CredentialsPositions
Board Certifications
Education and Training
- Clinical Assistant Professor, Department of Urology at NYU Grossman Long Island School of Medicine
- Director, Minimally Invasive Urology, NYU Langone - Long Island
Board Certifications
- American Board of Urology - Urology, 2015
Education and Training
- MPH from St. John's University, 2019
- Residency, Univ Hosp of Brooklyn-SUNY Ctr, 2011
- MD from Tufts University, 2006
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's CATS's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seventy ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatzy. Good morning everyone, and
welcome again to CATS's Corner here onwr iHeartRadio. So glad you could join
(00:43):
us this morning. We have agreat show for you today and a topic
that comes up rather frequently, veryfrequently in our patient population, and that
is the management of patients with anenlarged prostate and men who have urinary symptoms.
And to help us with this,discs Gusha, I've asked a wonderful
colleague, a dear friend of minefor many years now, doctor Jeffrey Schiff,
(01:04):
who is Director of minimally Invasive Surgeryhere at nyu Land gone on Long
Island, and he's been in thepractice now for I guess about eleven years
or so and takes care of alarge volume of men, many men who
have urinary symptoms and using different typesof methodologies which we'll talk about today,
(01:26):
procedures both in the hospital and aswell some new outpatient procedures and the latest
and greatest in some medications and lifestylealterations. Good morning, Jeffrey, and
thank you for coming on the show. Really appreciate you taking the time.
Good morning, doctor Katz. Thanksagain for the opportunity. It's always a
pleasure to chat with you on theair and share what we're doing here.
(01:47):
Yeah, we are doing a lot. We certainly have seen you certainly take
care of many men each year andover the years continue to do that.
And I guess the first thing thatI would start out with is, well,
you know, are there any breakthroughsin this area? Are there are
there any new things that you foundbe you know, rather exciting to help
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man alleviate these very bothersome symptoms thatwe hear about all the time. There's
a lot of a lot of excitingthings and a lot of new things and
the field continues to evolve on.There's a lot of clinical trials ongoing,
one of which we have at ourfacility, which has some exciting initial early
results. But we're doing a lotof office based procedures, especially at our
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new eleven eleven Franklin Avenue, whichis our new kind of state of the
art facility, which is the oldSeers Building as we call it in New
York here on Long Island that's beenoverhauled and renovated as part of NYU,
which is again, like I said, a beautiful state of the art facility
that gives us the latest and greatesttechnologies and ability to comprehensively care for our
patients. But again there's a lotof new technologies, new office based procedures
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trial, like I said, oneof which we're part of. And there's
a new surgical procedure called aqua oblation, which has been really revolutionizing my practice
more recently over the last six tonine months. So that's been very exciting
the results of that as well.Well. That's good to hear because we
certainly men I don't know, itdoes seem to be quite bothersome, and
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we're certainly seeing more and more mencome to the office thankfully, because they
realize that these symptoms are bothering them, they're interfering with their sleep and even
throughout the day. And of courseyou probably see men that have these symptoms
maybe bleeding blood in the urine thatyou know, may not be just benign,
right, I mean, there maybe some underlying cancer there. Yeah,
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of course, So it's important youknow, on those initial visits and
even in follow of patients that weleave no stone and turn that we're always
kind of looking for for other thingsthat would certainly take things in a very
different direction. So we've been followingpatients for for a benign condition, We
certainly do urine tests, are askedthem about their urinary symptoms, if they're
stable, if there's if they're noticingany deterioration, any blood in the urine,
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and doing a blood test called PSA, which is our kind of best,
you know, initial baseline screening testto make sure we're not missing something
like prostate cancer, which again notcommonly but certainly can coincidentally or in and
of itself cause urinary symptoms. Soare always on the lookout for that.
So we're doing that or making surethat sort of thing is up to date
and not being overlooked. Yeah,you know it's interesting, right, Jeff.
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I mean we you and I haveeven in the field. I've obviously
been in the field longer, butyou started out. And we're going to
get into more detail about some ofthe newer, greatest things that you're doing
here at NYU. But some ofthem have stayed true too for the years,
like the urine test to make surethey don't have an infection, and
the PSA test, which still ispretty much the gold standard for screening prostate
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cancer. I know you do thatquite a bit and have. Incidentally,
as you mentioned, any people don'trealize they're coming in for urinary symptoms.
The next you know, your PSAis up, and then you tell them
what you need an MRI and abiopsy, and now you have cancer.
You probably see that quite a bit. Yeah, absolutely, It certainly can
take patients by surprise, and theneven certainly and fortunately more often than not,
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you know, the patients come inwith symptoms and concerned for prostly cancer
and you go, oh, no, listen, we've done some testing here
and we find out that that's notthe case. But loone, we hold
we have a diagnosis or condition benignenlargement or benign growth of the prostate or
BPH that we call it, whichyou know, in the absence of prostly
cancer, the prostate can certainly causeurinary bothers some symptoms and that we have
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you know again fortunately or in areassurance frame of mind, that that there's
nothing dangerous or worriesome going on,but we do have options for you if
these symptoms become bothersome enough to you, right, And so beyond the surgical
things that you'd said or new arethere is there anything new out there in
terms of medical treatment that patients canconsider. Sure, there's latest, you
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know, generations of the tried andtrue. There's medications called alpha blockers.
