September 20, 2023 • 21 mins
In this segment, Dr. Mistry and Donna Lee is joined by interventional radiologist Dr. Preston Smith of Summit IR. One of the most common procedures Dr. Smith performs is prostate artery embolization, which shrinks an enlarged prostate by cutting off its blood supply. PAE is well-known as a minimally invasive and mostly permanent treatment for BPH. The process of embolization, or blocking an artery, has also been used to treat a variety of conditions from uterine fibroids to arthritic knees--but it's not for everyone. Dr. Smith and Dr. Mistry explain why this procedure is amazingly safe and effective for patients who have been deemed good candidates for PAE. Tune in to learn more about how interventional radiology and whether PAE is right for you! Visit Summit IR online or call 512-828-4300 today!
Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot
Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Speaker 2 (00:07):
Welcome to the Armor Men's Health Show with Dr.
Mystery and Donna Lee.
Speaker 1 (00:15):
Hello
Speaker 3 (00:16):
And welcome to the Armor Men's Health Show. This
is Dr. Mystery , your host,board certified urologist, and
happily joined by my wonderfulco-host, Donna Lee. That's
Speaker 4 (00:25):
Right. Welcome everybody. Look , thanks for
listening to the show.
Speaker 3 (00:28):
I have to be nice to you because our listeners like
you more than me.
Speaker 4 (00:30):
That is true.
Speaker 3 (00:31):
You are a , uh, a professional comedian and
right.
Speaker 4 (00:34):
I am. I have a show . Are
Speaker 3 (00:35):
You voted?
Speaker 4 (00:36):
Oh, I am the seventh funniest mom in America per
nick at night
Speaker 3 (00:39):
In , uh, circa 1998.
Speaker 4 (00:42):
1987. Oh , .
No, I'm kidding. . WhenI was in high school. No, it
was a long time ago. Yes. Youdon't have to go that route,
but I still have , I havestreet cred and there you go. I
Speaker 3 (00:53):
Have no comedian or comedian kind of awards, so.
That's right. We are a awardedurology practice, though. N a u
Urology Specialist. Mm-hmm .
, the practicethat I started in 2007 is what
brings you this show. We wouldlove to see you for any
consultation between thenipples and the knees. Donna,
how do people get ahold of usand how do people set us
questions? That's right . If
Speaker 4 (01:12):
You wanna learn more about your favorite holistic
urology group, call us at (512)238-0762. You can visit our
website, armor men'shealth.com. And uh, we're
located in Round Rock, northAustin. South Austin in
Dripping Springs. And I've hadtwo people tell me I talk too
fast. Was that okay?
Speaker 3 (01:28):
That was great.
Okay, good.
Speaker 4 (01:29):
I need to slow down.
.
Speaker 3 (01:31):
We are joined today by one of my favorite people on
this earth, Dr. Preston Smith.
Dr. Preston Smith. Welcometoday. That's
Speaker 4 (01:38):
Nice.
Speaker 5 (01:39):
Hey, thanks for having me on. I like that
introduction.
Speaker 3 (01:42):
. Dr. Smith
is an interventional
radiologist, which is usuallythe sworn enemy of the
urologist. However, we havejoined forces and we are now
taking over the world.
Speaker 5 (01:53):
It's like pinky in the brain.
Speaker 3 (01:55):
. I'm not
sure if our listeners are gonna
be too young or too old to knowthat reference. , which
one's? Pinky? Which one's ? Butteenage ages of 40 and 50.
You'll know. Pinky in the Brainwas all about, well, that
Speaker 4 (02:07):
Dr . Smith's really young. I'm surprised. He knows
. Yeah.
Speaker 3 (02:10):
So , uh, Preston, why don't you tell our
listeners what is the expertiseand education of a
interventional radiologist andhow are they different from a
regular radiologist?
Speaker 5 (02:20):
So back when I trained all of the
interventional radiologiststrained for a year or two after
going through a wholediagnostic radiology program.
So I had to suffer in theemergency room just reading
x-rays and CT scans, and thenafter an internship, and then
four years after that you couldapply to train as an
(02:41):
interventional radiologist. Nowthere is a separate pathway. So
interventional radiologist hasits own pathway that you can
apply to right after medicalschool. It is much more heavily
procedural and medicalmanagement based , whereas
diagnostic radiology is more ofa imaging consultant. I
(03:03):
actually got in , in hot wateron Twitter recently because I
described Oh, no, diagnosticradiology as coaching medicine.
Oh , and interventionalradiology is actually
practicing medicine. Holy, that, that didn't go over well with
a bunch of diagnosticradiologists.
Speaker 3 (03:18):
That's funny .
That's funny. Is probably funny. The nerdiest thing I've heard
all day. . I , I wantto thank you for putting half
of our listeners to sleep. Insimple terms, an interventional
radiologist that's funny issomeone that uses imaging to do
a procedure and that usuallyinvolves needles and biopsies
and so many cool things thatpeople may not even be aware
of. And in urology, we haveintroduced the interventional
(03:39):
radiology component forenlarged prostate management.
So, you know, our listeners getto hear me talk about prostate
stuff all the time. Preston,why don't you explain to our
listeners how you describeenlarged prostate and the
interventions that you do forour patients.
Speaker 5 (03:53):
So I tend to describe a large prostate as
something that half the menover 50 and you know, 70% of
the men over 70, it just sortof goes up and up and up as you
grow older. And one of the mostcommon questions I get from
patients is, why is thishappening to me? And I say, you
know, we don't exactly know,but it's related to your
testosterone. And then theysay, oh, I have low T and I'm
(04:16):
like, well if any t it'srelated to your testosterone.
