KATZ'S CORNER - - 11 - 10 - 24

Episode Transcript

Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.

Speaker 2 (00:09):
The following program is brought to you by NYU land
Go in Health. It's Kats's Corner with doctor Aaron Katz.
You're trusted expert in men's health, providing straight talk on
a wide range of men's health topics and advice on
how to live your healthiest life. Now on sevent ten
woor It's the Chairman of Urology at NYU land Gone Hospital,

(00:32):
Long Island. Here is doctor Aaron Katz.

Speaker 3 (00:36):
Well, good morning everyone, Welcome to CATS's Corner here on
wr iHeartRadio. So glad you could join me. We are
live this morning on November tenth. Just to just to
show you that we are alive. It is seven am
or so the left of seven am in the morning
here on November tenth is the second Sunday of November.

(00:58):
So glad you could join me this morning. If you'd
like to give me a call, I'd love to hear
from you. The number is eight hundred three two one
zero seven ten. That number again is eight hundred three
two one zero seven ten, and I hope you're all
having a wonderful weekend. For me, I was busy all

(01:20):
day yesterday. Some of the one of the other hats
that I wear beyond the chairman of the Urology Department
here at NYU Land going on Long Island, is to
run your residency program, the Urology residency program. I'm also
the program director of this, and we have had one

(01:41):
resident per year, and now because we've had significant increase
in our volume of patients that we're seeing, we've applied
to what's called the ACGME, which is the governing body
of all residencies in the United States, and they oversee
the pro We put in an application to increase our

(02:03):
complement of resident and now we're going from one resident
a year to two residents a year, which I'm very
excited about. The residency program is five years. When I
was training, the residency program was actually six years. You
would do two years of general surgery and then four
years of urology, and now it is basically six months

(02:27):
of general surgery and then four and a half years
of urology. So this is basically a five year program.
Most programs are in the country now ur five years.
And this, remember is after four years of college and
four years of medical school. Now you are getting paid
as a urology resident. So it's not like you have

(02:49):
to pay to be in the training program. We actually
do pay you. We also provide things like health benefits
and parking andational free lunches, and some stipend for housing.
And it is rather competitive. I'll tell you that this
year for my program, for the two spots, we had

(03:11):
one hundred and eighty four people apply. We decided to
interview twenty four. That was yesterday, So I interviewed me
and not just me. I have a faculty and that
I put on the residency interview committee. There's seven faculty
and we weter so we interviewed twenty four of those

(03:35):
one hundred and eighty and we're only going to accept two.
So if you do the math, I don't know. It's
super competitive. And what was impressive to me was the
both men and women, and yes, lots of women are
going into urology, which is wonderful to see. When I
was a resident back of the day, you know, it
was more like a guys field, you know, more of

(03:58):
a prostate oriented feelled and it just seemed like there
were more men. But now I would say almost half
the applicants that are applying are women and incredibly bright
young people that we interviewed yesterday, So the interview was
all day yesterday from eight in the morning. I gave
like a little orientation about our program, talking about the

(04:22):
NYU land Going system, which by US News and World Report,
we are ranked number two health system, you know, in
the in the country. We're number one in the New
York in the state of New York, and we're number
two in the country for urology. That's the NYU Health

(04:44):
System number two, so for urology. So, you know, I was,
you know, let the students know, the applicants know that
we've got a great healthcare system.

Speaker 4 (04:54):
Here.

Speaker 3 (04:54):
We see lots and lots of patients and yes, these
are young people that want to do an urology and
they're interested in the different surgical procedures and how are
they going to be mentored and how are they going
to train to do this. We have different ways of
training residents these days with simulation methods and actually in
the operating room they can learn to assist and they'll

(05:17):
get to see a lot of different procedures over the
course of the five years, and they not only do
adult urology, they learn to do pediatric urology. In fact,
at our hospital here at NYU on Long Island, we're
doing about seven hundred pediatric urology cases a year. And

(05:40):
you say, well, well, what kind of cases is that, Like,
what kind of surgeries are you doing on children? Well,
these are children that, unfortunately are born sometimes with a
congenital defect in their kidney. There could be a blockage
of their kidney, they could have a malformation of their penis,
they could be born with testicles that are not descended
in the scrotum. It's called undescended testicles that we need

(06:02):
to surgically bring down into the scrotum so that you
can feel your testicles and you can reduce your chance
of testicular cancer because that can happen if you have
undescended testicles. We have lots of children that are born
with urinary tract infections that we when we do in
an image is like an ultrasound or a cat scan,