And if and when you know patientsare in the office, I try and
use some imagery to help them understandwhat it is that we're talking about in
terms of you know, the proseatekind of blocking the road or kind of
impinging on the outflow from the bladder. It sits like a doughnut you pass
urn through it, and everything isto go from kind of closure or enlargement
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of the project to kind of openthings up. So the medications are what's
called alpha blockers, and that there'syou know, the most common one that
patients might recall or recognize the nameis flomax or tamslosin, but there's been
you know, two successive alpha blockerssince tam solosin's come out, one called
alpha zosin or uroxytral and scilodosin,which is so called wrapaflow. So these
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are kind of the latest and greatest, you know, so called more specific
to the proseate with with less systemicside effects and maybe better well tolerated and
more potential for symptomatic improvement for patients. In addition, there's overactive bladder medications
so called beta agonists. These aremedications that have less side effects than are
tried and true overactive bladder medication.So for patients in the absence of an
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obstruction of their prostate might still havejust kind of overactivity, meaning they're bladder
just might squeeze more than more thanthe next guys, and we have medication
to kind of quiet that sensation,to maybe even get them some more RESTful
sleep or throughout the day. Andthese are medications called beta agonists that have
less side effects. So those aretwo of the newer ones on the market
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that are exciting to offer to ourpatients because some of the older tried and
true medications had somewhat prohibitive side effectsof dry mouth and constant pation and dry
eyes and other things that would seemnot something that patients are looking for,
So the newer ones don't have thatsame side effect profile. So those have
been a good thing for our patientsas well. Yeah, you know,
patients come to me all the time, as I'm sure they do to you
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about all the side effects of medication. There's always potential side effects right of
these things, and I think that'swhy a lot of patients don't want to
take the medicaid and they would rathergo to a minimally invasive procedure, you
know, where maybe they can justfix the problem with a minimally invasive procedure.
And I know that you're doing anumber of these things even in the
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office now, so that you know, maybe patients don't need the medication.
And of course there's costs, althoughfor the most part, as you mentioned,
some of the older medications like Flomaxand even your rock cotrol are probably
not overly expensive, but you know, there is certainly a cost, and
there is side effects every day,So how do you put that together,
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you know, with balancing you know, side effects of medications and then maybe
saying, you know what, maybeyou should forget about that and we have
a couple of treatments we can offer, you know. Yeah, and that's
exactly right, and I kind ofpresent it to that way to patients where
we have these minimally invasive options andthat they kind of compete with medication.
So we know from data that there'spretty reasonably high you know, a third
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of patients might discontinuation, might sorrymight discontinuation their medications after a year or
so. So despite us thinking thateverything's great with the patients, they may
or may not be taking their medication. So these office based procedures essentially there's
kind of two main players currently,one of which is called your Lift.
The other one is called Resume.These are office based procedures that are done
in the office. They take afew minutes and they just might be able
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to get you off your medication andhave kind of that same improvement of your
symptoms with little side effects and getyou off that medication, that daily medication
that needs to be taken ongoing,So I think that has an appeal,
and that's another you know, pitsome patients are not responding adequately, or
they don't want to take the medication, or they're experiencing adverse effects. Well,
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then the next step or the nextrung up the ladder is maybe one
of these office based procedures to eitherhelp those patients where they're not responding,
or patients there there are improving,but they don't really like the idea of
taking something ongoing, especially if they'rein their sixties or so, what's the
end game here? I've been takingthis ongoing for and you try and bring
them around and say one day ata time, but again, it certainly
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does feel like a long time ifthey're going to be on these medications long
term. Yeah, I mean,these are really incredible innovations, aren't they.
In technology used to be that everybodythat needed a prostate procedure would have
to be done in the hospital underanesthesia with a catheter for a long period
of time and other sexual side effects. And now you've had these two procedures
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you mentioned, one being eurolift,the other being the resume procedure, which
you're done in the office. Andyou know with minimal really just a local
anesthetic that I've seen that you use, which is remarkable with no significant bleeding,
very minimal time with a catheter,and reduced sexual side effects. Is
(10:46):
that what you're finding. Yeah,and it's really again revolutionized my practice,
and like you said, kind ofin the end of my training, just
having that kind of medication or somethingsurgical in the hospital with a multiple day
hospital stay and blood loss and thingslike that, things have really changed for
the better for patients, which isas exciting and comforting to offer them something
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that's not as potentially scary as whattheir parents had gone through or something like
that. So these are nice thingsto offer. And then interestingly, you
know, when we're doing a largevolume with patients, we get presented from
industry, you know, opportunities todo run clinical trials. So we're running
a clinical trial here called the Expandertwo trial, which is looking at a
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novel device. So it's a randomizedclinical trial for patients that are interested that
they can have a device called theeuro Cross, which is a night and
all I call it kind of acage or a spring that gets put inside
of patients for six months duration intotheir prostate kind of springs things open and
then six months later we take itout. So this is a new technology,
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a new company based in California who'slooking to see the efficacy of this
device, to see about, youknow, pursuing FDA approval again, another
third option kind of coming down thepike. And we've had some good initial
success and results with this new deviceat our hospital as well. So that's
another option again that is non permanent, which is again they're big selling point.
(12:13):
It's pretty exciting as well. Yeah, I mean that's terrific and good
luck with that. And if youare interested, by the way, and
if you just wake it up inthe morning here on Katsus Corner, we're
talking with doctor Jeffrey Shift, thedirector of minimally invasive Surgery here at the
NYU Lean Going Health System on LongIsland. And if you are interested in
a clinical trial or seeing doctor Shiftin consultation at the eleven eleven Franklin Avenue,
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which is you did mention, isa beautiful new center that opened up.
We're there about six months now.You can give them a call.
The number and I'll announce it againat the end of the show is five
to one six five three five nineteenhundred. Then number again is five to
one six five three five nineteen hundred, and certainly these are really exciting development.
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So maybe you can just briefly explainwhat these differences between the two procedures
that are currently if they approve theeurolift and the resume for our folks that
are listening in sure, sure,so rezume is using water vapor therapy,
so again using that whole analogy kindof from close to open being the simplest
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way to understand. So when weperform a resume procedure, we're injecting water
or heated water into the prosthetic tissuefrom the urethra, from the inside out,
if you will, and that's causingsome tissue changes and almost kind of
consecutive you know, divots, ifyou will, where you know, it
kind of widens that channel through changesof the tissue, and that procedure can
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be completed in under sixty seconds.Obviously, it's not that easy in that
the sense the patients have to recoverfrom it, but the procedure time in
the office is literally under sixty seconds, though it does take a few weeks
to kind of fully recover from theprocedure with short term frequency and urgency.