Mm-hmm . , andthis in large prostate problem
causes many issues urinatingfor guys. And there are lots of
treatments that urologists havebeen providing over time, but I
can provide a treatment from atotally different avenue. And
(04:36):
specifically it is an angiogramwhere we go into the artery,
identify the prostate arteries,and then we drastically or
heavily slow down the bloodflow , uh, that is supplying
the prostate clan. And thatsignals to the body through
sort of a complex series ofcell signaling that the
prostate needs to get smallerbecause it's not getting enough
(04:58):
oxygen. And then in acontrolled fashion, slowly over
time after we do thisprocedure, the prostate will
shrink down and the majority ofthe patients have relief from
their urinary symptoms.
Speaker 3 (05:08):
So prostate artery embolization is this cutting
edge type of treatment that notall urology practices will
offer. And it is part of ourarmamentarium for dealing with
your enlarged prostate andurinary symptoms. When you come
and see us as a patient, you'regonna be given lots of
different options for yourprostate. Depending on the size
(05:28):
and the severity of yoursymptoms, you may be offered
medication. But medication forthe long term is something that
we tend to wanna discourage.
These alpha blockers likeFlomax, tamsulosin, fussin ,
psilocin , they cause yourblood pressure to decrease and
in the long term can contributeto cognitive decline as well as
fatigue. And so we don't likethis, you know, especially as
(05:51):
you get older. So depending onthe size of your prostate, you
can be offered a number ofmaximally or minimally invasive
treatments. When it comes toprostate artery embolization,
we do this right in the office,right, Dr. Smith?
Speaker 5 (06:02):
Yes. We have a , a nice cath lab, which is a , a
place for us to do live x-ray ,uh, built on the backside of
the office that is in the northside of Austin. It feels much
like a kind of little operatingroom inside of the office. It's
mm-hmm . , brandnew shiny,
Speaker 4 (06:19):
And Dr. Smith likes it to be 60 degrees in there .
Speaker 3 (06:22):
Yes. It has to be cold and you'll get a little
bit of an anesthetic. So alittle bit of something to kind
of sedate you so you don'tmove. And then , uh, how , how
do you access the arterialsystem? What, what , what ,
what's your access method?
Speaker 5 (06:32):
So back in the day, we used to just kind of feel
around for the artery and thenaccess it with a needle. And
nowadays we have so , so muchbetter technology than when I
first started training. We haveultrasound machines to guide
these very small needles in. Soit has essentially eliminated
any of these complications thatyou get from just kind of
(06:55):
fishing around with a needletrying to get inside of an
artery. Mm-hmm . So we mm-hmm .
We guide our small artery andthen our small access port into
the femoral artery is theartery that it people can feel
in their groin. Do you like to
Speaker 4 (07:06):
Say in front of patients? Oh, there it is.
.
Speaker 5 (07:09):
They are ,
but believe it, or oops ,
Speaker 4 (07:12):
As a joke,
Speaker 5 (07:13):
, uh,
depending on how sleepy there
are, I'll , I'll mess with that. That's
Speaker 4 (07:18):
True. They're probably
Speaker 5 (07:19):
Out . But yeah, our, our our , uh, nurse anesthetist
is excellent. So we, we havemost of the patients very
sleepy for the procedure andthey don't smart, they don't
remember it, you know, afterwe're done. And how
Speaker 3 (07:31):
Long does it take?
Speaker 5 (07:32):
It takes about an hour and 10 minutes.
Speaker 3 (07:34):
And then , uh, afterwards , uh, when can
patients start experiencingsome improvement in their
urinary symptoms? It
Speaker 5 (07:40):
Is variable, but generally it will happen
somewhere around 10 to 14 days.
Speaker 3 (07:44):
I mean, it's, it's a revolution when it comes to a
very specific type of patient.
So, you know, men don't likethe idea of having something
put in their penis. They don'tlike the idea of a catheter
postoperatively. They wantsomething that's not going to
affect their sexualfunctioning. It almost seems
like the perfect kind ofconfluence of trade-offs is to
(08:06):
get this prostate arteryembolization. And I think that
adding it to the armamentariumis really important, but not
all urologists offer it. And ,uh, I'd I'd love for you to
tell us why
Speaker 4 (08:16):
Oh, money.
Oh, I mean, sorry, what?
Speaker 5 (08:18):
Well, yeah, we're supposed to dance around it and
then lead people to the answer.
Right. I'll just put thatthere. In medicine, there are
often multiple things that youcan do to treat a problem. And
sometimes those solutions areproposed by different
specialists.
Speaker 3 (08:32):
So there's turf battles. So, you know, this
idea that your prostate wouldnot be treated by urologists
seems alien to some, and itkind of in some ways make some
urologists feel like it'staking a procedure or money
away from their pocket mm-hmm .
to be able to dosomething. But, you know, over
the years, so many of mypatients have just flat out
refused any procedure becausethey do not want, want a
(08:55):
catheter, they don't want anovernight stay. They don't want
anything that's gonna causeretrograde, you know, no, no,
no, no, no. I'll just live likeI am. And so the prostate
artery embolization fits aperfect niche for so many of
our patients. So, whichpatients are not going to be
great candidates for prostateartery embolization
Speaker 5 (09:13):
Patients that have, excuse me, I just had a voice
crack there. Oh , uh, you'restill growing patients.
Patients that have prostatesthat are very small may not be
as good of candidates. Althoughif Dr . Mystery shows that they
do have en large prostate on acystoscopy like a , a camera
study, then we still may do theprocedure. Patients that have
(09:35):
severe peripheral arterydisease, which is the hardening
of the arteries that is causedby high blood pressure smoking
and a couple of other things,those patients may develop
blockages or narrowings , uh,in their arteries. And that
makes it difficult or sometimesimpossible for us to do the
procedure. But other than that,that's about it. Oh . And
patients with , uh, kidneydisease that can't get contrast
(09:57):
dye because we have to use dyex-ray dye to use the procedure
makes ,
Speaker 3 (10:01):
That's a great one to remember. So we're gonna
come back and we're gonna talkmore about prostate artery
embolization, and if peoplewant to get a hold of you
directly, they can call summitir. What's your phone number?
