S03_E15 - UroLogic: Understanding Men's Urological Conditions

06/09/2024

The Healthy Matters Podcast

S03_E15 - UroLogic: Understanding Men's Urological Conditions

This is the second in a 2-part series on Urology (Episode 12 focused primarily on Women's urologic conditions and the pelvic floor) and on this episode we'll shed some light on the conditions that affect millions of men worldwide.  From BPH, to urinary incontinence, and yes, erectile dysfunction - we'll explore the anatomy and function of the male urinary and reproductive processes, and treatment options for when issues arise, with Dr. Travis Pagliara, MD. 

What does the prostate actually do?  Why do I need to go to the bathroom so often at night?   And how do I know when ED is actually a problem?   It's safe to say these are sensitive issues, not only for men, but often for their partners as well, and on this episode we'll go over the definitions, diagnosis and options for treatment for many of these conditions that can have a significant impact on quality of life.  Dr. Pagliara is one of the top specialists in the field, so this is a great opportunity to gain real insight on these all-too-common conditions and empower those experiencing them.  We hope you'll join us!

Dr. Pagliara will also be hosting this free webinar (Signs, Symptoms, and Treatment Options for Erectile Dysfunction and Urinary Incontinence) on June 20th at 6PM CST! Registration is confidential and free.

And for more information on this sensitive topic check out:
www.hennepinhealthcare.org/abouted
www.edcure.com

Got a question for the doc or a comment on the show?

Keep an eye out for upcoming shows on social media!

Email - healthymatters@hcmed.org

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Find out more at www.healthymatters.org

Transcript

Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilton .

Speaker 2: 0:18

Hey, everybody, it's Dr. David Hilton , and we are well into season three of the podcast. And today we are gonna talk about men's urologic issues. What is that? Well, we're gonna talk about things like prostate enlargement and incontinence, and yes, indeed, even erectile dysfunction. To help me out, I've invited Dr. Travis Pollara . He is a urologist at Hennepin Healthcare with me here in Minneapolis. Travis, thanks for being on the show.

Speaker 3: 0:41

Thanks for having me here, Dave.

Speaker 2: 0:43

So what does the urologist do?

Speaker 3: 0:44

I like to think of a urologist as the plumber of the body. So we're actually a subset of surgery, so we have all the surgical skills and we operate on the things that touch or make urine , uh, as well as the genitals. So

Speaker 2: 0:56

You do men's and women's urology, right? We

Speaker 3: 0:59

Do , uh, a lot of people subspecialize, so a lot of people will subspecialize into female urology only or male urology with a, you know, general touch of anybody who gets things that affect both sexes.

Speaker 2: 1:09

Yeah. So today we're gonna focus a lot on men's urologic conditions. I do wanna alert listeners, just a few episodes ago we did an episode about women's issues such as , uh, incontinence and pelvic floor issues. That was with Beth SRA Browse archives. You will find that episode , uh, just a few months ago from this one. We're gonna talk about three things today, Travis, if you would. I wanna talk about BPH or benign prostatic enlargement, a big prostate. We're gonna talk a little bit about incontinence, and then we're gonna talk about erectile dysfunction. So, are you ready?

Speaker 3: 1:40

I'm ready. That sounds great.

Speaker 2: 1:41

Okay , let's hit it . Let's start with BPH h That is benign prostatic hyperplasia, but we're not gonna say that very much anymore. It's a big prostate. Yeah . What causes it

Speaker 3: 1:48

So big prostate's the right term. That's the , what I use to describe all my patients. Uh, first just, what is the prostate? Right?

Speaker 2: 1:54

What does it

Speaker 3: 1:54

Do? The prostate's only job in your body is to make the fluid that becomes. It carries the sperm that allow for babies. That's it. Um, but at some point we don't need that anymore, and it can become pesky. So the prostate starting in our thirties, starts to grow. People always have thirties. Thirties even . Absolutely. So mid thirties, it's starting to grow at one

Speaker 2: 2:14

2% year . I have to interrupt you , but I'm gonna Everybody, all guys.