(06:22):
we find that the urine is going back up into
the bladder. That's called reflux, and so we need to
do a surgical procedure in some cases to change the
anatomy of the course of the urin of the tube
that goes from the kidney to the bladder so that
the urine won't reflux back up, because if you have

(06:44):
continued reflux of urine back into the kidney, that'll put
pressure on the kidney and you could wind up with
kidney failure even as a baby. And sometimes we find
these things in utero. We can do fetal ultrasounds. We
do fetal ultrasounds, and sometimes we find that the kidneys
are swollen or there's not enough amniotic fluid that's coming

(07:04):
out because most of the amniotic fluid is urine, and
so they're not producing urine. So we can sometimes do
fetal intervention. And then unfortunately, some children have tumors of
the kidney. Yes, you can have something called the Wilm's tumor,
which is a you know, a cancer of the kidney.

(07:24):
You can have a cancer of the bladder even as
a child, even of the prostate. Rare. These are rare,
but we do see these things. And then of course,
you know, we have lots and lots of children that
need circumcisions or have had a circumcision that went was
was not done properly by someone, so we have to
revise the circumcision. Maybe there's too much skin, or maybe

(07:48):
there's a bending of the penis. So there's lots and
lots of things that we do for children. So during
the residency program, if you're doing a urology resident, we
train you to do both adult and pediatric eurology. So anyway,
I just thought I would let you know that it's
an interesting part of my career in education to train

(08:10):
residents to a higher faculty that are not only good
surgeons and good humans, of course, but are good teachers,
are good mentors. These are remarkable people that we have
in the department that yesterday they spent the whole day.
I mean they're taking their time to interview all of

(08:31):
the candidates that come in and try to select the
top two, and then we come up with a list.
We rank the twenty four students that we interviewed yesterday,
and then the students rank US and other programs that
they're interviewing. And then there's something called a match, and
that'll happen for urology sometime in February. There's a computer

(08:55):
match and we find out on that match day of
who we got and done. So far, our program is
relatively young. We've been doing it six years now, but
we've had just terrific matches and great young people that
are interested in neurology. It gives you, you know, it
does give me a sense when I am interviewing and

(09:19):
I'm seeing these young people that are dedicated to the
field and want to help people. Many times they're asking
so many questions about how you know, the diversity of
patients that you see, and they want to help, you know,
people that are underprivileged. And you know, I always have
said to people and they say, oh, you know, you

(09:40):
don't want to go into medicine. You know you're not
going to make money, blah blah blah blah blah. You
know you'll have a fine living. You're not investment bankers.
You're not going to be making millions of dollars a year.
That's not what this is about. This has to come
from your heart. You know, you want to be a
physician first of all. You know, you want to be
able to be able to take care of patients, care

(10:00):
for patients, and be diligent and communicate because a lot
of the applicants, They ask me, well, you know, doctor Katz,
what do you want to see And you know, what
do you hope for in five years when I graduate?
What kind of a doctor will I be? What kind
of urologist will I be? And you know my answer is,
you know, yeah, I want you to be a great eurologist.
But first I want you to be happy, and I

(10:21):
want you to be productive, and I want you to
be a great physician, you know, to look at the
whole patient holistically and not just focus on the urological problem,
but and be able to communicate. Well, you know, we
we have sessions about communication, not only with the patients,
but with your colleagues, other residents, other staff, other attendings, nurses, pas,

(10:45):
medical assistants, so so many people in the hospital that
you have to learn to communicate with and be professional
about and respectful for everyone. That is so important these days.
Respect for the that's cleaning the patient's room, to the
surgeon that you're calling to assist you in the operating room.
Everyone needs to have equal respect. And that's what that's

(11:10):
what I want for my residents when they graduate, and yes,
I want them to be accomplished surgeons and I want
them to do lots of research, and we do lots
of research here at NYU. And I was really pleased
this year, and I said this in my opening remarks
to the applicants that we put in forty one abstracts
or like mini papers into the American Neurological Association National

(11:34):
Meeting this year. So we're doing lots of research in
both adult and pediatric urology. We're doing lots of research
in cancer, in prostate cancer, which is something that we
clearly see the most. Oh we also see lots of
lodder cancer, some kidney cancer that we're doing research on
as well. We're doing lots of pediatric urology research and

(11:55):
running clinical trials, and we also have a lab here
at the hospital that we're doing you want to do
basic science work and look at One of the things
that I'm very interested in is men with prostate cancer
and they're on hormone therapy. There's lots of new hormonal
agents that have come out about in the last few
years to reduce PSA and to allow men to live longer.

