KATZ'S CORNER 072323 Guest: David L. Peters, D.O. Urology

CredentialsPositions

• Clinical Assistant Professor, Department of Urology at NYU Long Island School of Medicine
• Director, Ambulatory Clinical Urology, Suffolk County - Long Island Community Hospital

Board Certifications

• American Board of Urology - Urology, 2019

Education and Training

• Fellowship, Cleveland Clinic Florida, Male/Female Sexual Dysfunction, Male Infertility&Prosthetics, 2017
• Residency, Brookdale University Hospital and Medical Center, Urology, 2016
• D.O. from New York Institute Of Tech, 2009

Episode Transcript

(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. It's CATS's Corner with Doctor
Aaron Katz. You are trusted expertin men's health, providing straight talk on
a wide range of men's health topicsand advice on how to live your healthiest

(00:20):
life. To reach doctor Kats,call eight hundred three two one zero seven
ten now live on seven ten wR. It's the Chairman of Urology at
NYU Landgoing Hospital, Long Island.Here is doctor Aaron Katz. Good morning
everyone, and welcome again to CATS'sCorner here on WR iHeartRadio. So glad

(00:42):
you could join me this morning,have a wonderful show for you. A
guest that's been here before, goodfriend and a colleague, Doctor David Peters.
Doctor Peters is a clinical Assistant Professorin the Department of Urology at the
Long Island School of Medicine, andhe is really an expert in the area
of sexual and urinary dysfunction. Andthere are some really interesting developments that have

(01:07):
come out and this morning will betalking specifically about men that have issues with
sexual dysfunction, sexual or erectile dysfunctionas it's been known, and I guess
viagra now has been out well overtwenty years or so. It used to
be where the sales reps would cometo the office and they would give us

(01:29):
samples of viagra and silis. Sothose were the good old days and talking
to our actually our practice manager aboutthat. Today we don't have that anymore,
and the medications can be pricey dependingupon where you go. There's a
lot of different things on online offlineup in Canada. It's really confusing for
patients for providers as well. Andthere has been a new topical, a

(01:55):
gel that was recently came onto themarket, and doctor Peters is going to
talk to us all about all thatinformation and what you need to know about
your evaluation and your health and whatit means if you do have erectile this
function. Good morning, David,Thank you so much for joining us here
on Kats's Corner. Hey you dotto Kad, Thanks for having me.

(02:15):
It's a pleasure. I know you'vebeen very busy and working you now see
patients in beth Page or see patientsout eastern part of Long Island. In
Suffolk County and in your practice.And I know you've been you know,
in practice for many years now,well not so many years. I mean,
I guess how many years have youbeen in practice? Actually it's a
good question. This is year numbersix practicing. Oh gosh, wow,

(02:38):
you seem like, you know,like you're you've been doing it for for
way longer than that. Only six. Wow. That's but and I know
that you take care of so manymen and are very helpful to them.
You know, maybe we can juststart out with a broad question about erectile
this function. You know, thepatients that you see, let's say,
men that did not have any radiationor surgery. Just you know, someone

(03:02):
that's in their fifties sixty seventies thatare is noticing a change in their erections.
What do you do for the evaluationfor these men? To a question?
Yeah, so we try to preachnowadays and this isn't, like you
said, without an obvious cause likea surgery or radiation to the prostate or
the pelvis. That erectile dysfunction isreally an organic problem. We used to

(03:29):
say, or wait before my timepracticing in the earlier part of the midpart,
rather of the twentieth century that erectiledysfunction is a psychological problem for the
most part of them. Well,we do think that does play a role.
In the modern era, we reallythink it's a minor role, and
that we're thinking it's a physical problem. Physical meaning maybe the patient has diabetes,

(03:53):
maybe the patient has heart disease,was the patient of tobacco smoke or
even if they were a former tobaccosmokeer, that really still does count.
Are they overweight, do they havehigh cholesterol, high blood pressure, do
they have a condition called sleep apnea, and so on and so forward that
we can go on and up,and so a big part of that evaluation
is me really doing a deep diveand figuring out why do you have this

(04:15):
problem? That's the patient's always wantto know, why do I have this?
We simply don't want to inna,simply don't want to chalk it up
to age. And so it's reallya nice investigation go through the history.
But then beyond that, we dodo laboratory testing, mostly focusing on the
male hormone that we call testosterol.And then beyond that, as a specialized