Do you know
Speaker 5 (10:13):
This happened last time I was on here? I have to ,
I have to pull out the phonenumber.
Speaker 3 (10:16):
You guys are really a piece of work.
Speaker 5 (10:18):
So our office number is 5 1 2 8 2 8 4300
Speaker 3 (10:23):
And it's summit-irad.com.com. But you
can just contact our office atarmor men's health.com and our
regular phone number, (512)238-0762 and we'll get you
right over. Hello and welcometo the Armor Men's Health Show.
This is Dr. Mystery , yourhost, board certified urologist
men's health expert, joined bymy co-host Donnel Lee . Hey
Speaker 4 (10:45):
Everybody. Welcome back to the show.
Speaker 3 (10:47):
I heard in your younger years you were also
kind of an expert on men'shealth. Hey . Hey
Speaker 4 (10:51):
. Just the
lower regions,
Speaker 3 (10:53):
Just the lower
Speaker 4 (10:53):
In college
Speaker 3 (10:55):
. Oh boy. Uh
, this is at Men's Health Show.
We deal with issues between thenipples and the knees in our
practice, n a u Urologyspecialists, we have an amazing
team of physicians and advancedpractice providers that are
here to take care of you in themost revolutionary and cutting
edge way. That's
Speaker 4 (11:14):
Right. We are available to you all the time
if you need anything at all. Iwould like to reference the
previous segment with Dr. Smiththat Yes, if you would like for
him to insult you on Twitter aswell, you can reach out to us
at 5 1 2 2 3 8 0 7 6 2 and ourwebsite is armor mens
health.com.
Speaker 3 (11:29):
Especially if you are a weak need diagnostic
radiologist.
Speaker 5 (11:33):
. It's not
helping . This is
Speaker 4 (11:35):
. You know
what you told us about it. So
Speaker 3 (11:37):
Dr. Preston is an interventional radiologist. He
is the latest addition to theJurassic Park that we call n a
u urology specialist. He makesa fifth doctor, four urologists
and one interventionalradiologist. An amazing
addition cutting edge . Uh ,probably the first one in
Texas. I don't know anyone thathas an interventional radiology
program in the entire state.
(11:57):
No, as far as I know. Right .
And it's so that we can add toour repertoire the prostate
artery embolization procedure.
If you wanna learn more aboutthe prostate artery
embolization for your enlargedprostate. You know who first
talked to me about p a e is myown father. Really? Yes. In
Houston. He's in Houston. Andhe called me 10 years ago and
(12:18):
was like, Sonny , where can Iget this prostate artery
embolization procedure? And Iwould have patients that left
Texas and go to other states inorder to get the prostate
artery embolization. Wow. Andever since my father shamed me
into not knowing enough aboutthat procedure, I have made it
my focus and goal to includethat as part of our approval .
Uh ,
Speaker 5 (12:37):
Is somebody still looking for
Speaker 3 (12:38):
Their father's approval? Perhaps
Speaker 5 (12:41):
Daddy
Speaker 3 (12:41):
Issues? I hope he doesn't hear this .
can't take . I'm sending it tohim. . So Preston, why
don't you tell us kind oftechnically what's some of the
equipment that you use and whatare some of the technical
considerations when it comesto, you know, performing the
best prostate arteryembolization procedure?
Speaker 5 (12:59):
So we use, first off an X-ray machine. It is a
little different than a, anormal, you know, fixed x-ray
machine that someone may go gettheir, you know, let's say they
, they broke their forearm likesomebody I know I e my
girlfriend. But it's a littledifferent than that. It's
called a C-arm. So it is, it'smobile and it allows us to see
(13:20):
what we're doing inside of yourbody. We also use what I call a
catheter. It can be confusingto some patients because when
they hear catheter, they thinkof a bladder catheter,
especially
Speaker 3 (13:30):
When they're in a urology office. Yes ,
Speaker 5 (13:31):
Mm-hmm.
. So we're reallysetting them up for getting
confused. But , uh, ourcatheters are angiographic or
catheters that are used to doan angiogram, which is a die
study of a vessel. So they'remuch smaller, they're much more
like a long iv and they havemany different shapes to them.
And those catheters will allowus to get inside of arteries
(13:53):
that are not just a , you know,a straight highway. So we can
get inside curved arteries,double curved arteries, hairpin
turned arteries. They are manydifferent catheter shapes. So
we use this X-ray machine. Thisis like F one. That's right,
exactly. I know F one
Speaker 3 (14:07):
For the veins.
Arteries. Arteries, sorry.
Speaker 5 (14:09):
So we use, we use that and then some wires to
kind of help snake thiscatheter inside of arteries.
And in this case, we combineall these things together and
we will identify by injectingdye through the catheter and
then work a catheter into theprostate arteries. And we do
all this with the live x-raymachine kind of going as
(14:30):
needed. And then once we are inthe right spot into the
arteries that are feeding theprostate, which is usually one
per side , uh, we will dripthese small beads, these small
medical grade plastic beadsinto the prostate arteries. And
the beads I use , uh, are alittle less than a half
millimeter in size.
Speaker 3 (14:50):
Wow. It's funny you, you mentioned that , uh, you
know what , I have probablybeen gifted with some of the
most amazingly self-taughtpatients on earth. They're
Google experts. It's Dr . Andone of them the other day
visited us from outta state andasked me what size bets Wow .
You used . I was like, I haveno idea. That's a pretty
specific question. So , so you, you , you use beads that are
(15:11):
about 500 nanometers. They
Speaker 5 (15:12):
Are 300 to 500 microns. Okay . Those are,
those are the microns wow comcommon size , so 0.3 to 0.5
milli millimeters.