(12:17):
But we're also seeing that some of these hormones may
affect the brain function, may affect cognitive function may affect
your ability to think clearly. And so we have these
nerve cells that we're growing in the lab and we're
exposing them to the hormonal agents and we're seeing if
they affect. These are human brain cells that we that
are growing in the lab, and we can then you know,

(12:42):
use them to affect to see how they affect the
nerve tissue. So anyway, those are my early thoughts on
the show. We're a live one eight hundred three two
one zero seven ten. We have a couple of calls,
so certainly if you want to give me a call,
you certainly can. One eight hundred three two one seven ten.

(13:05):
We have our first call from Michael. Good morning, Michael,
how are you.

Speaker 5 (13:09):
Good morning, doctor Katz, thank you for taking my call.
I'm going to ask I've always had a problem for
many many years. I'm sixty one years old and always
had a problem with getting my body to pee. Sometimes
I think it's uh, you know, shyness in like a
men's bathroom, let's say, or but it doesn't matter. I could,

(13:32):
you know, be on my own in my own bathroom,
and I just have a hard time to you know,
get my body to start to pee. I'm just wondering
if that's a UH.

Speaker 3 (13:41):
And you're saying that this is something that you've had
your your whole life.

Speaker 5 (13:46):
For a long long time. Yeah, I've you know, many
years ago, I went to UH doctors in New York
and you know, I went through all kinds of tests
and things like that. I've tried different medicaid, but I
gave up on them because it didn't really work. And yeah,
it's been quite some time.

Speaker 3 (14:09):
Have you ever seen a urologist before?

Speaker 5 (14:13):
Yeah, yeah, many years ago I went to a Matthew Rutman.

Speaker 3 (14:16):
I think it was in Colorure, you know, I know
Matt Rutmand.

Speaker 5 (14:20):
That's when, you know, and that's got to go. I mean,
that's got to go back like probably thirty years ago
that I went to see him, and I just, you know,
at one point, I just gave up on it and
I just just dealt with it. You know, It's always been,
you know, difficult.

Speaker 3 (14:35):
But yeah, well, I mean there certainly are lots of
people out there that do have what we call a
kind of a lazy bladder, and that sounds like something
that you're experiencing. I would first of all, go back
to a urologist if you haven't been to one in
thirty years, and would you know't what's called a eurodynamics test.

(15:00):
I don't know if you've ever had that done, but
that is clearly something that I would consider, which is
a test that can look at the functioning of the bladder.
Have you ever had something like that?

Speaker 5 (15:16):
I'm not sure.

Speaker 4 (15:17):
I don't read.

Speaker 3 (15:18):
No, you definitely need that. Yeah, if you haven't had that.
Now the question is, well, you know, if it's just
you know, a lazy bladder and you have some difficulty,
but you're not developing, you know, urinary tract infections, and
you're you're still able to at the end of the day,
Let's say, at the end of your urination, you're still
able to get your urine out and you're not retaining

(15:41):
lots of urine. Because if you're retaining urine, and I've
said this many times on the show, you're putting yourself
at risk for urinary tract infections. But I think if
you're not retaining and you are, it's just taking you
longer and you have kind of a lazy bladder over
your entire life, there's probably not a lot that you
could do. I would get a Eurodynamics test. And then

(16:03):
there are some newer treatments now for lazy blodder, like
a something called posterior tibial nerve stimulation where they put
these little stimulators on the on the back of your
ankle that stimulates the nerve that connects to the bladder.
That could potentially help you. There's things that can be
placed into the back. It's called sacral you know, neural modulators.

(16:28):
So there are some new treatments over the last few years.
My friend, I would get back into. If you know,
Matt Rutman is still practicing. He's at Colombia in the city.
I know him well. He's a good guy, and you know,
get a Eurodynamics test for sure, and have him check
you out, do an ultrasound, get of your bladder, of

(16:48):
your kidneys for sure, and get the eurodynamics and then
let's see what he says. But that's what I would do.

Speaker 5 (16:54):
Okay, As I listened to you, I remember back when
I was seventeen years old, I had I had a
football injury, ruptured spleen and you know, they had a
catheter in me for some time, and I wonder, is
there any possibility that some maybe some damage happened. I
always thought that it was my brain wasn't able to

(17:15):
tell my Uh.

Speaker 3 (17:17):
Could I mean, how long was the catheter in for?

Speaker 4 (17:21):
Uh?

Speaker 5 (17:21):
It was at least several days?

