More Holes, More Problems: Dr. Mistry Answers a Patient Question About Multiple TURPs and Chronic Pain Below the Belt - Armor Men’s Health (2022)

Donna Lee:

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762, or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.

Speaker 1:

Welcome 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 with my cohost and my partner in crime, Donna Lee.

Donna Lee:

I always wonder what you’re going to say after you say “my cohost and…”

Dr. Mistry:

Yes.

Donna Lee:

I’m always a little scared, because…

Dr. Mistry:

It’s always part of the…

Donna Lee:

…’tis I.

Dr. Mistry:

…part of the fear, really.

Donna Lee:

Or part of the mystery.

Dr. Mistry:

Part of the mystery. I am Dr. Mistry. This is the Armor Men’s Health Hour. This is a men’s health show, although we do talk about a lot of different topics that deal with both men and women type issues. I am a board certified urologist. Donna Lee is a board certified nut ball.

Donna Lee:

Maybe. To work with you, correct.

Dr. Mistry:

It would be really nice if we actually earned a actual award for this radio show, but we just keep finding more and more old awards that you just keep adding things to.

Donna Lee:

And I think we need to talk about the legitimacy. It is a legitimate award and we have given it to ourselves. So therefore we are an award winning podcast.

Dr. Mistry:

Well, I, you know, I think that it’s very important that you have your own degree of self-confidence.

Donna Lee:

And my label maker because I put “excellence in radio.” So there you go.

Dr. Mistry:

For those of you that have never heard this show, or don’t listen to us regularly, then shame on you. For those of you that take a real interest in men’s health, we just absolutely love providing this show to you. This is a practice that I started in 2007. Since we started practicing urology after I finished my training at Baylor college of medicine, and now we are up to four physicians in the practice, four physician assistants in the practice. And we have just a, what I think a very unique approach to urology, a more holistic approach, one in which we’re based on wellness, one in which we really try to achieve the right kind of treatment for you. And we love complicated, difficult things that you’ve had trouble getting your arms around because that’s exactly the kind of thing that we want to help you take care of.

Donna Lee:

And I love that we’re changing the narrative of urology because nobody thinks “holistic urology,” they think “urology equals surgery.” I think it’s great that you keep talking about this holistic approach and making people aware that it’s not all surgery. We’re going to fix you right up first.

Dr. Mistry:

That’s right. You know…

Donna Lee:

Maybe without surgery.

Dr. Mistry:

…getting you to think better is really our key. Your questions really drive this show. We’ve done over 300 individual segments for the radio.

Donna Lee:

The 300 podcasts. That’s gotta be the most men’s wellness podcast ever.

Dr. Mistry:

You wouldn’t think that we could talk about the same thing over and over again.

Donna Lee:

But we do!

Dr. Mistry:

That’s right.

Donna Lee:

You know why? Because all the questions are very similar, but that means there’s new listeners.

Dr. Mistry:

That’s right. And we really appreciate it. For those of you that have questions, please send us your questions. We really do appreciate the fact that we get so many patients coming just to see us and we’ll take care of you individually, when you come and make an appointment for our office. Your questions really are something that help other people answer difficult urologic type issues. Donna Lee, you want to tell people about our practice?

Donna Lee:

Yes, you can reach us all over central Texas. We are in Round Rock–that’s the main hub that Dr. Mistry opened 13 fabulous years ago. We’re in North Austin by Lakeline Mall. We’re also in South Austin, South Congress Avenue. And we’re also in Dripping Springs, which is super cute and lovely. Our phone number during the week is (512) 238-0762, and our website is armormenshealth.com. You can send your questions through that website or email us at armormenshealth@gmail.com. And I was laughing earlier that we had, we would have one or two questions in the beginning, remember? We were like, “What are we gonna talk about?” And now we get so many questions every week that we’re having to delay some of the questions.

Dr. Mistry:

Yes. I think that there are, they’re really great and really insightful. So why don’t we jump into one?

Donna Lee:

Let’s talk about this one. He sent it an in about a week ago: “Dr. Mistry, I have constant pain from the bladder through the prostate to the testicles. I’ve had two TURPs and other procedures in the past. I have been to several urologists recently and they tell me I need another TURP. I do not want to do that without solving the pain problems first. Help.”

Dr. Mistry:

It’s a great question. I think this listener was in his seventies and it looks like he’s had multiple different interventions for pain. For our listeners out there, I just like to say that it’s rare somebody has pain from an enlarged prostate. Those two don’t generally happen together. We do TURPs or surgery to open up…

Donna Lee:

What is a TURP?