Speaker 3: 2:17

Yeah, all guys. We, we know that it starts to get bigger. Now some people are gonna end up in their fifties and sixties and have a very similar size prostate that they did when they were younger. It might be 10%, 50% bigger at most. We , we described it in grams. Uh , I'm not gonna get too technical, but because of a genetic predisposition, kind of like, you know, you were born and you were gonna have a size 10 foot and I was gonna have a size 12 foot or whatever. Some guys end up with huge prostates, and these can vary from three times the normal size to 10 times the normal size. Do

Speaker 2: 2:45

We know why that happens? Uh ,

Speaker 3: 2:47

You know, I'm not fully versed in all the genetic components of it. Uh, and there's enough to know just about the treatment for it, <laugh>. But

Speaker 2: 2:54

First of all, how big does the normal prostate start at and, and, and where is it?

Speaker 3: 2:59

Yeah. So the prostate sits at the base of the bladder. So it, all of your urine funnels right from your bladder, which is the storage device about like a balloon size. And it funnels directly through the prostate into the urethra. Uh, and , and then out in men, of course, only , uh, on average it starts off between 20 and 30 grams in size, which I like to describe as like the size of a small walnut. Uh, but again, when you get to bigger size, I mean, it can be the size of a six inch softball in really, really big cases. Wow.

Speaker 2: 3:27

Yeah. Wow. And so a public service announcement, guys and women who might be listening to this, it's prostate. There's only one R in it. I do wanna say that because a lot of patients come and say, I wanna talk about my prostrate. The ,

Speaker 3: 3:39

The prostrate is one of my favorite words in all of medicine. <laugh> . I mean, it just, it it's , it's a running joke. We love it. But you know, whether you come in telling us about your prostrate or your prostate, either one, we like it .

Speaker 2: 3:48

I think you probably know what they're talking about. We do. We do. Okay. So what , who cares? My prostate's getting bigger. Who cares? What symptoms might I have? When does it become a problem? And what problems might I be having?

Speaker 3: 3:58

Yeah. You know , you know, the most interesting thing about it is that the prostate gets bigger and that is associated with symptoms , uh, but it's not definitively causative. And what I mean by that is that we see plenty of guys who do have big prostates and don't have any complaints at all. But for the people who come in of complaints, a slow stream peeing a lot at night, urgency or frequency to go to the bathroom, those sorts of things. Well , they're associated more with bigger prostates than they are small prostates. What about

Speaker 2: 4:26

Weak urinary streams? Exactly.

Speaker 3: 4:28

Slow and weak streams. So when you're the guy who's standing at the ball game and you are at the ural ,

Speaker 2: 4:34

We know that guy. Yeah.

Speaker 3: 4:34

We all know that guy.

Speaker 2: 4:35

We all know that guy.

Speaker 3: 4:36

When you're standing there and it takes this guy a minute, and you're all, you know, everybody's wondering what's taken that guy so long? Don't blame him. It's not his fault. It's just, you know, his prostate's probably a little bit bigger. There could be shy too, a shy bladder. Right . But in general, it , it's that he probably just has an issue.

Speaker 2: 4:51

Is that a thing? The shy bladder thing? Oh , because at the , I remember the metrodome where the twins and the Vikings used to play, used to have , uh, not to get too technical about it , but just a big long trough. And there's a lot of guys kind of standing there. I I I always wondered, are they just shy or is that the, is that their prostate?

Speaker 3: 5:07

No, I, I , I can't even go into, we would, we could spend all day talking about the complexity of urination , uh, the coordination that it takes internally without us knowing it. We rely on our little lizard brains to let us pee. Right? Yeah. But in reality, there are a lot of complex signals and muscular relax actions and contractions that all have to take place. And just being nervous can throw that off. Wow. So a shy bladder is a real thing. How

Speaker 2: 5:31

Aboutt , you're a , a riot at a cocktail party. Travis,

Speaker 3: 5:34

My wife's in advertising, and let's just say I'm usually a pretty popular guy at the company parties to talk <laugh> . Yeah. We, we end up having lots of good stories.