(04:39):
center here at NYU, we dowhat we call advanced diagnostic testing diagnostic testing,
and some of our men in whichwe actually do a special ultrasound study
which is really a radiology study ofthe genital organ specifically the penis, to
look at the internal structures that createthe erections, to look at the blood
flow specifically to coming in and outof the penis. So it's a pretty

(05:01):
comprehensive approach. And so in yourstudies you would find that, I mean,
what percentage of man would you say, and they're coming in with the
change in their erections, you actuallydo find some physical cause that it's not,
as you mentioned, an emotional orstress related or a psychological issue.
These days, Yeah, your psychologicalpsychogetic eeds we sometimes call it, is

(05:31):
rare. I'd think that they havemajority have some kind of organic problem.
I'd probably say about seventy to eightypercent. Okay, So that's that's quite
a bit, and that's certainly Imean, maybe it does give the patience
some if you want to say,satisfaction knowing that, Okay, there's a
cause, it's not just in mymind that really there is something going on

(05:55):
with my body, and maybe Ican correct it. Maybe if my book
pressures out of whack. Maybe ifmy sugars are not control, maybe I'm
just too you know, maybe myweight is a problem, maybe I should
lose some weight, or or ifit is a carnary issue, as you
mentioned, a hard issue, thatmaybe I should see a cardiotis. So

(06:15):
maybe you know, maybe that thatcan just help patients, just knowing that
when you find that and you sayto them, look, this is the
course, not that it's the fix, but at least that may help them
in some way. Oh, Icouldn't agree more. I mean, it's
a big part of why I lovewhat I do. And you and you
and I have talked off whine alot about this, the idea, you
know, patientful ask why is thisof interest to you, doctor Peters?

(06:39):
Why do you why do you wantto talk with guys about their erection problems?
If the many people for many menabout they even want to talk about
when it comes to themselves, Sowhy do you want to talk about strangers
with this type of problem? Andit's exactly what you'll allude them to.
It's an opportunity beyond just you know, proving someone happiness, the quality of
life and fixing this problem. It'sa way to really look for and help

(07:02):
patients discover if there's anything hiding underthe surface. In terms of a significant
medical issue. I mean we've hadpatients. I don't say this in a
gloating way, but we've had patientscome to us, come to my practice,
I don't think adopted. For years, we've done advanced testing to look
at the blood flow and the penis, the tiny arteries and the penis that

(07:23):
provide blood flow. If they lookdiseased, it stands to reason that the
arteries around the rest of the bodymay also be diseased. And when I
say that, I'm really thinking aboutthe arteries that supplied blood to your heart,
the arteries that supply blood to yourbrain. If either of those types
of arteries, as you know,get blocked, like an artery to the

(07:43):
heart, the coronary artery, thatcan call it a heart attack. I've
literally had patients that I've referred tocardiology because of their ed and I suspect
a cardiology issue. And I've gottenphone calls from patients or their cardiologist weeks
later saying, hey, doctor Peters, that Peyton you said me. We
put a stent in their heart.We just we stop them for open heart

(08:05):
surgery, and it really started withthem coming to the doctor's office simply for
erectile dyspulsion. So, yeah,were you alluded to what you're doing.
We take that really seriously. It'sa big part of what we do.
Yeah, I love what you're saying. I mean it goes in line with
you know my you know, Iwas trained as you were as as a
traditional alepathic, you know, Westerntype of doctor. But we do need

(08:28):
to be more in pardon the phrase, holistic when looking at men and all
of our patients and not just focusingon what the patient is coming in for,
but trying to understand, almost likedetective work, right, trying to
understand really or what's going on.So you you mentioned that the phrase what
we can fix that problems? Doyou think that if men, if you

(08:52):
find an organic cause, let's saythey're overweight, or let's say they've got
diabetes or a high flood pressure,can then you know, correct the underlying
medical condition without using let's say,some of the oral agents that we will
know that we talked about or biaggressialistCan they reverse their underlying medical conditions so

(09:13):
that they wouldn't need these oral agents? Is that possible. It's possible.
I wouldn't say it's very common,but it's it's definitely, it's not unrealistic.
Diet exercise lowering that blood pressure,which in turn to lower the progression
of cardiovas field disease, fixing thatcholesterol, that obesity. That really we

(09:37):
literally see differences in patients when theyactually pursue that and come back to the
office. We do see improvement inerectile function. We know there are studies
that show that that that famous chemicalnitric oxide, which is involved in blood
flow throughout our body and particularly involvedin the blood flow in the erection process.
We have studies that show that thisnitric oxide level in your body and