But then once they're out of theprocedure, there's no devices or implants or
anything left inside of the patient,So that carries some appeal for the patients
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in distinction to the eurolift, whichis a eclipse or implants that are kind
of put in, or some peoplehave equated it's kind of stapling back of
the tissue or pulling back of thecurtains, so we kind of push the
tissue back on the right, wepush it back on the left, and
then that kind of widens the insidechannel. So we can do these kind
of sequential implants put into the projectto kind of open things up, and
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that has a rapid recovery because we'renot heating the tissue and that's done in
the office. It takes just afew minutes to kind of clip things back
away, and it's using night andall and stainless seal and monofilament suture,
which is like a fishing line tokind of pull everything open. So it
has good tensile strength and has beenvery successful and really revolutionized my practice,
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you know, having done close toeight hundred these procedures with very good results.
For my patients. And those arethe two kind of the main stays
of treatment. And again this thirdone, which is under a clinical trial,
also has a lot of promise aswell. When you do these procedures
in your experience, what have youfound that what patients in terms of their
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symptom relief, Which symptoms that aremen having? They're presenting to you and
you say, you know what ifyou have this ural lift or the resume,
this is what you're going to feel. This is what you're going to
notice the most. Yeah, sowe do say that, you know,
some patients, you know, Ikind of present it fairly and say,
some patients go, I just havewhen I get up at night at around
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two o'clock in the morning, it'sjust a little bit slow. Do you
do you have anything for that?And you go, So they have very
specific set of symptoms symptoms, andI say that, you know, there's
these procedures are for the constellation ofsymptoms for frequency and urgency and weak stream
and getting up at night to goand a sensation of incomplete emptying. But
I have noticed profound improvement in youknow, even the nighttime. You know,
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patients get up, you know,three or four times a night,
and and I do set appropriate expectationsand say, listen, I think with
a successful procedure you'll get up oneto two times per night. So I
don't like to overp and say you'llget you know, nine hours of uninterrupted
sleep, but it'll be markedly improved. And again it's a big quality of
life improvement to go from three tofour to one to two. So and
patients do note that, and that'spretty consistent. They also notice less frequency
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and urgency and better ability to kindof hold back their urine and then not
going as often and even better emptyingfor that matter. So across the board
seeing pretty good improvement of the constellationof symptoms, Well, that's great.
I mean anything that it can prove, especially the night time thing, I
think because people wind up getting upa few times at night. Three four
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I've seen patient five times a night, and then I've had improvement with these
with the eurolift that you do.And as you mentioned, a quality of
life, you can't really overemphasize thatenough because people just get tired during the
day, they get irritable, they'rewaking up their spouse and that's not good
for a relationship. And then they'renot sleeping in the same bed. So
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you know, I don't I can'treally see all the listeners out there,
but I'm sure some of them arenodding their heads right now saying, yeah,
that's exactly what I have, DoctorKats, and I got to go
in and see doctor Shift to seeif I can't get this fixed, because
that is a difficult problem. Now, it's not always the sleep problem is
not always, as you know,right, Jeffrey, from the prostate,
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but many times it can be.I mean, it can be from other
things. Medications, diuretics, ifyou're a diabetic, Let's say, certainly,
how much what are you drinking beforeyou go to bed, If you're
drink drinking a lot of coffee ortea, or diet sodas during the day,
all these can can contribute. Butthrough your evaluations, when you find
that it is a prostate issue,that's you know, you know, pushing
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on the bladder and causing bladder overactivity, and you do these procedures, it
really is remarkable, isn't it.Yeah, absolutely, it's really. It
sounds trivial, but you get somereally satisfied patients and you know, some
genuine you know, thank you doctor. You know some really appreciative, grateful
patients that it's really made a significantimpact on their quality of life. So
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it's it's very rewarding in that sense. And when it hit the you know,
the papers and our journal and ourmeetings and our journals, it was
really these procedures were touted as youknow, they're minimally invasive and they'll relieve
the urinary symptoms and you won't havethat sexual side effect of that interference not
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only with the erection but with preservationof the ejaculation. Have you found that
in your experience. Yeah, Sothat's really one of the more main tipping
points or things for patients where again, a lot of the medications and a
lot of the the bigger procedure haveat more significant risk, and these minimally
invasive procedures seem to again your lifthas that as kind of a zero percent
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likelihood of ejaculatory dysfunction, which isquite compelling, and the resume is,
you know, less than five toten percent. So those are again pretty
good calls to action for paid whoare bothered by symptoms and or side effects
of their medications and looking for asolution that makes these highly appealing to patients.
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Yeah, I mean, you know, we're dealing with men usually in
their sixties seventies, but you know, I'm sure that you've taken care of
men and done this in their fifties. And it's not about that they need
to ejaculate for fertility, but itis the preservation of normal orgasm and normal
feelings and sensation, and it doesmean a lot to men and if they
don't have to give that up andcan have get a procedure in the office
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without going to the hospital. Andagain, it's not for everyone, and
we'll talk about another procedure that you'redoing for men with larger prostates in a
moment, but certainly it really canmake a big impact on men. So
terrific job. They're really great,and I'm glad that you're continuing to do
it. I mean, eight hundred. I didn't realize you were up to
eight hundred cases, so you probablyhave one of the largest experiences here on
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Long Island for sure, maybe evenin the metropolitan area. Great job there.
Let's talk about because we only haveprobably been a few minutes left.
But there's a newer procedure you mentionedit earlier, called the aqua ablation,
which is done in the hospital,is done under anesthesia. Maybe you could
tell us about that. Sure,So in presenting these options to my patients,
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we say, listen, we dohave a menu, I call it.