Speaker 3 (17:25):
No, no way? Uh okay, So I don't think so much, friend.
I mean, you've had a catheter in for months and months,
then your bladder is not going to be working. Then
I'd say, yeah, I mean that's not great. That could
affect your bladder functioning. But I mean, listen, it could
be that this is just the way that you were born.
You've got a lazy bladder. And again, as long as
you're not getting infections, as long as you're empty, as

(17:45):
long as you don't have any kidney swelling, you're probably
not gonna be able to do anything for it. But
I maybe that there's some newer, you know, techniques like
the posteriortial nerve or the neural the sacral neural modulators.
I would go back.

Speaker 5 (18:00):
Eurodynamics test is.

Speaker 3 (18:01):
What it's called, right, eurodynamics, my friend, that's okay the
way to go. Okay, thank you, my friend, thanks for calling.
We got Frank up next here on Kats's corner. If
you're just listening. You want to give me a call.
I got a few minutes left one eight hundred three
two one zero seven to ten. Frank, how are you.

Speaker 4 (18:17):
Hey, doctor? I'm good, Thank you doctor. Last May I
had a year in every tracking section. This past May,
I want to see my GP. I told him I'm
experiencing pain and burning when I urinate in my penis.
So he put me on antibiotics for a week. The

(18:40):
infection went away, but it came right back. So he
put me on anibiotics for two weeks, and this time
it wiped the infection out. But the past few days,
the last two or three days, I'm noticing not every
time when I urinate, but for the most part, I
feel the pain and the burning again. Now, could this
be something other than a urinary tract infection? And I

(19:02):
read that woman mainly get repeated in terinary track.

Speaker 3 (19:06):
How old are your friends? How old are seventy two?
And have you seen a urologist?

Speaker 4 (19:14):
No? Not yet.

Speaker 3 (19:15):
Yeah, you need to see a eurologists because you know
you're probably not emptying your bladder or there could be
an anatomic abnormality within your bladder or perhaps your kidneys
that's causing you to have recurrent infection. Maybe it's a stone.
Maybe there's an abnormality, like your prostrate is too large
and you're not emptying your bladder. You need to hear eurologists.

Speaker 4 (19:34):
My friend, where do you live in New Jersey?

Speaker 3 (19:38):
Okay? Well, you could either come to the city. NYU
has offices in the city, of course, I see patients
in the city at the NYU Men's Center on fifty
fifth in Madison, or you can call you know, any
one of the NYU locations. But you know, the fact
is you do need a urologist. If you're a male
having recurrent urinary tract infections, you do need to be
evaluated because if there's an abnormality there, you're going to

(20:02):
continue to get that infection. Now you know, it could
be not emptying the bladder. As I said, maybe you've
got a stone, maybe you've got a large prostate, maybe
you've got a prostate infection. But certainly you need eurological evaluation.
Your Internet should be sending you over to a urologist.

Speaker 4 (20:19):
Okay. And he also did a complete blood work on me,
my general practitioner, and tell me my kidneys were functioning fine.
According to the blood work.

Speaker 3 (20:29):
Okay, that's fine, Okay, good, love to hear that. But
have you had an ultrasound of your kidneys? I mean
you could have normal kidney functioning, one kidney could be
blocked and the other kidney could be normal, and you
could still your blood work could look normal, but you know,
it still could be an underlying issue. Okay. I mean,
of course it's good that your overall kidney function is nice,
but you you definitely need to get that evaluated, my friend,

(20:55):
because recurrent infections is not normal.

Speaker 4 (20:58):
Now, what are your all just do that a GP
would do. Besides the scan of the kidneys.

Speaker 3 (21:05):
Well, there's an ultrasound of the bladder that they could
do in the office. There's repeat cultures that could be done,
of course by the internest. And then the possibility that
you might need what's called a cystoscopy, which is a
look inside the bladder to see if there's bladder stones,
if there's a bladder tumor if there's a blockage of
your prostate. So those are things that an internist cannot

(21:28):
do and may need you may need to have that done.
This is what we deal with every day, you know.
So I you know again, I sound like a broken record,
I guess, but this is what I would recommend. You're
asking me over the phone. You've got recurrent infections your seventies.
In your seventies, you need eurological evaluation period.

Speaker 4 (21:49):
And where were you located in New York City?

Speaker 3 (21:53):
I see patients on fifty fifth in Madison, five to
five to five Madison Avenue. It's at the one of
the NYU locations. It's the ny you Men Center, beautiful
center actually located in central Manhattan. But there are other
urologists in the city part of NYU that you could
see as well. But if you wanted to see me,
that's where I am in New York.