(10:00):
es substantially with daily, regular cardiovascularexercise. So we do think you could
do something about all right, that'sthat's fair, And I think what you
need to do is set realistic expectationswith patients because everybody you know in America,
especially in New York, they wanta quick fix, right they but
you need to encourage them to,you know, to alter and change the

(10:22):
underlying metabolic condition. But as well, um, we have a variety of
different methods now to help men.So let's let's focus now on that.
And UM, let's first start talkingabout some of the integrator or herbal things
that are out there. You mentionednitric oxide, and I was watching TV

(10:43):
I don't know, about a monthago, I guess, and late at
night there was a commercial about,oh, you know, men need nitric
oxide and here's the supplement, andyou know it's going to fix your erections.
Is there any any any truth toyou know, I know that nitric
oxide is involved in in interactions.Do you can you take a pill of
nitric oxide? Is that? Isthat possible? And and and studies have

(11:07):
shown that this could help or isit just anecdotal at this point? Yeah,
I mean, well certainly there areUM pills and over the counter options
available for it. I mean,there's a whole big business involved with the
sale and production of nitric oxide becauseyou know, many folks in the healthcare

(11:30):
world know that it's involved in theerectile function process, and so it stands
to reason that if you provide someof those components, some of those chemicals
that we know are involved in theprocess, well maybe it will help.
UM. There's there's no FT approvedmedical therapy in the form of nitric oxide
to treat erectile dysfunction. There's there'susually a good reason for that, UM,

(11:52):
because it has to be proven toreally work. UM. So what
I really rely on is feedback frompatients. And a lot of patients will
walk into a GNC or one ofthese help food type of stores supplement type
of stores and purchase different formulations ofnitric oxide, and you really hear very

(12:16):
mixed responses from patients. And there'sa good reason for that, because you
know, we can figure out thatall the chemicals you want in the body
that are needed to treat various conditions, Well, if you're gonna put that
in your mouth and try to digestit, the question after that is,
you know what happens to that chemicalonce your body breaks it down? Does
it does it go to the placewe want it to? Does it go

(12:37):
in the form that we want itto? Do we just simply excrete it
or eliminate it from our body?What percentage of it is not eliminated?
So that's really the problem and thereason why a lot of these supplements.
So I don't as to make alomar answer short, I don't recommend or
advise patients to use supplements of thatnature. Okay, that's a fair enough.

(13:00):
I mean, you want some evidence, and these things may not be
a cheap or you know, Imean, maybe it won't hurt the patient,
but what we're saying is it probablywon't help. Now, we were
talking before the show earlier about anew gel that just got approved, something
called Erectson to tell us about that, Yeah, it's it's a it's a

(13:26):
gel's exactly like you said, Soit's a topical therapy. Um. This
has been approved for over the cultureuse, which I think is really what's
making it stand out, UM,and the reason why there's so much buzz
around this in the world that we'rein men's health and sexual medicine. UM.

(13:48):
What's really interesting, which UM I'mglad to explain to your listeners today,
is that it's actually it's actually fulledunder the classification of the device rather
than a medication, which I knowsounds really strange, but there's a reason
for that. When you take let'slet's say what you brought up, a

(14:09):
nitric oxide supplement or a viagal orsome kind of medication or a medication to
treat blood pressure, whatever you wantit to be These are chemicals that are
having a chemical reaction inside your body, and roxon does not do that.
It's actually having a physical reaction throughthe skin of the pans, and through

(14:35):
that physical reaction it leads to adirection. And so it's actually classified as
a almost like a device in asense, rather than a medication, which
makes it really interesting that I thinkis one of the reasons why the FDA
has approved it for over the counteruse. And this is the first you

(14:58):
know, I remember, and Iknow that you're very You also treat men
with a penile injections, which whichwe'll get to, but this is the
first topical UH approach for for men, I mean a gel correct for erecting
functional. It really is UM.There was talk some years ago UM about

(15:22):
using nitroglycer or some form of thattopically that was not after you have proven
the results really were not UM earthshattering. UM. There are some positories
that go into the whole of thepenis to your refra um. The brand
name of that is called news Um, and so in a sense you can

(15:46):
make an argument that that's somewhat topical, but again that's going that's a little
more invasive. It's going inside theopening of the penis where you urinate from,
and it has a helical reaction.UM. And there is some compounded
versions of that that do come intojail. But again, UM, they're
not FT improved and they're they're they'redesigned to have chemical reactions inside your body,

(16:10):
for example, in the bloodstream,if you will, and this really
doesn't do that. So this isthe first FT improved topical therapy for EED.
I mean, this sounds like abreakthrough. Is it available now over
the counter? Do you know itwas FT improved in June? I want
to say June thirte off the topof my head of twenty three of this