Speaker 3 (15:22):
Millimeters. Wow.
And about how many beads likego into like an artery in case
some patient asks me next day . Yeah .
Speaker 5 (15:28):
It's , it's, I , I tell people if, 'cause that's
about the size of a grain ofsand or a little bigger than
grains of sand. So I'll tellpeople, if you just took , uh,
a generous pinch of sand, youknow, we will probably use a
quarter of that. And , and Imean, just with your fingers,
not the palm of your hand, notgrabbing it just like mm-hmm .
, like a pinch ofsalt, like a , a big pinch of
(15:49):
salt. Mm-hmm. ,we probably use half of that or
less than half of that , but
Speaker 3 (15:52):
You're able to check in real time whether or not the
blood flow through that arteryis being obstructed properly.
So you'll use more or less ofthe beads in order to
appropriately occlude thatartery. Yeah .
Speaker 5 (16:01):
It's , it's highly variable. It's generally, so a
big pinch of sand is how muchcomes in like one dose, you
know, it's , it's mm-hmm .
, it's , it'sabout two cubic centimeters and
it's rare that I'll use thewhole thing whenever I'm using
the whole thing. I'm like, ohmy gosh.
Speaker 3 (16:14):
So explain to me physiologically, because I
know, but our listeners may notknow, why don't the beads go
anywhere else?
Speaker 5 (16:21):
So as, yeah. As arteries kind of break into
more and more branches and theybreak into an almost
innumerable number of branchesby the time you get to the
capillaries mm-hmm.
, so half of amillimeter in size is way, way
higher up in the branching ofthe tree. So those beads will
get stuck, let's say after anartery branches into just
(16:45):
eight, eight arteries. And theywill get lodged in there. Like
I tell 'em , like a fat guytrying to get through a door
and they'll get stuck. And so Idon't think you can say that
anymore. Yeah. I don't, youcan't say it . No . Especially
Speaker 3 (16:55):
When a large
Speaker 5 (16:56):
Heavy
Speaker 3 (16:56):
Or a large man man can't say of these things , a
big man coming through a tinycat door
Speaker 5 (17:01):
. Yeah. A
small guy or a big guy or , or
a , a big guy trying to put ona small coach jacket . There we
go, Tommy, Tommy boy, .
Um, so once those beads getstuck in there, the blood flows
in one direction or generallyone direction only. So your
blood flow is going to be kindof hammering with your pulse,
these beads into a smaller thanspace than they are. And these
(17:24):
beads are kind of like rubberbouncing balls. They're a
little squishy, so they getlike squeezed into whatever
space they are and then they'restuck there so they don't wash
through and come back out andgo somewhere, somewhere else or
swim against. They're notsalmon, they don't swim against
the , uh, the current of yourblood . Here's our
Speaker 3 (17:41):
T-shirt. Another thing
Speaker 5 (17:42):
People beads are not salmon.
Speaker 3 (17:44):
Yeah . Another thing that , uh, uh, patients , uh,
are frequently concerned aboutis like this idea that you're
cutting blood flow off to anorgan. Like doesn't it die? And
so I I kind of explain it's alittle bit like yeah . You know
, uh, uh, choking , uh,
Speaker 5 (18:00):
For those who
Speaker 3 (18:00):
Like that, for those who like that , uh, it's a
little bit of excellent choking, uh, but not completely
choking to death becausethere's other blood flow to the
prostate, you know, from theurethra, from the bladder, from
the penis. And so the prostatedoesn't completely die. Right.
Speaker 5 (18:14):
It , yeah, it doesn't, it's, I , I mean,
they've done studies on thiswhere they, you know, before we
tried this out on humans,luckily we have the F D A who
says, you gotta show me thatthis works on something else.
So, you know, at the risk ofoffending peta , I'll tell you
they did this on like pigs, youknow? Mm . And they embolized
the prostate using the samesize beets we do, and then they
took the prostate out andlooked at it and the prostate
(18:36):
doesn't die or necros rightaway. Mm-hmm . ,
they're tiny areas of it thatdo just right next to blood
vessels, but your body canhandle that. But most of the
prostate shrinks down andthey're like sunny explained,
there are two, there are tworeasons for that. One, the ,
the prostate has a bunch ofdifferent blood supplies,
alternate pathways, and thentwo, the bigger particles you
(18:58):
use . So if we used 500 to 700or all the way up to a a
millimeter in size particles orbeads , uh, red blood cells can
kind of sneak around thesebigger beads. So if we use
really small ones, those getstuck much deeper and they kill
things, you know, more so thesize of the beads we use is
(19:18):
very specific
Speaker 3 (19:19):
Size matters.
Speaker 5 (19:20):
Yes . Size is what we ,
Speaker 3 (19:21):
We believe strongly there's , please reference our
previous Dr . Dellinger penisenlargement , uh, conversation.
So , um, when somebody , uh, isgetting this type of procedure
done, what do you generallytell them about how quickly
they can get back to theirnormal activity? Because they
can get back to golfing prettyquick , right? That's
Speaker 5 (19:38):
The best part.
Mm-hmm . , youknow, you , you just have to
stay away from heavy liftingfor 48 hours. And that's really
something that I told peoplethat, you know, in the old
days, in older days, yeah. Sowe surprisingly knock on wood
out of like over 250 patientsthat we've only specifically
done prostate embolization to ,no one has had a real groin
(19:59):
complication, which is prettyunbelievable. And so that means
that either means our patientsare following their directions
Exactly. Which I sometimesdon't believe or . Um,
we could, they could probablydo even more. They can pretty
much walk out on their own.
They have to, yeah. Yeah .
They're walking.
Speaker 3 (20:15):
And a lot of our listeners are gonna go online
and see like a company likeAustin Radiologic Association
or a r a offer, the sameprostate artery embolization,
but this, these areunsupervised radiologists. You
need a urologist that's workingwith your radiologist to get
the best possible outcome. Andso I highly discourage people
(20:36):
to going just straight to aradiologist to get this done.