We have the medications, we havethese office spaceed procedures that we mentioned,
and then the latest and greatest issomething called the aqua ablation or kind
of water jet ablation of the prostatetissue. So the way I kind of
have tried to you know, there'ssome imagery on their website aquablation dot com,
but there's also an ability to kindof show that to patients or to
(20:40):
kind of imagine or explain it tothem where we're using a pressurized water jet
that's not heated, and I usethe analogy of kind of power washing the
deck or the house or the boatand kind of trying to clean out things
so that we can do an aquajet or an aqua ablation to the prostate
tissue. So what happens in thatscenario is it's under general anesthesia. So
again it's a bigger undertaking, butI do present a trailerly We say,
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listen, we have these office basedprocedures where you can get pretty significant improvement
of your symptoms without having to goto the hospital. But for the toughest
of cases or the bigger prostates,I think you need something more involved and
it's done in the hospital under anesthesia. It's called ocwelblation, and that what
we're going to do is kind ofdraw out a treatment plan we call it
so under ultrasound guidance. And thisis just trying to imply the precision that
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we're using as opposed to our priort rps that were terps that we used
to do. We're now shaping outthe project with this water jet that we
come up with a treatment plan underultrasound guidance to kind of preserve the bladder,
neck and the ejaculatory ducts which areimportant for continents and preservation of ejaculatory
(21:47):
functions. So now I have anew procedure which is similar to the older
procedures in its approach, but nowit's just that much more precise. And
what we do is we kind ofwater jet or remove all the tissue with
this pressurized water and that's it.And then so again with respect for these
anatomic structures, and then we keepthese patients off and overnight just for really
called twenty three hour observation, meaningyou're staying with us overnight just to be
(22:11):
watched and then we send them homein the morning. But this has had
also profound improvement for my patients andeven patients in retention, meaning patients who
really they come in with a catheter, they're really not able to go at
all. We can do this procedureand get them going on their own,
and patients who are actually advising youneed a catheter for life. I've done
(22:32):
a number of these procedures and gotthem off of a catheter. So it's
really again those quality of life thingsthat are we kind of take for granted
or we pooh pooh, but gettingsomebody to go again or getting them free
of the catheters is rewarding for patientand doctor alike. Yeah, it's really
fantastic and congratulations of getting that programup and running, and I know that
(22:53):
in the NYU Health system certainly they'vebeen doing them in the city and now
we have the advantage to do thisrobotic driven aqua oblation out here on Long
Island. Before we end the show, I just want to give everyone the
phone number again if you are interestedin seeing doctor Jeffrey Schiff, You certainly
can give them a call. Thenumber is five one six five three five
(23:18):
nineteen hundred. Five one six fivethree five nineteen hundred. If you were
a loved one has been you know, suffer, I would say suffering because
many many men do suffer from theseissues. And certainly if there's a concern
about in your urinary pattern, ifyou've had a change in urinary pattern,
you know, it's not always benign, as we were talking about earlier,
and so you should get tested andcome in to see the urologist. We
(23:42):
can do ultrasounds in our offices oneleven eleven right there. Check your bladder,
make sure you're emptying your bladder,do blood tests to make sure that
you don't have prostate cancer, numberone cancer in men. And certainly you
do need to be tested if youare, you know, having these symptoms
for certain and you know, sometimesit is just a urinary infection and that
(24:02):
could be, but it could bethat you're not emptying the bladder and you're
holding onto the urine. So andthat's really a great summary, and Jeffrey
really appreciate that in terms of youknow, I always have to ask you
because I'm always interested to hear ifthere's anything new in the area of supplements
and diet or vitamins or herbal things. And if there's nothing new, and
(24:26):
a patient says to you, theywant to take all of those things,
what are your thoughts about those Ioften refer to you as my diet and
supplement expert, just but knowing thatyour protocol and your fund of knowledge on
those things, I kind of say, listen. You know, patients often
come in, they have pictures thatthey bring a shopping bag full of supplements
that they're taking, and I applaudtheir efforts. And I've said, I
(24:48):
don't blame you. I don't knowspecifically, I don't endorse any particular supplement,
but if I listen, I thinkthat you know, oftentimes they're for
mild to mind. There's symptoms.I think, sure, yeah, saw
palmetto. There's some kind of commoningredients. I say, if you stay
up late at night on TV,you'll see certain advertisements, but these are
(25:10):
the common ones. Suit you knowthat that they all have some kind of
saw palmetto or selenium or other thingsthat might be helpful for symptoms and pumpkin
seed. But I don't particularly endorseanyone, but I think, you know,
patients find improvement, and then I'mall for it. Yeah, yeah,
no, I agree with you.And one of the things that we
do in our office is we havepatients fill out a questionnaire it's called the
(25:33):
ips S score, the International ProstateSymptom Index Score, which gives us an
idea of the patients are having mild, moderate, or severe symptoms and if
they're very mild, I have hadsuccess, let's say with patients staying on
herbal things. Is it a placebomaybe, but you know, patients seem
to be enjoying it, as someof the patients say they do have a
(25:56):
better flow with it. So,but if they're only mild symptom in that
small category, but I do agreewith you that majority of these patients are
coming to us because they're not mild. They are more significant. And thankfully,
as you've very nicely outlined for ustoday and really appreciate that, there
are lots of options. There's medications, and there's these new minimum invasive treatment
(26:17):
options including the eurolift which you've doneeight hundred on now, the rezume and
the aqua ablation. So again thatnumber is five one six five three five
nineteen hundred if you want to seedoctor Jeffrey Shift, the director of minimally
invasive Surgery at the NYU Land GoingHealth System on Long Island. Jeffrey,
thank you so much for coming onthe show. Sorry, that's it.
We probably could go on for anotherhour or so, but really appreciate you
(26:41):
coming on and educating all of usthis morning. Thank you for the opportunity.
Enjoy your the rest of your weekend. Sure thing you as well.
Well, that's the end of theshow. Everyone tune in every Sunday here
on Katz's Corner. We'll be backnext week with a great show for you.
This is doctor Aaron Katz. You'vebeen listening to Katzer's Corner. Come
back every week to hear more greattalk on a wide range of men's health
(27:02):
topics and advice on how to liveyour healthiest life. The proceeding was a
paid podcast. iHeartRadio's hosting of thispodcast constitutes neither an endorsement of the products
offered or the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's CATS's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seventy ten WOOR. It's theChairman of Urology at NYU Land Going Hospital,
Long Island. Here is doctor AaronKatzy. Good morning everyone, and
welcome again to CATS's Corner here onwr iHeartRadio. So glad you could join
(00:43):
us this morning. We have agreat show for you today and a topic
that comes up rather frequently, veryfrequently in our patient population, and that
is the management of patients with anenlarged prostate and men who have urinary symptoms.