Dr. Mistry:

A TURP is the trans urethral resection of the prostate. It’s also known colloquially as the “Rotor Rooter.” It’s essentially an instrument in which we remove tissue that is obstructing the bladder by removing the tissue by putting this instrument into the penis. Usually while you’re sleeping.

Donna Lee:

I hope so.

Dr. Mistry:

That’s right.

Donna Lee:

“Hey! I’m awake!”

Dr. Mistry:

Hello! And so it’s rare that pain is going to get improved by doing something like that. When we really think about what does pain, Is it caused by, it’s going to be either because you’re obstructed or blocked, or in this case, I think that this listener probably has something neurologic that could be leading to pain that goes from the bladder to the testicle, to the prostate or paraniem area. Fascinatingly is that these parts of our body are actually connected to one another. The pelvic floor, which is a muscle basket like support system supports all of our pelvic organs, and there are four holes in that basket. There are two holes that surround the tubes, the spermatic cords that go to our testicles. And there’s one hole that we pee from. And there’s one pole hole that we poop from. So if you have a problem with the muscular basket of our pelvic floor, any one of those four holes can give us the trouble. So we see people with bladder pain, prostate pain, urgency, people that have trouble with constipation or problems with loose stools and then testicular pain is something that we see all the time. So that’s a common area in which you can have pain in multiple different areas. So that’s how you can kind of connect your testicle to your prostate, to your bladder. Now, there are people that have stones, kidney stones that can have pain that, you know, that would be improved by surgery in some cases, but it’s rare to have what I would consider an obstructing prostate that can cause pain. There are things that we will do. You know, one of the things that we have in our office is a pelvic floor, physical therapist. Her name is Angela Treadway. We also have an incredible system of looking at inflammation, inflammatory markers, chronic prostititus, things that may respond to different kinds of medicine like Amitriptyline or Gabapentin. But I would absolutely not operate on something the third time if it didn’t work the first two times.

Donna Lee:

Right? Good point.

Dr. Mistry:

I think somebody once said the definition of insanity is doing the same thing over and over again and expecting a different result.

Donna Lee:

Well that’s just TURP insanity then.

Dr. Mistry:

That’s right. And if ultimately you see me and I think that a TURP is necessary, it’s not going to be because I have no other ideas. It’s going to be because there’s something obvious, like in the way that’s causing a problem, but in most cases, we’re going to try a nonsurgical approach to start with, and only pull the trigger on a surgical approach if we have no other, no other insight into what we can do for you.

Donna Lee:

Yeah. And it sounds like those other folks are just not listening to his request to address the pain.

Dr. Mistry:

Or, you know, urologists are a very smart little group of doctors.

Donna Lee:

But only if they went to Baylor.

Dr. Mistry:

It does help to go to Baylor College of Medicine. But, so I will say that if multiple doctors have recommended that a repeat TURP should be performed, then I have to assume that there’s something obvious, something obvious and anatomic, because most urologists probably wouldn’t try a third time to take care of a problem, unless there was an obvious anatomic thing in the way. And there can be things, I’ll give you a classic example that I’m kind of dealing with more and more often now, is people will have like a minimally invasive surgery, something called a Urolift or a Rezume things that work very well. But in some patients, it doesn’t work well on them. And so if those patients have a side effect or a problem and they have pain, then sometimes we have to go in and reverse what was done. I’d like to all of our listeners that everything works just rosy every time, but that’s not the case. And what you want in a surgeon is someone that’s going to listen to you, make sure that your, anytime things don’t go exactly as smoothly as you thought they would, that they listen to you. And we pride ourselves–if you get a surgery by us, whether it be a vasectomy or a prostate removal or a kidney stone problem, and you’re having a problem, the very first thing we tell you is, “Come right in and we’ll see you today,” because if you’re having a problem, I want to know immediately and I want my eyes and hands on that problem. And I want to either reassure you that everything is normal or find out about a problem early. And that is the philosophy that I think that we pride ourselves on in our practice.

Donna Lee:

For 13 years, ee’ve prided ourselves.

Dr. Mistry:

That’s right. It’s hard. It’s hard to do that. And it’s sometimes hard to maintain that level of care, but in the end, you know, I have to sleep at night. I want to make sure that the people that we take care of are…

Donna Lee:

Do you?

Dr. Mistry:

…I do have a lot of ideas. It’s hard to sleep sometimes.

Donna Lee:

And now you have a new whiteboard, so it’s all over for the rest of us.

Dr. Mistry:

That’s right. It’s my favorite thing, really, whiteboards.

Donna Lee:

If you have a gift in mind for Dr. Mistry, please make sure it’s a whiteboard. And by the way, Dr. Mistry is his real name.

Dr. Mistry:

That’s right. So…

Donna Lee:

It’s not a gimmick.