Even though it's a somewhatunique offering. We take all
insurances, we will do acompletely thorough evaluation
and make sure that yourlifestyle and your expectations
are met. So , uh, when it comesto prostate artery embolization
, uh, urology radiologycollaboration is something I
(20:57):
cannot emphasize more. Donna,how do people get more
information and get ahold ofus? That's
Speaker 4 (21:01):
Right. You can call us at (512) 238-0762 and visit
our website, armor men'shealth.com.
Speaker 2 (21:08):
The Armor Men's Health Show is brought to you
by N a U Urology Specialist.
For questions or to schedule anappointment, please call 5 1 2
2 3 8 0 7 6 2 or online atarmor men's health.com.
Speaker 2 (00:07):
Welcome to the Armor Men's Health Show with Dr.
Mystery and Donna Lee.
Speaker 1 (00:15):
Hello
Speaker 3 (00:16):
And welcome to the Armor Men's Health Show. This
is Dr. Mystery , your host,board certified urologist, and
happily joined by my wonderfulco-host, Donna Lee. That's
Speaker 4 (00:25):
Right. Welcome everybody. Look , thanks for
listening to the show.
Speaker 3 (00:28):
I have to be nice to you because our listeners like
you more than me.
Speaker 4 (00:30):
That is true.
Speaker 3 (00:31):
You are a , uh, a professional comedian and
right.
Speaker 4 (00:34):
I am. I have a show . Are
Speaker 3 (00:35):
You voted?
Speaker 4 (00:36):
Oh, I am the seventh funniest mom in America per
nick at night
Speaker 3 (00:39):
In , uh, circa 1998.
Speaker 4 (00:42):
1987. Oh ,
No, I'm kidding.
was a long time ago. Yes. Youdon't have to go that route,
but I still have , I havestreet cred and there you go. I
Speaker 3 (00:53):
Have no comedian or comedian kind of awards, so.
That's right. We are a awardedurology practice, though. N a u
Urology Specialist. Mm-hmm .
brings you this show. We wouldlove to see you for any
consultation between thenipples and the knees. Donna,
how do people get ahold of usand how do people set us
questions? That's right . If
Speaker 4 (01:12):
You wanna learn more about your favorite holistic
urology group, call us at (512)238-0762. You can visit our
website, armor men'shealth.com. And uh, we're
located in Round Rock, northAustin. South Austin in
Dripping Springs. And I've hadtwo people tell me I talk too
fast. Was that okay?
Speaker 3 (01:28):
That was great.
Okay, good.
Speaker 4 (01:29):
I need to slow down.
Speaker 3 (01:31):
We are joined today by one of my favorite people on
this earth, Dr. Preston Smith.
Dr. Preston Smith. Welcometoday. That's
Speaker 4 (01:38):
Nice.
Speaker 5 (01:39):
Hey, thanks for having me on. I like that
introduction.
Speaker 3 (01:42):
radiologist, which is usuallythe sworn enemy of the
urologist. However, we havejoined forces and we are now
taking over the world.
Speaker 5 (01:53):
It's like pinky in the brain.
Speaker 3 (01:55):
be too young or too old to knowthat reference.
one's? Pinky? Which one's ? Butteenage ages of 40 and 50.
You'll know. Pinky in the Brainwas all about, well, that
Speaker 4 (02:07):
Dr . Smith's really young. I'm surprised. He knows
. Yeah.
Speaker 3 (02:10):
So , uh, Preston, why don't you tell our
listeners what is the expertiseand education of a
interventional radiologist andhow are they different from a
regular radiologist?
Speaker 5 (02:20):
So back when I trained all of the
interventional radiologiststrained for a year or two after
going through a wholediagnostic radiology program.
So I had to suffer in theemergency room just reading
x-rays and CT scans, and thenafter an internship, and then
four years after that you couldapply to train as an
(02:41):
interventional radiologist. Nowthere is a separate pathway. So
interventional radiologist hasits own pathway that you can
apply to right after medicalschool. It is much more heavily
procedural and medicalmanagement based , whereas
diagnostic radiology is more ofa imaging consultant. I
(03:03):
actually got in , in hot wateron Twitter recently because I
described Oh, no, diagnosticradiology as coaching medicine.
Oh , and interventionalradiology is actually
practicing medicine. Holy, that, that didn't go over well with
a bunch of diagnosticradiologists.
Speaker 3 (03:18):
That's funny .
That's funny. Is probably funny. The nerdiest thing I've heard
all day.
of our listeners to sleep. Insimple terms, an interventional
radiologist that's funny issomeone that uses imaging to do
a procedure and that usuallyinvolves needles and biopsies
and so many cool things thatpeople may not even be aware
of. And in urology, we haveintroduced the interventional
(03:39):
radiology component forenlarged prostate management.
So, you know, our listeners getto hear me talk about prostate
stuff all the time. Preston,why don't you explain to our
listeners how you describeenlarged prostate and the
interventions that you do forour patients.
Speaker 5 (03:53):
So I tend to describe a large prostate as
something that half the menover 50 and you know, 70% of
the men over 70, it just sortof goes up and up and up as you
grow older. And one of the mostcommon questions I get from
patients is, why is thishappening to me? And I say, you
know, we don't exactly know,but it's related to your
testosterone. And then theysay, oh, I have low T and I'm
(04:16):
like, well if any t it'srelated to your testosterone.
Mm-hmm .
causes many issues urinatingfor guys. And there are lots of
treatments that urologists havebeen providing over time, but I
can provide a treatment from atotally different avenue. And
(04:36):
specifically it is an angiogramwhere we go into the artery,
identify the prostate arteries,and then we drastically or
heavily slow down the bloodflow , uh, that is supplying
the prostate clan. And thatsignals to the body through
sort of a complex series ofcell signaling that the
prostate needs to get smallerbecause it's not getting enough
(04:58):
oxygen. And then in acontrolled fashion, slowly over
time after we do thisprocedure, the prostate will
shrink down and the majority ofthe patients have relief from
their urinary symptoms.