Speaker 4 (22:13):
Okay, okay, great, thank you, Donson, have a good day.

Speaker 3 (22:16):
Okay, my friend, Okay, be well, Okay, but definitely do that. Yeah,
I mean, this is the situation. You know. I see
men all the time, and if you're not emptying the bladder,
maybe you want to try erbal things. Can you try rbals?

Speaker 4 (22:30):
Yeah?

Speaker 3 (22:31):
You could. I've had great success with many different types
of herbal things in my practice. I have been known
to have a holistic bent, if you will to my
practice where we use some herbals like salt palmettos thing, nettles,
pumpkin seeds. There's a compound called Zeiflemen that I've used
for many years that can be helpful for many men.

(22:53):
But if you are retaining lots of urine and you're
getting infections, you may need a medication. We have lots
of different medications now. Of course, the old standard flomax
tamsilosin has been around for god knows how many years,
at least probably forty years. There's something called Wrappa flow
so lotus in. There's something called uroxatrol alflus usin. There's

(23:16):
a maybe the newer one on the block, which is
not so new anymore, which is used for sexual help
as well as urinary help. Is Cialis t dalaphill can
be used as a five milligram dose, a low dose
every day, and that can be helpful for both urinary
and sexual function. And you know you should also I

(23:37):
didn't tell this, gentleman, but you should also check his PSA. Now,
you don't want to check your PSA when you've got
a urinary tract infection. That's something you don't want to
do because you're gonna get a false elevation. Then you're
gonna freak out and your PSA is going to be
too high, especially if you have an infection. So get
your infection clear and then get a PSA, you know,
and you want to know what your PSA is. I
should have asked them that, but I didn't. But you know,

(24:00):
that would be something that you'd want to do. And
sometimes I have patients that are on both medications and
the herbal things, you know, combination. And if that is
combination is still not working and you're still getting infections
and you're retaining urine and you're having lots of urinary issues,
you know, with burning frequency, urgency, getting up at night,

(24:20):
running to the bathroom, weak stream, then you might need
a procedure, you know. And that's what we do as urologists.
We evaluate and we determine if you need a procedure
or not. Now, you know, one of the things I
was talking to this future residence yesterday was you know,
it's not about Yeah, we can do procedures, and we
will teach you to do the procedures. That's that's a

(24:43):
that's a very very important part of the residency. But
a more important part, I think is determining who should
have a procedure and who should not have a procedure,
you know, determining when to do the procedure. Not everybody
that walks into your office, he's a procedure, and then
selecting the proper pers today for the prostate issues. If
this gentleman that we just spoke with has a prostate issue,

(25:05):
well used to be just the gold standard, you know,
scrape out the prostate. Well no, not anymore. We have
ways now of taking these small little metallic clips and
pushing it back and pushing the prostate back. That's called
a euro lift. We do that quite a bit here
for patients that need that. We have a procedure called

(25:26):
aqua oblation, which is a robotic driven procedure using high
powered water jets. For patients that have larger prostates that
that can be done effectively. We can robotically remove the
prostate if you need to have that, based upon your size.
So there's lots of different ways of treating it medically, herbally,

(25:50):
you know, non non traditionally let's say, you know, using
herbs or using medication, and then sometimes procedures. And here
at NYU we have all of the latest and greatest
you know, bells and whistles of procedures and surgeons that
are very experienced at them. But like I tell everyone,
you know, there's always risks and benefits, and you know,

(26:14):
if you're really miserable, the benefit is going to certainly
outweigh any risk, and the risk of these procedures. There
are some risks, yes, but they're relatively small, especially in
our hands where we're doing very high volume. And I
started out the show this morning. You know, we're getting
an increase in our resident complement because we're doing a
high volume, and we're seeing lots of patience here, thankfully,

(26:36):
because we are number two in the entire nation and
we're number one in New York. And unfortunately that's the
end of the show. But I'm going to continue to
come here live on Sundays and talk with you all.
So remember if you want to talk with me next week,
great one eight hundred and three to two one zero

(26:56):
seven ten, or you can email me this week Men's
Health at NYU land going dot org. Well, I guess
that's the end of the show. Everyone, have a great Sunday.
Tune in every Sunday here on Katz's Corner, and we'll
be back next week. With a great show. This is
Doctor Aaron Katts.

Speaker 2 (27:22):
You've been listening to Katz's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice on how to live your
healthiest life.

Speaker 1 (27:33):
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