And to help us with this,discs Gusha, I've asked a wonderful
colleague, a dear friend of minefor many years now, doctor Jeffrey Schiff,
(01:04):
who is Director of minimally Invasive Surgeryhere at nyu Land gone on Long
Island, and he's been in thepractice now for I guess about eleven years
or so and takes care of alarge volume of men, many men who
have urinary symptoms and using different typesof methodologies which we'll talk about today,
(01:26):
procedures both in the hospital and aswell some new outpatient procedures and the latest
and greatest in some medications and lifestylealterations. Good morning, Jeffrey, and
thank you for coming on the show. Really appreciate you taking the time.
Good morning, doctor Katz. Thanksagain for the opportunity. It's always a
pleasure to chat with you on theair and share what we're doing here.
(01:47):
Yeah, we are doing a lot. We certainly have seen you certainly take
care of many men each year andover the years continue to do that.
And I guess the first thing thatI would start out with is, well,
you know, are there any breakthroughsin this area? Are there are
there any new things that you foundbe you know, rather exciting to help
(02:09):
man alleviate these very bothersome symptoms thatwe hear about all the time. There's
a lot of a lot of excitingthings and a lot of new things and
the field continues to evolve on.There's a lot of clinical trials ongoing,
one of which we have at ourfacility, which has some exciting initial early
results. But we're doing a lotof office based procedures, especially at our
(02:34):
new eleven eleven Franklin Avenue, whichis our new kind of state of the
art facility, which is the oldSeers Building as we call it in New
York here on Long Island that's beenoverhauled and renovated as part of NYU,
which is again, like I said, a beautiful state of the art facility
that gives us the latest and greatesttechnologies and ability to comprehensively care for our
patients. But again there's a lotof new technologies, new office based procedures
(03:00):
trial, like I said, oneof which we're part of. And there's
a new surgical procedure called aqua oblation, which has been really revolutionizing my practice
more recently over the last six tonine months. So that's been very exciting
the results of that as well.Well. That's good to hear because we
certainly men I don't know, itdoes seem to be quite bothersome, and
(03:21):
we're certainly seeing more and more mencome to the office thankfully, because they
realize that these symptoms are bothering them, they're interfering with their sleep and even
throughout the day. And of courseyou probably see men that have these symptoms
maybe bleeding blood in the urine thatyou know, may not be just benign,
right, I mean, there maybe some underlying cancer there. Yeah,
(03:44):
of course, So it's important youknow, on those initial visits and
even in follow of patients that weleave no stone and turn that we're always
kind of looking for for other thingsthat would certainly take things in a very
different direction. So we've been followingpatients for for a benign condition, We
certainly do urine tests, are askedthem about their urinary symptoms, if they're
stable, if there's if they're noticingany deterioration, any blood in the urine,
(04:06):
and doing a blood test called PSA, which is our kind of best,
you know, initial baseline screening testto make sure we're not missing something
like prostate cancer, which again notcommonly but certainly can coincidentally or in and
of itself cause urinary symptoms. Soare always on the lookout for that.
So we're doing that or making surethat sort of thing is up to date
and not being overlooked. Yeah,you know it's interesting, right, Jeff.
(04:28):
I mean we you and I haveeven in the field. I've obviously
been in the field longer, butyou started out. And we're going to
get into more detail about some ofthe newer, greatest things that you're doing
here at NYU. But some ofthem have stayed true too for the years,
like the urine test to make surethey don't have an infection, and
the PSA test, which still ispretty much the gold standard for screening prostate
(04:51):
cancer. I know you do thatquite a bit and have. Incidentally,
as you mentioned, any people don'trealize they're coming in for urinary symptoms.
The next you know, your PSAis up, and then you tell them
what you need an MRI and abiopsy, and now you have cancer.
You probably see that quite a bit. Yeah, absolutely, It certainly can
take patients by surprise, and theneven certainly and fortunately more often than not,
(05:13):
you know, the patients come inwith symptoms and concerned for prostly cancer
and you go, oh, no, listen, we've done some testing here
and we find out that that's notthe case. But loone, we hold
we have a diagnosis or condition benignenlargement or benign growth of the prostate or
BPH that we call it, whichyou know, in the absence of prostly
cancer, the prostate can certainly causeurinary bothers some symptoms and that we have
(05:34):
you know again fortunately or in areassurance frame of mind, that that there's
nothing dangerous or worriesome going on,but we do have options for you if
these symptoms become bothersome enough to you, right, And so beyond the surgical
things that you'd said or new arethere is there anything new out there in
terms of medical treatment that patients canconsider. Sure, there's latest, you
(06:01):
know, generations of the tried andtrue. There's medications called alpha blockers.
And if and when you know patientsare in the office, I try and
use some imagery to help them understandwhat it is that we're talking about in
terms of you know, the proseatekind of blocking the road or kind of
impinging on the outflow from the bladder. It sits like a doughnut you pass
urn through it, and everything isto go from kind of closure or enlargement
(06:23):
of the project to kind of openthings up. So the medications are what's
called alpha blockers, and that there'syou know, the most common one that
patients might recall or recognize the nameis flomax or tamslosin, but there's been
you know, two successive alpha blockerssince tam solosin's come out, one called
alpha zosin or uroxytral and scilodosin,which is so called wrapaflow. So these
(06:44):
are kind of the latest and greatest, you know, so called more specific
to the proseate with with less systemicside effects and maybe better well tolerated and
more potential for symptomatic improvement for patients. In addition, there's overactive bladder medications
so called beta agonists. These aremedications that have less side effects than are
tried and true overactive bladder medication.So for patients in the absence of an
(07:08):
obstruction of their prostate might still havejust kind of overactivity, meaning they're bladder
just might squeeze more than more thanthe next guys, and we have medication
to kind of quiet that sensation,to maybe even get them some more RESTful
sleep or throughout the day. Andthese are medications called beta agonists that have
less side effects. So those aretwo of the newer ones on the market
(07:28):
that are exciting to offer to ourpatients because some of the older tried and
true medications had somewhat prohibitive side effectsof dry mouth and constant pation and dry
eyes and other things that would seemnot something that patients are looking for,
So the newer ones don't have thatsame side effect profile. So those have
been a good thing for our patientsas well. Yeah, you know,
patients come to me all the time, as I'm sure they do to you
(07:49):
about all the side effects of medication. There's always potential side effects right of
these things, and I think that'swhy a lot of patients don't want to
take the medicaid and they would rathergo to a minimally invasive procedure, you
know, where maybe they can justfix the problem with a minimally invasive procedure.