Speaker 3 (05:08):
So prostate artery embolization is this cutting
edge type of treatment that notall urology practices will
offer. And it is part of ourarmamentarium for dealing with
your enlarged prostate andurinary symptoms. When you come
and see us as a patient, you'regonna be given lots of
different options for yourprostate. Depending on the size
(05:28):
and the severity of yoursymptoms, you may be offered
medication. But medication forthe long term is something that
we tend to wanna discourage.
These alpha blockers likeFlomax, tamsulosin, fussin ,
psilocin , they cause yourblood pressure to decrease and
in the long term can contributeto cognitive decline as well as
fatigue. And so we don't likethis, you know, especially as
(05:51):
you get older. So depending onthe size of your prostate, you
can be offered a number ofmaximally or minimally invasive
treatments. When it comes toprostate artery embolization,
we do this right in the office,right, Dr. Smith?
Speaker 5 (06:02):
Yes. We have a , a nice cath lab, which is a , a
place for us to do live x-ray ,uh, built on the backside of
the office that is in the northside of Austin. It feels much
like a kind of little operatingroom inside of the office. It's
mm-hmm .
Speaker 4 (06:19):
And Dr. Smith likes it to be 60 degrees in there .
Speaker 3 (06:22):
Yes. It has to be cold and you'll get a little
bit of an anesthetic. So alittle bit of something to kind
of sedate you so you don'tmove. And then , uh, how , how
do you access the arterialsystem? What, what , what ,
what's your access method?
Speaker 5 (06:32):
So back in the day, we used to just kind of feel
around for the artery and thenaccess it with a needle. And
nowadays we have so , so muchbetter technology than when I
first started training. We haveultrasound machines to guide
these very small needles in. Soit has essentially eliminated
any of these complications thatyou get from just kind of
(06:55):
fishing around with a needletrying to get inside of an
artery. Mm-hmm . So we mm-hmm .
We guide our small artery andthen our small access port into
the femoral artery is theartery that it people can feel
in their groin. Do you like to
Speaker 4 (07:06):
Say in front of patients? Oh, there it is.
Speaker 5 (07:09):
They are
Speaker 4 (07:12):
As a joke,
Speaker 5 (07:13):
are, I'll , I'll mess with that. That's
Speaker 4 (07:18):
True. They're probably
Speaker 5 (07:19):
Out . But yeah, our, our our , uh, nurse anesthetist
is excellent. So we, we havemost of the patients very
sleepy for the procedure andthey don't smart, they don't
remember it, you know, afterwe're done. And how
Speaker 3 (07:31):
Long does it take?
Speaker 5 (07:32):
It takes about an hour and 10 minutes.
Speaker 3 (07:34):
And then , uh, afterwards , uh, when can
patients start experiencingsome improvement in their
urinary symptoms? It
Speaker 5 (07:40):
Is variable, but generally it will happen
somewhere around 10 to 14 days.
Speaker 3 (07:44):
I mean, it's, it's a revolution when it comes to a
very specific type of patient.
So, you know, men don't likethe idea of having something
put in their penis. They don'tlike the idea of a catheter
postoperatively. They wantsomething that's not going to
affect their sexualfunctioning. It almost seems
like the perfect kind ofconfluence of trade-offs is to
(08:06):
get this prostate arteryembolization. And I think that
adding it to the armamentariumis really important, but not
all urologists offer it. And ,uh, I'd I'd love for you to
tell us why
Speaker 4 (08:16):
Oh, I mean, sorry, what?
Speaker 5 (08:18):
Well, yeah, we're supposed to dance around it and
then lead people to the answer.
Right. I'll just put thatthere. In medicine, there are
often multiple things that youcan do to treat a problem. And
sometimes those solutions areproposed by different
specialists.
Speaker 3 (08:32):
So there's turf battles. So, you know, this
idea that your prostate wouldnot be treated by urologists
seems alien to some, and itkind of in some ways make some
urologists feel like it'staking a procedure or money
away from their pocket mm-hmm .
the years, so many of mypatients have just flat out
refused any procedure becausethey do not want, want a
(08:55):
catheter, they don't want anovernight stay. They don't want
anything that's gonna causeretrograde, you know, no, no,
no, no, no. I'll just live likeI am. And so the prostate
artery embolization fits aperfect niche for so many of
our patients. So, whichpatients are not going to be
great candidates for prostateartery embolization
Speaker 5 (09:13):
Patients that have, excuse me, I just had a voice
crack there. Oh , uh, you'restill growing patients
Patients that have prostatesthat are very small may not be
as good of candidates. Althoughif Dr . Mystery shows that they
do have en large prostate on acystoscopy like a , a camera
study, then we still may do theprocedure. Patients that have
(09:35):
severe peripheral arterydisease, which is the hardening
of the arteries that is causedby high blood pressure smoking
and a couple of other things,those patients may develop
blockages or narrowings , uh,in their arteries. And that
makes it difficult or sometimesimpossible for us to do the
procedure. But other than that,that's about it. Oh . And
patients with , uh, kidneydisease that can't get contrast
(09:57):
dye because we have to use dyex-ray dye to use the procedure
makes ,
Speaker 3 (10:01):
That's a great one to remember. So we're gonna
come back and we're gonna talkmore about prostate artery
embolization, and if peoplewant to get a hold of you
directly, they can call summitir. What's your phone number?
Do you know
Speaker 5 (10:13):
This happened last time I was on here? I have to ,
I have to pull out the phonenumber.
Speaker 3 (10:16):
You guys are really a piece of work.
