:
Yeah. There's definitely a psychosexual component.
Dr. Mistry:
And who wouldn't be psychologically affected by their lack of erection. So, but necessarily the cause I don't know. And so the idea of prosthetic surgery, what we do is we put in a actual foreign, silicone-type[ inaudible] object in the penis. Maybe you could describe the most common ways that's done, and then we'll ask that question that the patient has.
Dr. Yang:
Yeah. So basically if you think of the penis, you know, I think of the penis always as three long cylinders. I don't know how you think of it, Donna.
Dr. Mistry:
Not thin. Not thin.
Donna Lee:
There's just one. It's just one large cylinder.
Dr. Yang:
Well, inside of that one large cylinder, there's three--one of the urethra where you urinate through often, obviously. But there's two other cylinders called the Corpus cavernosum, and those are on the top. And those are the cylinders that fill up with blood when you get an erection. So when you can't get erection and those aren't getting full, and that's why you're not getting an erection.
Donna Lee:
Sounds like science.
Dr. Yang:
Yeah. Science. The way that these prostheses work is basically we put something in those cylinders that give you an erection. There's two main types. There's the one that came from the small carry on called a malleable prosthesis. These are cylinders that are always firm, but you could bend up and bend down.
Dr. Mistry:
We call them gumbies.
Dr. Yang:
Yeah, bend to whichever direction you want. The other type is the inflatable prosthesis, which is made somewhere, it was in invented somewhere in Houston, I think.
Dr. Mistry:
It's called the Texas Medical Center at Baylor College.
Dr. Yang:
[inaudible] Okay. Those are actually like balloons. So those you can inflate and deflate kind of like the old[inaudible].
Donna Lee:
Right. That's the one I see in, in the South Austin office. Right?
Dr. Yang:
Yeah. You see them all over the place.
Dr. Mistry:
So Donna, why don't you ask this question because really relates to these two different kinds of prostheses.
Donna Lee:
All right, Dr. Yang, this patient said,"I've had multiple back surgeries that have left me impotent and with very little feeling in my groin. I have a rigid implant that does not help. It bends when it needs to go straight. Before I got the implant, I tried the pills and injection, neither of which worked for me. Also, I have retrograde ejaculation due to a TURP. Now I'm considering a pump device. I've heard they can also help with length and girth. Can you help me?" And then he put PLEASE in all caps.
Dr. Mistry:
So I thought we'd talk about first, just, just briefly, just this mention of the fact that if you've had previous back surgeries and you have diminished sensation in the genital area, erectile dysfunction can be certainly something that follows that.
Dr. Yang:
Yeah. So number one, you know, we're pretty glad you don't live in the sixties where they would just say that it's due to psychology. But yeah. You know, definitely any sort of back surgery, back injury, if it affects the nerves that go to the penis, it can definitely affect sensation and make it tougher for you to get stimulation, which typically leads to, to erection.
Dr. Mistry:
So, so, you know, on a, on a, on another episode, I might talk about how diminished sensation erectile dysfunction is, is treated by us, but this guy's already got kind of, he's already further along in the process. So we can't go backwards and use all the old different techniques. He's already had what sounds like a malleable prosthesis. What should his expectations be if we were to switch him over to an inflatable prosthetic?
Dr. Yang:
Sure. So as far as the malleable prosthesis, well, if you have any prosthetic right now, there's no going back. So if we were to take it out, you know, nothing that we have available now, like medications is, is going to work anymore. But the idea is, you know, if we can switch it over to inflatable penile prosthesis, that should make it so that it's more comfortable when he's deflated and hopefully more rigid, more, more able to penetrate, you know, when he's inflated.
Dr. Mistry:
It'll feel more natural. And it's something that, that, you know, we can, we are able to do, right? We can go in and take those malleable prosthesis, prosthetic cylinders out and put in a three-piece inflatable prosthesis.
Dr. Yang:
Yeah. That's definitely something that's possible. You know, of course every patient is different. There may be some reason why it would be tough to, because the inflatable prosthesis does have a reservoir that needs to go somewhere above the scrotum, above the penis. So in very certain patients, that's not possible. But in general, yes, we could. We can upgrade the malleable.
Dr. Mistry:
In most patients, if they're a Medicare or a VA patient, the malleable prosthesis and the inflatable processes are covered by insurance, right?
Dr. Yang:
Yeah. There's a lot of insurance companies that cover these devices. It's definitely something that, you know, some plans specifically exclude, but that's something that our, our back office or, our team is very good at checking into or looking into.
Dr. Mistry:
Now we do things a little different than others in terms of how long patients stay and things like that. Why don't you just explain briefly, what can a patient expect in terms of how long the procedure is going to last and, and how long they'll stay in the hospital?
Dr. Yang:
Yeah. So typically the surgery itself takes about one to two hours. Sometimes it's done as an outpatient, meaning go on the same day. Sometimes we do it with one day, stay in the hospital. I tailor that to the individual patient, kind of how they feel, their level of pain tolerance and kind of their expectations, their goals.
Dr. Mistry:
I think that it's also important to note that your general medical history, you know, this is a really a lifestyle surgery. You need to have your diabetes under control. You need to have your cholesterol and your, and your high blood pressure under control.
Dr. Yang:
Exactly.
Dr. Mistry:
So don't be surprised or angry when we're like,"No, no, no, your blood sugar is 300. You can have a surgery that could potentially get infected."
Dr. Yang:
Yeah, yeah. That, that's definitely correct. Infection is the worst thing that can happen. But you know, if you think of this treatment compared to any other, it's the only way to fix the erectile dysfunction. Anything else, meaning the pills, injection, shockwave, all of that just kind of treats it, it just trying to glam over it. It tries to make it a little bit better, but doing the surgery actually fixes it.
Dr. Mistry:
It's an amazing insight from someone who's dedicated a year of their life to a penile prosthesis and implant surgery. If you are interested in getting the best care for your erectile dysfunction, we get a lot of questions for Peyronie's. Dr. Yang here trained specifically for, for Peyronie's treatment. If you are in interested in the best of men's health treatment, we would encourage you to come see us. Donna, how do people get ahold of us?
Donna Lee:
You can call us at(512) 238-0762. And check out our website armormenshealth.com.
Dr. Mistry:
Thanks a lot, Chris.
Speaker 1:
The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.