Dr. Mistry:

…if you think it’s just a gimmick, thank you for that person.

Donna Lee:

We can’t drop that. He’s called us gimmicky one time, a long time ago. And we’ve been talking about it ever since.

Dr. Mistry:

You know, we have this show and really put ourselves out there, then people kind of, you know, say things that hurt our feelings.

Donna Lee:

Yeah. We’re not gimmicky, I promise.

Dr. Mistry:

Why don’t you tell people how to get ahold of us?

Donna Lee:

You can call us during the week if you’d like that appointment or the second opinion at (512) 238-0762. You can even ask for me if you want to call our phone number, again (512) 238-0762. Google us. Our email address is armormenshealth@gmail.com, and the website is armormenshealth.com. So send us your questions. We really look forward to it. I’m going to make a new T-shirt that says “More holes, more problems.” We’ll be back.

:

Dr. Mistry wants to hear from you! Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.

Donna Lee: 0:00 The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762, or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject …

For questions during the week, call us at (512) 238-0762, or visit our website at armormenshealth.com.. Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.. This is a men’s health show, although we do talk about a lot of different topics that deal with both men and women type issues.. For those of you that take a real interest in men’s health, we just absolutely love providing this show to you.. And we love complicated, difficult things that you’ve had trouble getting your arms around because that’s exactly the kind of thing that we want to help you take care of.. That’s gotta be the most men’s wellness podcast ever.. You wouldn’t think that we could talk about the same thing over and over again.. Donna Lee, you want to tell people about our practice?. We were like, “What are we gonna talk about?” And now we get so many questions every week that we’re having to delay some of the questions.. Mistry, I have constant pain from the bladder through the prostate to the testicles.. So we see people with bladder pain, prostate pain, urgency, people that have trouble with constipation or problems with loose stools and then testicular pain is something that we see all the time.. He’s called us gimmicky one time, a long time ago.. You know, we have this show and really put ourselves out there, then people kind of, you know, say things that hurt our feelings.

Chronic pain lasts months or years and interferes with your daily activities. Treatment includes medications, therapies and lifestyle changes.

Where your pain is.. Your healthcare provider may physically examine your body and order tests to look for the cause of the pain.. The cause of your pain, if known.. If you have chronic pain and depression and/or anxiety, it’s important to seek treatment for your mental health condition(s) as well.. Your healthcare provider may recommend certain medications to relieve chronic pain, including:. Other medical treatments your healthcare provider may have you try include:. Complications from medical treatments for chronic pain can include:. Exercise can also be a stress reliever for some people, which is important to manage when you have chronic pain.. Certain therapies may help you manage chronic pain, including:. Since many conditions or injuries can cause chronic pain, there are several risk factors for experiencing it.

Learn about this procedure used to treat urinary problems caused by an enlarged prostate gland.

As men age, the prostate gland can grow larger, a condition known as benign prostatic hyperplasia (BPH).. This can lead to uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder.. Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.. The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.. TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:. Frequent, urgent need to urinate Difficulty starting urination Slow (prolonged) urination Increased frequency of urination at night Stopping and starting again while urinating The feeling you can't completely empty your bladder Urinary tract infections. TURP might also be done to treat or prevent complications due to blocked urine flow, such as:. Recurring urinary tract infections Kidney or bladder damage Inability to control urination or an inability to urinate at all Bladder stones Blood in your urine. Until you can urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.. In transurethral resection of the prostate (TURP), a combined visual and surgical instrument (resectoscope) is inserted through the urethra where it's surrounded by prostate tissue.. An electrical loop cuts away excess prostate tissue to improve urine flow.. Contact your doctor if the blood in your urine is thick like ketchup, bleeding appears to be worsening or your urine flow is blocked.. Are unable to urinate Notice bright red blood or an increase in clots in your urine Notice that your urine isn't becoming more clear after drinking more fluid and resting for 24 hours Develop a fever above 100.4 degrees F (38C)

Understand difficulty walking symptoms, including 10 causes & common questions.

Walking is a complex interplay between multiple systems of the body; the nervous system, musculoskeletal system and cardiovascular system are all necessary for the control of walking.. Multiple conditions can affect the peripheral nervous system without affecting the central nervous system and result in gait abnormalities and associated symptoms.. These mechanical causes can affect how you walk and result in associated walking difficulty symptoms.. Autoimmune: Many inflammatory diseases that result in the body attacking itself can also affect the nerves and muscles and cause injuries that result in gait abnormalities.. Top Symptoms: lower back pain, back pain that shoots down the leg, back pain that shoots to the butt, difficulty walking, thigh pain. Top Symptoms: pain in one shoulder, spontaneous shoulder pain, pain that radiates down arm, pain in the back of the neck, severe shoulder pain. Symptoms that never occur with peripheral arterial disease (pad): calf pain from an injury, thigh pain from an injury

What is complex regional pain syndrome? What are typical symptoms of CRPS? What causes CRPS? How is CRPS diagnosed? How is CRPS treated? What research is currently being done on CRPS?