Speaker 5 (10:18):
So our office number is 5 1 2 8 2 8 4300
Speaker 3 (10:23):
And it's summit-irad.com.com. But you
can just contact our office atarmor men's health.com and our
regular phone number, (512)238-0762 and we'll get you
right over. Hello and welcometo the Armor Men's Health Show.
This is Dr. Mystery , yourhost, board certified urologist
men's health expert, joined bymy co-host Donnel Lee . Hey
Speaker 4 (10:45):
Everybody. Welcome back to the show.
Speaker 3 (10:47):
I heard in your younger years you were also
kind of an expert on men'shealth. Hey . Hey
Speaker 4 (10:51):
Speaker 3 (10:53):
Just the lower
Speaker 4 (10:53):
In college
Speaker 3 (10:55):
We deal with issues between thenipples and the knees in our
practice, n a u Urologyspecialists, we have an amazing
team of physicians and advancedpractice providers that are
here to take care of you in themost revolutionary and cutting
edge way. That's
Speaker 4 (11:14):
Right. We are available to you all the time
if you need anything at all. Iwould like to reference the
previous segment with Dr. Smiththat Yes, if you would like for
him to insult you on Twitter aswell, you can reach out to us
at 5 1 2 2 3 8 0 7 6 2 and ourwebsite is armor mens
health.com.
Speaker 3 (11:29):
Especially if you are a weak need diagnostic
radiologist.
Speaker 5 (11:33):
Speaker 4 (11:35):
Speaker 3 (11:37):
Dr. Preston is an interventional radiologist. He
is the latest addition to theJurassic Park that we call n a
u urology specialist. He makesa fifth doctor, four urologists
and one interventionalradiologist. An amazing
addition cutting edge . Uh ,probably the first one in
Texas. I don't know anyone thathas an interventional radiology
program in the entire state.
(11:57):
No, as far as I know. Right .
And it's so that we can add toour repertoire the prostate
artery embolization procedure.
If you wanna learn more aboutthe prostate artery
embolization for your enlargedprostate. You know who first
talked to me about p a e is myown father. Really? Yes. In
Houston. He's in Houston. Andhe called me 10 years ago and
(12:18):
was like, Sonny , where can Iget this prostate artery
embolization procedure? And Iwould have patients that left
Texas and go to other states inorder to get the prostate
artery embolization. Wow. Andever since my father shamed me
into not knowing enough aboutthat procedure, I have made it
my focus and goal to includethat as part of our approval .
Uh ,
Speaker 5 (12:37):
Is somebody still looking for
Speaker 3 (12:38):
Their father's approval? Perhaps
Speaker 5 (12:41):
Daddy
Speaker 3 (12:41):
Issues? I hope he doesn't hear this .
can't take . I'm sending it tohim.
don't you tell us kind oftechnically what's some of the
equipment that you use and whatare some of the technical
considerations when it comesto, you know, performing the
best prostate arteryembolization procedure?
Speaker 5 (12:59):
So we use, first off an X-ray machine. It is a
little different than a, anormal, you know, fixed x-ray
machine that someone may go gettheir, you know, let's say they
, they broke their forearm likesomebody I know I e my
girlfriend. But it's a littledifferent than that. It's
called a C-arm. So it is, it'smobile and it allows us to see
(13:20):
what we're doing inside of yourbody. We also use what I call a
catheter. It can be confusingto some patients because when
they hear catheter, they thinkof a bladder catheter,
especially
Speaker 3 (13:30):
When they're in a urology office. Yes ,
Speaker 5 (13:31):
Mm-hmm.
confused. But , uh, ourcatheters are angiographic or
catheters that are used to doan angiogram, which is a die
study of a vessel. So they'remuch smaller, they're much more
like a long iv and they havemany different shapes to them.
And those catheters will allowus to get inside of arteries
(13:53):
that are not just a , you know,a straight highway. So we can
get inside curved arteries,double curved arteries, hairpin
turned arteries. They are manydifferent catheter shapes. So
we use this X-ray machine. Thisis like F one. That's right,
exactly. I know F one
Speaker 3 (14:07):
For the veins.
Arteries. Arteries, sorry.
Speaker 5 (14:09):
So we use, we use that and then some wires to
kind of help snake thiscatheter inside of arteries.
And in this case, we combineall these things together and
we will identify by injectingdye through the catheter and
then work a catheter into theprostate arteries. And we do
all this with the live x-raymachine kind of going as
(14:30):
needed. And then once we are inthe right spot into the
arteries that are feeding theprostate, which is usually one
per side , uh, we will dripthese small beads, these small
medical grade plastic beadsinto the prostate arteries. And
the beads I use , uh, are alittle less than a half
millimeter in size.
Speaker 3 (14:50):
Wow. It's funny you, you mentioned that , uh, you
know what , I have probablybeen gifted with some of the
most amazingly self-taughtpatients on earth. They're
Google experts. It's Dr . Andone of them the other day
visited us from outta state andasked me what size bets Wow .
You used . I was like, I haveno idea. That's a pretty
specific question. So , so you, you , you use beads that are
(15:11):
about 500 nanometers. They
Speaker 5 (15:12):
Are 300 to 500 microns. Okay . Those are,
those are the microns wow comcommon size , so 0.3 to 0.5
milli millimeters.
Speaker 3 (15:22):
Millimeters. Wow.
And about how many beads likego into like an artery in case
some patient asks me next day
Speaker 5 (15:28):
It's , it's, I , I tell people if, 'cause that's
about the size of a grain ofsand or a little bigger than
grains of sand. So I'll tellpeople, if you just took , uh,
a generous pinch of sand, youknow, we will probably use a
quarter of that. And , and Imean, just with your fingers,
not the palm of your hand, notgrabbing it just like mm-hmm .