And I know that you're doing anumber of these things even in the
(08:11):
office now, so that you know, maybe patients don't need the medication.
And of course there's costs, althoughfor the most part, as you mentioned,
some of the older medications like Flomaxand even your rock cotrol are probably
not overly expensive, but you know, there is certainly a cost, and
there is side effects every day,So how do you put that together,
(08:33):
you know, with balancing you know, side effects of medications and then maybe
saying, you know what, maybeyou should forget about that and we have
a couple of treatments we can offer, you know. Yeah, and that's
exactly right, and I kind ofpresent it to that way to patients where
we have these minimally invasive options andthat they kind of compete with medication.
So we know from data that there'spretty reasonably high you know, a third
(08:58):
of patients might discontinuation, might sorrymight discontinuation their medications after a year or
so. So despite us thinking thateverything's great with the patients, they may
or may not be taking their medication. So these office based procedures essentially there's
kind of two main players currently,one of which is called your Lift.
The other one is called Resume.These are office based procedures that are done
in the office. They take afew minutes and they just might be able
(09:22):
to get you off your medication andhave kind of that same improvement of your
symptoms with little side effects and getyou off that medication, that daily medication
that needs to be taken ongoing,So I think that has an appeal,
and that's another you know, pitsome patients are not responding adequately, or
they don't want to take the medication, or they're experiencing adverse effects. Well,
(09:43):
then the next step or the nextrung up the ladder is maybe one
of these office based procedures to eitherhelp those patients where they're not responding,
or patients there there are improving,but they don't really like the idea of
taking something ongoing, especially if they'rein their sixties or so, what's the
end game here? I've been takingthis ongoing for and you try and bring
them around and say one day ata time, but again, it certainly
(10:03):
does feel like a long time ifthey're going to be on these medications long
term. Yeah, I mean,these are really incredible innovations, aren't they.
In technology used to be that everybodythat needed a prostate procedure would have
to be done in the hospital underanesthesia with a catheter for a long period
of time and other sexual side effects. And now you've had these two procedures
(10:24):
you mentioned, one being eurolift,the other being the resume procedure, which
you're done in the office. Andyou know with minimal really just a local
anesthetic that I've seen that you use, which is remarkable with no significant bleeding,
very minimal time with a catheter,and reduced sexual side effects. Is
(10:46):
that what you're finding. Yeah,and it's really again revolutionized my practice,
and like you said, kind ofin the end of my training, just
having that kind of medication or somethingsurgical in the hospital with a multiple day
hospital stay and blood loss and thingslike that, things have really changed for
the better for patients, which isas exciting and comforting to offer them something
(11:07):
that's not as potentially scary as whattheir parents had gone through or something like
that. So these are nice thingsto offer. And then interestingly, you
know, when we're doing a largevolume with patients, we get presented from
industry, you know, opportunities todo run clinical trials. So we're running
a clinical trial here called the Expandertwo trial, which is looking at a
(11:28):
novel device. So it's a randomizedclinical trial for patients that are interested that
they can have a device called theeuro Cross, which is a night and
all I call it kind of acage or a spring that gets put inside
of patients for six months duration intotheir prostate kind of springs things open and
then six months later we take itout. So this is a new technology,
(11:52):
a new company based in California who'slooking to see the efficacy of this
device, to see about, youknow, pursuing FDA approval again, another
third option kind of coming down thepike. And we've had some good initial
success and results with this new deviceat our hospital as well. So that's
another option again that is non permanent, which is again they're big selling point.
(12:13):
It's pretty exciting as well. Yeah, I mean that's terrific and good
luck with that. And if youare interested, by the way, and
if you just wake it up inthe morning here on Katsus Corner, we're
talking with doctor Jeffrey Shift, thedirector of minimally invasive Surgery here at the
NYU Lean Going Health System on LongIsland. And if you are interested in
a clinical trial or seeing doctor Shiftin consultation at the eleven eleven Franklin Avenue,
(12:35):
which is you did mention, isa beautiful new center that opened up.
We're there about six months now.You can give them a call.
The number and I'll announce it againat the end of the show is five
to one six five three five nineteenhundred. Then number again is five to
one six five three five nineteen hundred, and certainly these are really exciting development.
(12:56):
So maybe you can just briefly explainwhat these differences between the two procedures
that are currently if they approve theeurolift and the resume for our folks that
are listening in sure, sure,so rezume is using water vapor therapy,
so again using that whole analogy kindof from close to open being the simplest
(13:16):
way to understand. So when weperform a resume procedure, we're injecting water
or heated water into the prosthetic tissuefrom the urethra, from the inside out,
if you will, and that's causingsome tissue changes and almost kind of
consecutive you know, divots, ifyou will, where you know, it
kind of widens that channel through changesof the tissue, and that procedure can
(13:37):
be completed in under sixty seconds.Obviously, it's not that easy in that
the sense the patients have to recoverfrom it, but the procedure time in
the office is literally under sixty seconds, though it does take a few weeks
to kind of fully recover from theprocedure with short term frequency and urgency.