(16:30):
year. Um, it is.It is not physically available in the United
States, Like you can't walk intoa local pharmacy where or some other storing
get it. UM from what Iam reading UM, and I've been I've
tried to be in contact with themakers of this of this product. UM.
We're looking at UM and I thinkend of twenty twenty three, but

(16:53):
probably more realistically than the start ofthe new year. Okay, And so
you wouldn't need a prescription, soI assume that there's no real side effects.
It's it's over the counter, haveyou. Yeah, really minimal UM,
I would say. So they hadtwo two um uh studies, two
I would say, landmark studies withregards to this product UM where they looked

(17:17):
at that they locally looked at thesafety profile UM and it seems to be
the majority of the side effects oradverse events or local skinny irritation to the
penis UM and I want to saythe number was about two percent of pain
studies. That's worth a risk manyeight percent, don't get That's fine,

(17:38):
right, which which is very expected. This is a topical baramount. So
what are the big supplies? Thequestion would be what about be the partner.
They looked at female partners, andin one study they showed virtually no
side effects with the female partner,and in the other study it showed less
than five percent, less than zeropoint five percent, so pretty well tolerated.

(18:00):
The other side effect which was interesting, which is a headache which could
have happened like two percent as well, which is a systemic side effect.
I thought that was interesting, butagain, really low side effect profile.
The headaches on the man not thewoman, I assume exact exact Good God,
yeah, now it's an exciting development, and thank you for bringing that

(18:22):
to our attention. I was notaware of this, and I think it's
exciting. It's um you know,this is something that's always been in the
hands of the urologist, of thephysicians, so now patients are going to
be trying this on their own.One of the other things that you certainly
treat a lot of men with twotwo other categories I want to touch with
before the show ends. One ispenile injections and the other is peanot implants,

(18:44):
and I know that you do alot of those. That tell us
quickly about both of those options.Yeah, I appreciate your bringing those up
as well. We're, as youknow, doctor Kats, we're a high
volume center for pinot implant surgery andfor all of these other advanced therapies for
male sexual dysfunction. Let's start withthe injection. So this involves taking a

(19:11):
medication that doesn't work exactly like aviaglar or a salis, but in a
similar way. It's an essentially ina liquid form and using a very tiny
needle, about as tiny as youcan possibly use in medicine, You're injecting
into the side of the shaft ofthe penis, and it sounds to many

(19:32):
of my male patients barbaric. AndI can just tell you, and I
think you know this already, thatso many of these patients who are resistant
to trying this experimenting with it inthe office try and then say to me,
oh, that wasn't nearly what Ithought it was going to be like.
So it's far more tolerated than youone would think. And unlike a

(19:52):
viagra or a salis that can inducean erection quite quickly in as little as
ten minutes or fifteen admit, sexualstimulation helps, but alike of viaggreacy alic,
you technically don't even need sexual stimulationto produce a direction. So it's
a pretty amazing drug. Was reallygroundbreaking when it came out many years ago.

(20:15):
And I have a subset of patientsthat really swear by it and use
it for years. Yeah, Iagree. I mean I've had many patients
that have had an excellent quality oferection. It is a little cumbersome.
You have to what I remember,you have to keep it in the refrigerator
or the injections at least there aredifferent forms of the injection. I guess,

(20:36):
but the most common one I thinkyou have to refrigerate, is that
right? Right? Yeah? Butonce you're really good at it, you
know, you just go to thebathroom, you put put it into the
side of the penish, you setand the direction comes on pretty quickly and
can be you know, an excellentquality erection for many men. And then
what about the implant, because Iknow we're kind of short on time here

(20:57):
to tell us about that, andwho would be a candidate for that?
Yeah, the penile implant. Theprosthesis is, truth be told, the
really the only proud at approved restorativetherapy for rectile dysfunction. And I got
to be careful when I use thatword, and I'll explain restorative. This

(21:19):
is a mechanical prosthetic device. Youhave compartments deep inside the penis that hold
the blood and expand with blood toactually produce that erection, that rigidity that
we know about. And so weactually through through for the most part,
one small incision place a device thatholds fluid in the form of saline,

(21:42):
not blood, and it goes intothose same compartments, and attached to that
device is a pump that transfers thefluid in and out of those compartments that
you can be flaccid or rigid whenyou want to be, and it's all
concealed, has a natural appearance fromthe outside. And what I say restored

(22:03):
to what I really mean is almostlike if you think of like a hip
replacement, the orth to be exurgiis not you know, growing bone tissue
per se and your hip. You'reputting a prosthetic device, but it restores
function, it makes it gets youback to as close as you were before.
And so that's what we get intopenal implant, which believe it or
not, free date. So manyof these elect called dysfunctioning tree, butent

(22:27):
options such as Biagler. People realizethat the penal prostheses that you can inflate
in deefly, which is what Ipredominantly use for my patients. This dates
back to the nineteen seventies and it'sstill so many patients don't know about this
option when it comes to my office, which it fascinates me. A great
point, big believing a lot ofthe surgery, but it's not for everybody.