(15:49):
salt. Mm-hmm.
less than half of that , but
Speaker 3 (15:52):
You're able to check in real time whether or not the
blood flow through that arteryis being obstructed properly.
So you'll use more or less ofthe beads in order to
appropriately occlude thatartery. Yeah .
Speaker 5 (16:01):
It's , it's highly variable. It's generally, so a
big pinch of sand is how muchcomes in like one dose, you
know, it's , it's mm-hmm .
it's rare that I'll use thewhole thing whenever I'm using
the whole thing. I'm like, ohmy gosh.
Speaker 3 (16:14):
So explain to me physiologically, because I
know, but our listeners may notknow, why don't the beads go
anywhere else?
Speaker 5 (16:21):
So as, yeah. As arteries kind of break into
more and more branches and theybreak into an almost
innumerable number of branchesby the time you get to the
capillaries mm-hmm.
higher up in the branching ofthe tree. So those beads will
get stuck, let's say after anartery branches into just
(16:45):
eight, eight arteries. And theywill get lodged in there. Like
I tell 'em , like a fat guytrying to get through a door
and they'll get stuck. And so Idon't think you can say that
anymore. Yeah. I don't, youcan't say it . No . Especially
Speaker 3 (16:55):
When a large
Speaker 5 (16:56):
Heavy
Speaker 3 (16:56):
Or a large man man can't say of these things , a
big man coming through a tinycat door
Speaker 5 (17:01):
a , a big guy trying to put ona small coach jacket . There we
go, Tommy, Tommy boy,
Um, so once those beads getstuck in there, the blood flows
in one direction or generallyone direction only. So your
blood flow is going to be kindof hammering with your pulse,
these beads into a smaller thanspace than they are. And these
(17:24):
beads are kind of like rubberbouncing balls. They're a
little squishy, so they getlike squeezed into whatever
space they are and then they'restuck there so they don't wash
through and come back out andgo somewhere, somewhere else or
swim against. They're notsalmon, they don't swim against
the , uh, the current of yourblood . Here's our
Speaker 3 (17:41):
T-shirt. Another thing
Speaker 5 (17:42):
People beads are not salmon.
Speaker 3 (17:44):
Yeah . Another thing that , uh, uh, patients , uh,
are frequently concerned aboutis like this idea that you're
cutting blood flow off to anorgan. Like doesn't it die? And
so I I kind of explain it's alittle bit like yeah . You know
, uh, uh, choking , uh,
Speaker 5 (18:00):
For those who
Speaker 3 (18:00):
Like that, for those who like that , uh, it's a
little bit of excellent choking, uh, but not completely
choking to death becausethere's other blood flow to the
prostate, you know, from theurethra, from the bladder, from
the penis. And so the prostatedoesn't completely die. Right.
Speaker 5 (18:14):
It , yeah, it doesn't, it's, I , I mean,
they've done studies on thiswhere they, you know, before we
tried this out on humans,luckily we have the F D A who
says, you gotta show me thatthis works on something else.
So, you know, at the risk ofoffending peta , I'll tell you
they did this on like pigs, youknow? Mm . And they embolized
the prostate using the samesize beets we do, and then they
took the prostate out andlooked at it and the prostate
(18:36):
doesn't die or necros rightaway. Mm-hmm .
they're tiny areas of it thatdo just right next to blood
vessels, but your body canhandle that. But most of the
prostate shrinks down andthey're like sunny explained,
there are two, there are tworeasons for that. One, the ,
the prostate has a bunch ofdifferent blood supplies,
alternate pathways, and thentwo, the bigger particles you
(18:58):
use . So if we used 500 to 700or all the way up to a a
millimeter in size particles orbeads , uh, red blood cells can
kind of sneak around thesebigger beads. So if we use
really small ones, those getstuck much deeper and they kill
things, you know, more so thesize of the beads we use is
(19:18):
very specific
Speaker 3 (19:19):
Size matters.
Speaker 5 (19:20):
Yes . Size is what we ,
Speaker 3 (19:21):
We believe strongly there's , please reference our
previous Dr . Dellinger penisenlargement , uh, conversation.
So , um, when somebody , uh, isgetting this type of procedure
done, what do you generallytell them about how quickly
they can get back to theirnormal activity? Because they
can get back to golfing prettyquick , right? That's
Speaker 5 (19:38):
The best part.
Mm-hmm .
stay away from heavy liftingfor 48 hours. And that's really
something that I told peoplethat, you know, in the old
days, in older days, yeah. Sowe surprisingly knock on wood
out of like over 250 patientsthat we've only specifically
done prostate embolization to ,no one has had a real groin
(19:59):
complication, which is prettyunbelievable. And so that means
that either means our patientsare following their directions
Exactly. Which I sometimesdon't believe or
we could, they could probablydo even more. They can pretty
much walk out on their own.
They have to, yeah. Yeah .
They're walking.
Speaker 3 (20:15):
And a lot of our listeners are gonna go online
and see like a company likeAustin Radiologic Association
or a r a offer, the sameprostate artery embolization,
but this, these areunsupervised radiologists. You
need a urologist that's workingwith your radiologist to get
the best possible outcome. Andso I highly discourage people
(20:36):
to going just straight to aradiologist to get this done.
Even though it's a somewhatunique offering. We take all
insurances, we will do acompletely thorough evaluation
and make sure that yourlifestyle and your expectations
are met. So , uh, when it comesto prostate artery embolization
, uh, urology radiologycollaboration is something I
(20:57):
cannot emphasize more. Donna,how do people get more
information and get ahold ofus? That's
Speaker 4 (21:01):
Right. You can call us at (512) 238-0762 and visit
our website, armor men'shealth.com.
Speaker 2 (21:08):
The Armor Men's Health Show is brought to you
by N a U Urology Specialist.
For questions or to schedule anappointment, please call 5 1 2
2 3 8 0 7 6 2 or online atarmor men's health.com.
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