But then once they're out of theprocedure, there's no devices or implants or
anything left inside of the patient,So that carries some appeal for the patients
(14:01):
in distinction to the eurolift, whichis a eclipse or implants that are kind
of put in, or some peoplehave equated it's kind of stapling back of
the tissue or pulling back of thecurtains, so we kind of push the
tissue back on the right, wepush it back on the left, and
then that kind of widens the insidechannel. So we can do these kind
of sequential implants put into the projectto kind of open things up, and
(14:22):
that has a rapid recovery because we'renot heating the tissue and that's done in
the office. It takes just afew minutes to kind of clip things back
away, and it's using night andall and stainless seal and monofilament suture,
which is like a fishing line tokind of pull everything open. So it
has good tensile strength and has beenvery successful and really revolutionized my practice,
(14:43):
you know, having done close toeight hundred these procedures with very good results.
For my patients. And those arethe two kind of the main stays
of treatment. And again this thirdone, which is under a clinical trial,
also has a lot of promise aswell. When you do these procedures
in your experience, what have youfound that what patients in terms of their
(15:05):
symptom relief, Which symptoms that aremen having? They're presenting to you and
you say, you know what ifyou have this ural lift or the resume,
this is what you're going to feel. This is what you're going to
notice the most. Yeah, sowe do say that, you know,
some patients, you know, Ikind of present it fairly and say,
some patients go, I just havewhen I get up at night at around
(15:28):
two o'clock in the morning, it'sjust a little bit slow. Do you
do you have anything for that?And you go, So they have very
specific set of symptoms symptoms, andI say that, you know, there's
these procedures are for the constellation ofsymptoms for frequency and urgency and weak stream
and getting up at night to goand a sensation of incomplete emptying. But
I have noticed profound improvement in youknow, even the nighttime. You know,
(15:50):
patients get up, you know,three or four times a night,
and and I do set appropriate expectationsand say, listen, I think with
a successful procedure you'll get up oneto two times per night. So I
don't like to overp and say you'llget you know, nine hours of uninterrupted
sleep, but it'll be markedly improved. And again it's a big quality of
life improvement to go from three tofour to one to two. So and
patients do note that, and that'spretty consistent. They also notice less frequency
(16:15):
and urgency and better ability to kindof hold back their urine and then not
going as often and even better emptyingfor that matter. So across the board
seeing pretty good improvement of the constellationof symptoms, Well, that's great.
I mean anything that it can prove, especially the night time thing, I
think because people wind up getting upa few times at night. Three four
(16:36):
I've seen patient five times a night, and then I've had improvement with these
with the eurolift that you do.And as you mentioned, a quality of
life, you can't really overemphasize thatenough because people just get tired during the
day, they get irritable, they'rewaking up their spouse and that's not good
for a relationship. And then they'renot sleeping in the same bed. So
(16:56):
you know, I don't I can'treally see all the listeners out there,
but I'm sure some of them arenodding their heads right now saying, yeah,
that's exactly what I have, DoctorKats, and I got to go
in and see doctor Shift to seeif I can't get this fixed, because
that is a difficult problem. Now, it's not always the sleep problem is
not always, as you know,right, Jeffrey, from the prostate,
(17:18):
but many times it can be.I mean, it can be from other
things. Medications, diuretics, ifyou're a diabetic, Let's say, certainly,
how much what are you drinking beforeyou go to bed, If you're
drink drinking a lot of coffee ortea, or diet sodas during the day,
all these can can contribute. Butthrough your evaluations, when you find
that it is a prostate issue,that's you know, you know, pushing
(17:41):
on the bladder and causing bladder overactivity, and you do these procedures, it
really is remarkable, isn't it.Yeah, absolutely, it's really. It
sounds trivial, but you get somereally satisfied patients and you know, some
genuine you know, thank you doctor. You know some really appreciative, grateful
patients that it's really made a significantimpact on their quality of life. So
(18:04):
it's it's very rewarding in that sense. And when it hit the you know,
the papers and our journal and ourmeetings and our journals, it was
really these procedures were touted as youknow, they're minimally invasive and they'll relieve
the urinary symptoms and you won't havethat sexual side effect of that interference not
(18:25):
only with the erection but with preservationof the ejaculation. Have you found that
in your experience. Yeah, Sothat's really one of the more main tipping
points or things for patients where again, a lot of the medications and a
lot of the the bigger procedure haveat more significant risk, and these minimally
invasive procedures seem to again your lifthas that as kind of a zero percent
(18:49):
likelihood of ejaculatory dysfunction, which isquite compelling, and the resume is,
you know, less than five toten percent. So those are again pretty
good calls to action for paid whoare bothered by symptoms and or side effects
of their medications and looking for asolution that makes these highly appealing to patients.
(19:10):
Yeah, I mean, you know, we're dealing with men usually in
their sixties seventies, but you know, I'm sure that you've taken care of
men and done this in their fifties. And it's not about that they need
to ejaculate for fertility, but itis the preservation of normal orgasm and normal
feelings and sensation, and it doesmean a lot to men and if they
don't have to give that up andcan have get a procedure in the office
(19:33):
without going to the hospital. Andagain, it's not for everyone, and
we'll talk about another procedure that you'redoing for men with larger prostates in a
moment, but certainly it really canmake a big impact on men. So
terrific job. They're really great,and I'm glad that you're continuing to do
it. I mean, eight hundred. I didn't realize you were up to
eight hundred cases, so you probablyhave one of the largest experiences here on
(19:56):
Long Island for sure, maybe evenin the metropolitan area. Great job there.
Let's talk about because we only haveprobably been a few minutes left.
But there's a newer procedure you mentionedit earlier, called the aqua ablation,
which is done in the hospital,is done under anesthesia. Maybe you could
tell us about that. Sure,So in presenting these options to my patients,
(20:19):
we say, listen, we dohave a menu, I call it.
