The Armor Men's Health Show
The Armor Men’s Health Show is what happens when a board-certified urologist and a stand-up comedian walk into a studio… and actually help people.
Hosted by Dr. Sandeep Mistry, founder of Urology Specialists of Austin, and professional, touring standup comedian, Donna Lee, this weekly podcast tackles the medical topics men care about… but don’t always want to Google in public.
We talk about all things men's wellness including the big stuff:
Erectile dysfunction.
Prostate cancer.
Low testosterone.
Enlarged prostate.
Fertility.
Kidney stones.
Vasectomies.
Yes. We go there. Boldly.
Dr. Mistry brings the medical expertise. Donna Lee brings the questions you’re slightly embarrassed to ask. Together, they make men’s health informative, approachable and occasionally hilarious. But it’s not just about anatomy — The Armor Men’s Health Show takes a holistic approach to wellness, covering nutrition, weight loss, sleep, sex therapy, pelvic floor physical therapy, and how all of it connects to living better (and longer). Also featured are top physicians and specialists from around Austin — from cardiology to endocrinology to orthopedics — because men’s health isn’t one-size-fits-all. If you like your medical advice credible, practical, and sprinkled with comedy, this is your show. Because taking care of yourself shouldn’t feel awkward. Unless we’re talking about a crooked body part. Then it’s a little awkward...but they can fix that.
The Armor Men's Health Show
EP 659: Dr. Smith on Why PAE is the BEST KEPT SECRET in Urology
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In this episode, Dr. Mistry and Donna Lee are joined by interventional radiologist Dr. Preston Smith of Summit IR to discuss Prostate Artery Embolization. PAE is a cutting-edge, minimally invasive, and mostly permanent treatment for an enlarged prostate (also known as BPH). The process of embolization shrinks the prostate by cutting off its blood supply by blocking an artery. Embolization is also used to treat a variety of conditions from uterine fibroids to arthritic knees--but it's not for everyone. Dr. Smith and Dr. Mistry explain why this procedure is amazingly safe and effective for patients who have been deemed good candidates for PAE. Tune in to learn more about how interventional radiology and whether PAE is right for you! Visit Summit IR online or call 512-828-4300 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
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Speaker 2Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.
Speaker 3Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery , your host, always joined by my co-host, Donnel Lee .
Speaker 4Hi. Welcome everybody. Welcome back to the Shoe .
Speaker 3This show is brought to you by NAU Urology Specialists, the urology company that I started in 2007. We have four offices. We have seven medical doctor providers. Mm-Hmm . And we have so much to offer our patients. Donna, how do people get ahold of us? That's
Speaker 4Right. You can call us to learn more about our providers at 5 1 2 2 3 8 0 7 6 2 and check out our website, armor men's health.com. Like Dr . Mystery said, we're all over the place. We're worldwide. Dr . Mystery,
Speaker 3Worldwide when it comes to men's health, prostate health and urinary health is a big deal.
Speaker 4It is a big deal.
Speaker 3And when men are confronted by BPH or enlarged prostate with urinary issues such as slow flow, urinary hesitancy, and problems with urgency Mm-Hmm. <affirmative> , they're given a a lot of different options. Yep . And if you have a urologist out there, or your primary care doctor is taking care of you, you may be given options. And so we'd love to talk about some options that we offer that are different. And we are gratefully joined by one of our amazing partners here, Dr. Preston Smith. Welcome Dr. Smith. Hey,
Speaker 5How you doing Preston ?
Speaker 3You're amazing. <laugh> .
Speaker 4So engaging right off the bat . <laugh> ,
Speaker 3He , he's so engaging. You know , uh, uh, interventional radiologists and urologists have a love-hate relationship. Do they? They do. Oh , because
Speaker 4They're both nodding. So that must be true
Speaker 3Because we need them to do things in the hospital. Mm . And oftentimes they don't do it.
Speaker 4Why? I don't know .
Speaker 3Why
Speaker 4Don't they do it, Dr. Smith?
Speaker 5Well, that's a, that's a whole, that's a whole long story that I don't want to get into right now.
Speaker 3<laugh> , there's a lot of like, jealousy on their part.
Speaker 4Oh, no.
Speaker 3Because urologists are good looking . Oh, smart. Oh, my
Speaker 4Intelligent didn't have big hands. Both.