(22:51):
Yeah, I know, it's agreat point. The surgery takes so
you're under anesthesia. How long doesthe surgery typically take? Because of an
hour hour and a half if Iremember, ye picks me about an hour
to do. And like I said, if there's one incision, you're fully
under general anaesthesia. Um, thereare colleagues of mine around the country.
You try to experiment with different typesof anesthesia, local with local anesthesia,

(23:14):
with the lighter sedation, but that'snot the I would say, that's not
the standard of hair now. Andso yeah, it's it's about an hour
and it's from my patients. It'sthe same day surgery to ambulatory surgery,
which I think is really Yeah,and as you mentioned, it's been around
for quite a long time, althoughthe devices have changed and now they are
a you know, inflatable, soit's not like you're walking around with an

(23:36):
erection all the time, and it'sit's on demand, and it can be
as firm and naturally looking as asif you had a normal erection and you
have the normal sensation, the normalejaculation. It is a surgical procedure like
any other surgical procedure. There's alwaysrisks and benefits, of course, but
the risks of infection in someone likeyou who is a high implant as you

(23:59):
say it, I would think isprobably very low, probably in the range
of probably less than five percent,or maybe lower than that. Yeah,
it is. It's it's very lower. It at our institution, in particular,
because we have such a great team. Not only you have the surgeon,
you have staff, nurses, operatingroom technicians, the whole facilities really

(24:21):
take part in this, and soour infection rates are incredibly low. Nationally,
infection rate in the proper hands orprobably about two to three percent,
I would say we're certainly lower thanthat, probably closer to one percent.
Wow. That's terrific work here,and it's a devastating complication when you do
get a deep infection, that implantwould have to be removed, but we

(24:44):
very rarely see that. We goto great lengths to really prevent that.
And like you said, you boreup so many good points. Patients want
to know, sensation to the penis, orgasm, ejaculation, you're an age
it, All of these things couldbe the same if they're not, I
mean for people in law. Sono, that's all the same as it
was before. Yeah, those aregreat points, and also thanks for bringing

(25:07):
up your team. You know atNYU in the operating room, the nurses
people that are helping you that arereally experts as well, because you really
want to maintain excellent sterility in handlingthe device and in handling the implant before
it's inserted into the penis. Sowe really have outstanding staff and both you
and I know that, and we'revery fortunate to work at high quality,

(25:32):
high performance here at NYU, clearlynot only the best in the region,
but best in the nation. Weonly have about that thirty seconds left if
patients are interested in seeing you forconsultation. I know that you're you're working
on the eastern part of Long Island. Is there a number that people can
call to reach you or is itthey just check out David Peters at the
NYU site. Yeah, all ofthe aboult So I'll give you the full

(25:55):
number at five one thick seven fiveeight eight six zero zero at our Specialty
center in beth Paid, Long Island. And surely you can find me so
easily on the internet just googling anyof these problems that we're talking about,
like a rectile dysfunction. And ShirleyNYU Lang Gold has a pretty incredible patient

(26:17):
website to find doctors and to makeconsultation. It's pretty incredible, all right,
Well, thank you very much,doctor David Peters. You can certainly
check him out at the NYU Landgownwebsite. Clearly an expert. Thank you
so much David for coming on thismorning and educating all of our listeners as
well as myself about the new topicaljail and all the options that are available

(26:37):
and understanding men's health. Thank youvery much. Have a great day.
Everyone. Tune in every Sunday yearon Katz's Corner. Have a great day.
This is doctor Aaron Katz. You'vebeen listening to CATS's Corner. Come
back every week to hear more straighttalk on a wide range of men's health
topics and advice on how to liveyour healthiest life. The proceeding was a

(26:59):
paid prom w r's airing of thisprogram constitutes neither an endorsement of the products
offered or the ideas expressed. Theproceeding was a paid podcast. iHeartRadio's hosting
of this podcast constitutes neither an endorsementof the products offered or the ideas expressed.