In some people the nerve injury is obvious but in others a specialist may be needed to locate and treat the injury.. Changes in skin temperature, skin color, or swelling of the affected limb.. In CRPS-affected limbs, bones that receive signals from the damaged nerves rarely become affected.. Nerve specialists help locate the injured nerve by mapping the sensory changes on the skin.. Psychological treatment helps people with CRPS to feel better and better recover from CRPS.. Drugs often used to treat CRPS include:. Acetaminophen to reduce pain associated with inflammation and bone and joint involvement.. Rarely used former treatments include:. Cutting injured nerves or nerve roots.. People with CRPS often ask if cutting the damaged nerve above the site of injury would end the pain.. For more information, see the HEAL Initiative .

Around 95% of BPH patients still get TURP surgery. This is because it is still one of the most effective and affordable BPH surgeries available.

Transurethral Resection of the Prostate or TURP is a minimally invasive surgical procedure that is performed for the treatment of abnormal growth in the prostate gland.. The procedure is performed using a resectoscope.. Instead, BPH usually causes urinary discomfort and dysfunction by compressing the urethra.. Hence, when the prostate doctor removes the extra part of the enlarged prostate gland, it relieves the urethra and restores urinary function.. TURP is usually the first treatment a surgeon recommends if your symptoms are not being relieved via medicines and other non-surgical management techniques.. The most effective treatments of BPH are medical management and surgery.. In most cases, the decision of choosing between medical management and surgery is taken out of the patient’s hands depending on the severity of the condition and their symptoms.. Even among the different surgeries for BPH, TURP is still considered to be the gold standard because it is effective and has a fast recovery.. Surgery: Once the inspection is complete, the surgeon will insert a resectoscope through the urethra and cut excess part of the prostate.. The surgery takes about 60-90 minutes and is performed under either general or spinal anesthesia, depending on the patient’s condition and the surgeon’s preference.. You may need a catheter for at least 1-2 weeks after the surgery, or at least until the swelling in the urethra has gone down.. Recovery is usually fast after TURP surgery as it is a minimally invasive procedure.. Make sure to complete your antibiotic course to prevent infection.. Avoid sex for at least 3-4 weeks to ensure the urethra is completely healed.. Around 95% of BPH patients still get TURP surgery, even with other treatment techniques available.

Treatment for benign prostate conditions, such as hyperplasia, can have many complications and an extensive recovery time. Learn more about it here.

During the procedure, surgeons remove the excess prostate tissue through the urethra.. Share on Pinterest To perform a transurethral resection of the prostate, a surgeon will insert a resectoscope into the urethra.. Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.. The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.. Possible but rare risks associated with TURP procedures include:. This is where too much of the fluid used for surgical flushing is absorbed by the body, leading to major electrolyte, fluid, and blood volume imbalances .. bleeding from the urethra, outer prostate, or penis inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery blood in the urine that is severe or lasts longer than 4 to 6 weeks severe clots of blood in urine or urine that is entirely red weakness and fatigue that does not improve after 4 weeks impotence or erectile dysfunction difficulty ejaculating dizziness, shortness of breath, or confusion severe or intensifying abdominal pain or discomfort. Though TURP remains the commonly performed BPH surgery, several other procedures are available to treat BPH that may be more appropriate for some people or carry a lower risk of complications.. During TUIP procedures, the surgeon will insert a cystoscope into the urethra and widen the urethra by making tiny cuts in the prostate, and the area where the urethra connects to the bladder.. Many of the side effects, complications, and risks associated with TUIP are similar to those of TURP.. Many HoLEP surgeries also only require one night of hospitalization and catheter use.. But while the procedures have been shown to be better at reducing BPH symptoms than medications alone, they are not considered as good as TURP or TUIP surgeries.

Struggling with mechanical ventilation? Need to study? Here are a few multiple choice questions on mechanical ventilation. This can be useful for medical, nursing, physiotherapy, and respiratory therapy students.

Controlled Mandatory Ventilation. Controlled Mandatory Ventilation. Controlled Mandatory Ventilation. JR Krishna (author) from India on September 29, 2019:. JR Krishna (author) from India on September 25, 2015:. JR Krishna (author) from India on September 25, 2015:. I mean when we were (older generation) were students, we were taught is "controlled mechanical ventilation or "controlled mandatory ventilation.. JR Krishna (author) from India on September 16, 2013:

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