Speaker 3And we have humongous hands. Oh boy . And luckily Preston was, you know, birthed with small hands.
Speaker 5<laugh>, you need small hands to do the fine, you know, the fine work that I do. You're
Speaker 4Saying he's a better doctor than you are, Dr . <inaudible> ?
Speaker 3No, no . Small hands.
Speaker 4<laugh>. He's more precise with this now.
Speaker 3Yeah , perhaps. Um, so interventional radiology is a field of medicine that does what Dr. Smith.
Speaker 5We do minimally invasive image-guided procedures, and many of them are replacements or alternatives to traditional open surgical techniques.
Speaker 3So, as we talk in our first segment about what you do , uh, perhaps you could tell me the breadth of all the different procedures that you offer within our practice to help patients improve their life.
Speaker 5So the two main ones that we do within this urology practice are prostate artery embolization and varicose embolization. And we do the, each of these procedures for several different things. Prostate embolization is most often used for shrinking down and large prostates and relieving the symptoms that they cause. And vari cil embolization is done for several reasons. Uh, first we do it for pain and maybe we wanna talk about what a vari CIL is in a little bit. Yeah . And then second we do them for fertility issues. Both of these are outpatient procedures. And we do both of them using live x-ray guidance, which is also called fluoroscopy.
Speaker 3So that's like what we do in urology. But we have more things that we do even in urology that you are a part of. So, biopsies of different lesions , uh, including lesions like lymph nodes. You can do biopsies of renal tumors and you can even cure kidney cancer. Is that right?
Speaker 5Yes, that's true. Instead of traditional nephrectomy or resection of a tumor that's in the kidney, we can put small needles inside of these tumors and then create what we like to call. 'cause it sounds really cool, is an ice ball and frees the tumors, more balls, they're everywhere. <laugh>.
Speaker 3So , um, as a surgeon, I love to cut. Why would a patient want not to be cut on? It seems odd to me .
Speaker 5<laugh> . Well, sometimes when you, when you cut, if it's just a small hole, it's, you know, it's no big deal. But if you're gonna remove a kidney, that's a , that's a bigger hole, you know , uh, many times or sometimes, whereas if we go into the kidney and then freeze the tumor, the holes I need to create are only as small as the needles we need to place inside the tumors. So they're, they're very small. Not even requiring a stitch , uh, once we pull the needles out.
Speaker 3Mainly because you can sew correct.
Speaker 5<laugh> ? Well, I've got these small hands. They're very good for sewing <laugh> .
Speaker 3And then sometimes patients come to us with , uh, masses on their kidney that they wanna know if it's cancer or not. And you're able to do a biopsy, correct? Mm-Hmm. <affirmative>, talk us through what that may look like for a patient.
Speaker 5So when patients are undergoing biopsies, they come to us for an outpatient procedure. So you don't have to go to a hospital to get this done. Typically, we can see these kidney lesions with one of two imaging modalities, either ultrasound or ct. Um, you can't typically see them with x-rays. And we don't do things under MRIs to the kidneys.
Speaker 3'cause they take you long to like process the images. Yeah.
Speaker 5It , it would be somewhat impractical. And then there's a whole, you can't use metal things inside of the MRIs. That's special needles.
Speaker 3Your needle's gonna fly away. Yeah. <laugh> . And so , um, beyond that we also do uterine fibroid embolization. Can you talk a little bit about
Speaker 5That? Yes. Uterine fibroids are benign tumors of the uterus that usually cause lots of bleeding during women's menstrual cycles and sometimes bleeding outside of the cycles. And then they can also grow large enough to where they kind of push on everything else in the pelvis. So that's the bladder, the bowels, sometimes the muscles of the back. And they can cause a lot of different issues. And if they get large enough, women are left with one of two options, either wait around for menopause to happen or get your whole uterus taken out. A lot of women don't like either of those options. So they'll come to us interventional radiologist and ask us to perform a uterine fibroid embolization, which is a procedure where we inject small plastic beads to block off the blood flow to the uterine fibroids and cause them to shrink down. And this will help relieve all of the symptoms that the fibroids cause again, most often bleeding and pain.
Speaker 3And so most of our listeners would also not know that a urologist or a interventional radiologist that is a part of a urology practice could take care of knee pain. Can you talk to me about knee pain?