We have the medications, we havethese office spaceed procedures that we mentioned,
and then the latest and greatest issomething called the aqua ablation or kind
of water jet ablation of the prostatetissue. So the way I kind of
have tried to you know, there'ssome imagery on their website aquablation dot com,
but there's also an ability to kindof show that to patients or to
(20:40):
kind of imagine or explain it tothem where we're using a pressurized water jet
that's not heated, and I usethe analogy of kind of power washing the
deck or the house or the boatand kind of trying to clean out things
so that we can do an aquajet or an aqua ablation to the prostate
tissue. So what happens in thatscenario is it's under general anesthesia. So
again it's a bigger undertaking, butI do present a trailerly We say,
(21:03):
listen, we have these office basedprocedures where you can get pretty significant improvement
of your symptoms without having to goto the hospital. But for the toughest
of cases or the bigger prostates,I think you need something more involved and
it's done in the hospital under anesthesia. It's called ocwelblation, and that what
we're going to do is kind ofdraw out a treatment plan we call it
so under ultrasound guidance. And thisis just trying to imply the precision that
(21:27):
we're using as opposed to our priort rps that were terps that we used
to do. We're now shaping outthe project with this water jet that we
come up with a treatment plan underultrasound guidance to kind of preserve the bladder,
neck and the ejaculatory ducts which areimportant for continents and preservation of ejaculatory
(21:47):
functions. So now I have anew procedure which is similar to the older
procedures in its approach, but nowit's just that much more precise. And
what we do is we kind ofwater jet or remove all the tissue with
this pressurized water and that's it.And then so again with respect for these
anatomic structures, and then we keepthese patients off and overnight just for really
called twenty three hour observation, meaningyou're staying with us overnight just to be
(22:11):
watched and then we send them homein the morning. But this has had
also profound improvement for my patients andeven patients in retention, meaning patients who
really they come in with a catheter, they're really not able to go at
all. We can do this procedureand get them going on their own,
and patients who are actually advising youneed a catheter for life. I've done
(22:32):
a number of these procedures and gotthem off of a catheter. So it's
really again those quality of life thingsthat are we kind of take for granted
or we pooh pooh, but gettingsomebody to go again or getting them free
of the catheters is rewarding for patientand doctor alike. Yeah, it's really
fantastic and congratulations of getting that programup and running, and I know that
(22:53):
in the NYU Health system certainly they'vebeen doing them in the city and now
we have the advantage to do thisrobotic driven aqua oblation out here on Long
Island. Before we end the show, I just want to give everyone the
phone number again if you are interestedin seeing doctor Jeffrey Schiff, You certainly
can give them a call. Thenumber is five one six five three five
(23:18):
nineteen hundred. Five one six fivethree five nineteen hundred. If you were
a loved one has been you know, suffer, I would say suffering because
many many men do suffer from theseissues. And certainly if there's a concern
about in your urinary pattern, ifyou've had a change in urinary pattern,
you know, it's not always benign, as we were talking about earlier,
and so you should get tested andcome in to see the urologist. We
(23:42):
can do ultrasounds in our offices oneleven eleven right there. Check your bladder,
make sure you're emptying your bladder,do blood tests to make sure that
you don't have prostate cancer, numberone cancer in men. And certainly you
do need to be tested if youare, you know, having these symptoms
for certain and you know, sometimesit is just a urinary infection and that
(24:02):
could be, but it could bethat you're not emptying the bladder and you're
holding onto the urine. So andthat's really a great summary, and Jeffrey
really appreciate that in terms of youknow, I always have to ask you
because I'm always interested to hear ifthere's anything new in the area of supplements
and diet or vitamins or herbal things. And if there's nothing new, and
(24:26):
a patient says to you, theywant to take all of those things,
what are your thoughts about those Ioften refer to you as my diet and
supplement expert, just but knowing thatyour protocol and your fund of knowledge on
those things, I kind of say, listen. You know, patients often
come in, they have pictures thatthey bring a shopping bag full of supplements
that they're taking, and I applaudtheir efforts. And I've said, I
(24:48):
don't blame you. I don't knowspecifically, I don't endorse any particular supplement,
but if I listen, I thinkthat you know, oftentimes they're for
mild to mind. There's symptoms.I think, sure, yeah, saw
palmetto. There's some kind of commoningredients. I say, if you stay
up late at night on TV,you'll see certain advertisements, but these are
(25:10):
the common ones. Suit you knowthat that they all have some kind of
saw palmetto or selenium or other thingsthat might be helpful for symptoms and pumpkin
seed. But I don't particularly endorseanyone, but I think, you know,
patients find improvement, and then I'mall for it. Yeah, yeah,
no, I agree with you.And one of the things that we
do in our office is we havepatients fill out a questionnaire it's called the
(25:33):
ips S score, the International ProstateSymptom Index Score, which gives us an
idea of the patients are having mild, moderate, or severe symptoms and if
they're very mild, I have hadsuccess, let's say with patients staying on
herbal things. Is it a placebomaybe, but you know, patients seem
to be enjoying it, as someof the patients say they do have a
(25:56):
better flow with it. So,but if they're only mild symptom in that
small category, but I do agreewith you that majority of these patients are
coming to us because they're not mild. They are more significant. And thankfully,
as you've very nicely outlined for ustoday and really appreciate that, there
are lots of options. There's medications, and there's these new minimum invasive treatment
(26:17):
options including the eurolift which you've doneeight hundred on now, the rezume and
the aqua ablation. So again thatnumber is five one six five three five
nineteen hundred if you want to seedoctor Jeffrey Shift, the director of minimally
invasive Surgery at the NYU Land GoingHealth System on Long Island. Jeffrey,
thank you so much for coming onthe show. Sorry, that's it.
We probably could go on for anotherhour or so, but really appreciate you
(26:41):
coming on and educating all of usthis morning. Thank you for the opportunity.
Enjoy your the rest of your weekend. Sure thing you as well.
Well, that's the end of theshow. Everyone tune in every Sunday here
on Katz's Corner. We'll be backnext week with a great show for you.
This is doctor Aaron Katz. You'vebeen listening to Katzer's Corner. Come
back every week to hear more greattalk on a wide range of men's health
(27:02):
topics and advice on how to liveyour healthiest life. The proceeding was a
paid podcast. iHeartRadio's hosting of thispodcast constitutes neither an endorsement of the products
offered or the ideas expressed.
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