Speaker 5Uh , yes. Knee pain, it's interventional radiology taking care of knee pain is, is coming in in vogue right now. Just like some of the other conditions we talked about. Traditionally, if you have very bad osteoarthritis of your knee, which is traditionally thought of as the wear and tear type arthritis, you can manage it with knee injections and some other, some other types of injections that are not , uh, the typical steroids that have been used. Or you can get a knee replacement. There's not like a middle option. Recently interventional radiologists have started embolizing or reducing the blood flow in areas where there is active inflammation due to osteoarthritis of the knee. And this is really good for people who may not be ready for a knee replacement or may not have enough cartilage damage to really warrant a knee replacement, but they still have very significant lifestyle limiting pain. So they're sort of stuck between a rock and a hard place.
Speaker 3And so for us , um, we talked a little bit about baric seal embolization. And so I send patients to you that are older, that have significant varicose seals. How do you explain to a patient what a varicose seal is? And then I'll do it.
Speaker 5So a varicose seal is, it's no different than a incompetent vein or a varicose vein, which is most often found in a patient's thigh. Often in the, the thigh of a , you know, a woman,
Speaker 3Those big blue veins that we see in the thigh and the calf.
Speaker 5And that vein that we see is usually the result of something deeper upstream. A vein that doesn't have working valves, allowing blood to kind of pool or drain flow in the wrong direction with gravity away from the heart with gravity. So I'll tell the patients that these ropey visible veins can be fixed by fixing the drainage problem, which is upstream.
Speaker 3And so in urology we see verica seals commonly in people with left-sided testicular pain, usually a dull ache with continuous standing or , uh, heavy lifting. And then we see it often in people with infertility. And so you can have it surgically repaired by an open incision and a microscope. And we love doing those and we do tons of them. Uh, but you do it in a minimally invasive way. How long does the procedure take
Speaker 5A unilateral vari cil embolization? I'll tell patients it's one of the simplest things that I do, you know, the common left sided embolization, because the incompetent vein almost always comes off of the left kidney vein. And if we approach it by getting into that vein from above, which is access in the main vein in the neck, it is almost a straight shot. So it'll take us like 30 minutes, quote unquote , from door to door when we start to, you know, start the clock for the, with the anesthesiologist to when we're rolling outta the
Speaker 3Room. That's amazing because it takes me , uh, two hours to do it. And uh, Donna, if people are interested in an interventional radiology or a minimally invasive technique for any of the conditions we talked about today, how do they get ahold of us? You
Speaker 4Can call us at (512) 238-0762 our website, armor men's health.com. Send Dr. Smith any questions you'd like and we'll answer them anonymously.
Speaker 3Hello and welcome to the Armor Men's Health Show. I'm Dr . Mystery , your host here as always with my wonderful, beautiful co-host Donnelley . Oh.
Speaker 4Oh , that's me. <laugh> . You're gonna say something else. Thank you. That's very nice.
Speaker 3I've decided to be nicer to you.
Speaker 4I like that approach. 'cause you've been mean to me for four years.
Speaker 3Yes. It's probably no longer going to get me anything because so many of our patients and so many of our listeners love you more than me. That's
Speaker 4Right. And you do need to be nicer to the love to one on the show. That's
Speaker 3Correct. That isn't . And so this show was started , uh, by my urology practice. NAU urology specialist , uh, started in 2007. Donna, how big are we?
Speaker 4We're so big. We're busting at the seams. And we need another office, Dr . Tory . That's how big we
Speaker 3Are. Size does matter. Sometimes it
Speaker 4Does matter. We're second largest, but now we're like really large . Second largest. The
Speaker 3Second largest urology practice in Austin.
Speaker 4That's right. It was a joke before. 'cause we had so few doctors, but now we have too many.
Speaker 3We have too many <laugh> . Uh, but we do have availability for you if you want to be seen. Um, and uh , Donna, how do people get ahold of us?
Speaker 4Call us during the week. Get 5 1 2 2 3 8 0 7 6 2 in our website, armor men's health.com where you can submit your questions. We'll answer them anonymously. And remember, we have podcasts wherever you listen to free podcasts.
Speaker 3What's nice about being big but not too big is that we're not owned by anybody. Mm-Hmm. <affirmative> . We have our own doctor led organization. Right. We really care about patients and their care and we're able to offer state-of-the-art cutting edge technology because I believe in it and our doctors believe in it. And we don't have to worry about a corporate overlord worrying about our decision making . That's
Speaker 4Right. And the big group doesn't have what we have.
Speaker 3Not yet.
Speaker 4That's right. We got Dr. Smith.
Speaker 3We got Dr. Smith. Dr. Preston Smith is joining us again. Uh, Dr. Smith, thanks for joining us today.
Speaker 5Anytime . So
Speaker 3I want to talk , uh, today about prostate artery embolization. So why don't you tell me your talk track or what you tell patients about what symptoms of BPH people can expect to get as they get older?
Speaker 5As you get older, and I know our listeners are, they are very well educated on BPH, but it is a process that we don't completely understand. We know it's testosterone related, and we know that this is at the root of causing the prostate to slowly grow as we enter middle age and later age , uh, later in life. And the prostate as it grows, will many times slowly kind of choke off the exit of urine from the bladder. And that will cause two things. One of them, you, you feel it right away. It's a weak stream or difficulty initiating urination. And then the other one, which is, is what I tell patients, the real problem is that they start holding on to more urine as it gets more difficult for them to urinate.
Speaker 3And that's called urinary retention. And urinary retention can cause urinary tract infections, bladder, stone , and even sometimes in drastic fashion. Renal failure. Mm-Hmm. <affirmative> . And so , um, most urologists offer many different ways of treating this and they can include terp , they can include aqua ablation, UroLift, rezum. You may have heard many different terms to fix BPH. And we offer within our office prostate artery embolization. Can you briefly talk about what are the benefits of PAE over traditional ways of dealing with BPH?
Speaker 5The benefit of PAE is best ex , I best try to explain it by comparing it to those nasal strips that let people breathe easier. You know, for years there were many different ways that people would try to fix their breathing through their nose. And it always involved blowing balloons up or putting tubes in or doing all kinds of things to the nostrils. And then some smart guy came and said, Hey, how about we put something on the outside of it to just kind of open things up a little bit. And you know, that that guy saved a lot of people because it's a lot easier and it required a lot less kind of , you know, stuff going inside of people's noses.
Speaker 3And in this nose and tr um , arena, you can actually go in there and scrape stuff out just like a turp .
Speaker 5Right, exactly.
Speaker 3And so , uh, in the same way you go , uh, arterially through the vasculature and try to cut off the blood flow to the prostate to shrink it. Mm-Hmm. <affirmative> . Um, what does the procedure look like for our patients?
Speaker 5It is, it , it is a, a an angiogram, which is a die study done with live X-ray, where we identify the arteries of the prostate. And then we slowly drip these small beads that are less than a millimeter in size into these arteries. And this chokes off most of the blood flow to the prostate gland without actually, you know, touching the gland physically. And patients undergo this as an outpatient procedure. So they'll come into our office, change clothes, roll back into our live X-ray room, which is called a cath lab, and then undergo this procedure. It takes about an hour and 10 minutes. And then they'll roll back out and recover for an hour. And then we'll get 'em up , make sure they're walking around. Okay. And then they can leave.
Speaker 3When can they expect improvement?
Speaker 510 to 14 days after the prostate embolization is the average time for noticing, usually it's first off improvement of urine flow or patients will describe it as things are things are loosening up and I'm able to pee a little easier. Um, and then a lot of the other symptoms which are that silent, you know, the silent symptoms we talked about earlier,
Speaker 3Urgency, frequency, nighttime peeing.
Speaker 5Yes. Tho those symptoms will begin to improve some somewhat right away with the improved flow. And then they'll continue to improve kind of as the bladder sort of regains its flexibility over the next several months.
Speaker 3And I tell patients that you have to wait about 12 weeks before to see maximum improvement. Mm-Hmm. <affirmative> , what do you tell them? Yes.
Speaker 5I I tell 'em the same thing. Just because it takes, the prostate will keep shrinking. Although its gains after, let's say eight weeks are not as much, whereas the bladder will keep regaining its flexibility all the way out to three months.
Speaker 3So then you have , uh, the lack of a need for a catheter. Correct?
Speaker 5Yes. It's a patient's favorite part about see .
Speaker 3So nothing in your peepee . Nothing. And that's amazing. And then in terms of sexual function , uh, what do you tell patients in what they can expect for a difference in sexual function?
Speaker 5Uh, some patients will actually notice that their sexual function improves. The number is somewhere around 15%. We don't quite understand exactly why this happens, but there are nerves that run along the outside of the prostate gland and through the prostate gland. And if those are left alone during any sort of intervention, then as the prostate shrinks, there is sometimes a chance for improvement.
Speaker 3So when somebody gets one of these and if it works, then they can get off their medications and if it doesn't work, does it interfere with any other procedures?
Speaker 5No, this is, it doesn't take anything else off the table. So I , I try to tell patients it's like going in and getting a haircut right before some really important event. Like let's say you're getting married and you're going to get a haircut the next day or , or the day before, you can always cut off a little more hair. But if you shave your head, you can't add that hair back on before the wedding. So
Speaker 3You're not married. Correct.
Speaker 5<laugh>? I'm <laugh> , I'm not. I've got long hair not, not cutting it. No
Speaker 4Small hands , long hair.
Speaker 3It's
Speaker 5Okay . It's a great company . He's not,
Speaker 3He's not, he's not Mary worthy. But , uh, that's okay .
Speaker 4That is not true.
Speaker 3It's because he is short.
Speaker 4Be nice to our doctors.
Speaker 3Anyway. Dr. Smith , uh, so when it comes to recovery, what do you tell your patients in terms of , uh,
Speaker 5Recovery? I tell them that it's going to, their only restrictions are two days of no heavy lifting. And then patients will also ask when they can resume any sort of sexual activity. And that's also two days of no heavy lifting. Wink wink. Yeah. Silly .
Speaker 4I feel bad. Two days
Speaker 3Just stay there. Right ? Just , just lie there. <laugh> .
Speaker 4Oh no. I could see a prescription pad going crazy with instructions.
Speaker 3And when it comes to payment for this, this is not a cash paste , uh, service that we offer many interest to pay for it. Uh , if somebody had to pay cash, what do we charge?
Speaker 5We charge, gosh, I think it's $12,001 million.
Speaker 4No ,
Speaker 3$1 million. Mm-Hmm .
Speaker 5<affirmative> , it's 12 , $12,000. Mm-Hmm.
Speaker 3<affirmative> . So that is what our cash pay price is because on this show we always talk about price. So you know what to expect and , but , uh, a lot of insurance pay for it , uh, which ones all
Speaker 5Of the major insurances except for Aetna will cover this procedure.
Speaker 4So patients just pay a copay? Yes. And they're just gonna have this amazing procedure and their lives are changed
Speaker 3And Medicare pays for it. Medicare. Right . Which is very important. And we also use this procedure to downsize a prostate. So if you have a humongous prostate, a normal one is 30 grams. If you have 120 gram prostate, we can downsize it and then maybe make you eligible for a less invasive procedure.
Speaker 5Yes. It, it works hand in hand with some of the other minimally invasive interventions that still go through the urethra or through the penis, but cause less issues afterwards. So it's, it's kind of like down staging cancer from a high stage to a low stage. We downstage your prostate , uh, to a smaller size.
Speaker 3What kind of diagnostic evaluation would you like to see before you do APAE on a patient?
Speaker 5Generally the one number I have to know is the size of the prostate clinic because
Speaker 3Really, really small prostates don't do
Speaker 5Well. They don't do as well. Yeah.
Speaker 3What is your ideal prostate size?
Speaker 5Greater than 50 grams is good. Greater than 40 grams is still still okay. Greater than 80 grams is really good. So if everyone had an above 80 gram prostate,
Speaker 4How big is an 80 gram? Is that a walnut?
Speaker 3It's like a tennis ball . Tennis ball .
Speaker 4Oh, that's big. Okay. Right .
Speaker 3It's a big prostate
Speaker 5Hundred. I forget what grapefruit is. It's like, like 160 or something.
Speaker 6That's a big grapefruit baby. That's it. Yeah .
Speaker 3Donna, how do people get ahold of us and how do people meet Dr. Smith?
Speaker 4You can call Dr. Smith at (512) 238-0762 and visit our website, armor men's health.com. Check out our podcasts wherever you listen to podcasts. Thanks Dr. Smith. Thanks Dr. Mistri .
Speaker 2The 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.