Speaker 2: 5:41

So all these symptoms or , and if you're from a northern climate like we are, the weak stream is always, I used to ask guys, can you write your name in the snow? And you know, it's Nope .

Speaker 3: 5:49

Just the initials now. Yeah,

Speaker 2: 5:50

Exactly. Exactly. So those are some of the symptoms. And , um, how do you diagnose what the problem is? Is it benign non-cancerous, enlarged prostate? And specifically, I guess my question is gonna be how do you di differentiate that from like cancer, which we are gonna talk about in a later episode. So listeners, we're not gonna delve deeply into prostate cancer today. Look for a later episode on that. But just briefly, how do you diagnose a benign enlarged prostate?

Speaker 3: 6:17

Sure. So obviously we have to screen for cancer first. And again, we'll go into that in detail at a later podcast. But that's with a simple blood test called the PSA. It is a molecule that's made by your prostate. It's made more by prostate cancer. So if that is below a certain threshold, then we go down the pathways of just diagnosing your symptoms and how bad they are. That can come from very subjective tests like questionnaires where we say, look, how long does it take you to pee? Do you feel like it bothers you a lot to objective testing where we actually have you, for instance, pee into a machine that measures how fast you can pee? You wouldn't know that that exists, right? No. You can actually find out a , compare yourself to other people and say, did how fast do I pee compared to Bob? And you can find out what it means. Wow . And we know what standards are where you should be, and then where we can get you. And then for sizing, we have lots of different tests from ultrasounds, CT scans, or even putting a camera into your bladder and looking at the prostate itself. Do

Speaker 2: 7:08

We do that very much anymore? And I'm, I'm kind of leading the witness here. You know, I don't do very much anymore in my primary care clinic, actual , um, the finger exam and , and I , and we're talking about sensitive subjects, but man , you know what I'm talking about. Yeah . The where your doctor uses a finger, do we do that very much anymore?

Speaker 3: 7:24

To be honest, it's fallen out of favor a lot. You know?

Speaker 2: 7:28

Hallelujah. <laugh> ,

Speaker 3: 7:30

You're not missing for me too. Yeah , no , honestly, patients always ask, they come in nervous about it. Yeah . And we tell 'em, we're like, it's not our favorite part of the procedure or the visit either. And realistically, we've shown, and there's pretty good articles in urology now saying that it falls out of favor and the likelihood of catching anything with that test is far, far less than even like a half of 1%. So it's, it's just a, it's a, it's an intrusive test that doesn't tell us a lot. And to do it well would even take thousands of times of experience to do it. So we're just, it's falling by the wayside.

Speaker 2: 7:59

When would somebody come to you to see , uh, to do all this more specific diagnosis?

Speaker 3: 8:05

Great. I mean, I think honestly, if you, if your primary care doesn't feel comfortable prescribing some of the generic easy medications that are out there, then obviously a good referral from a primary care doctor is always a great idea. But we're entering an age of medicine where people need to advocate for themselves a lot. You know? So if you notice I'm having urologic issues, I'm just having, just having pee trouble, I'm not peeing great. You can always call a local urologist. And depending on your insurance, if you can get a direct access or if you have to have a referral, et cetera, find your way to a clinic and ask. Yeah.

Speaker 2: 8:32

Yeah. I like that you said that. Uh, Dr. Paria , because, you know, we're joking a little bit around here because it's, you know, it , this topic kinda lends itself to some kind of lighthearted discussion, but it's a serious topic. If you are struggling with your urination, in all seriousness, you ought to get

Speaker 3: 8:45

Help. I'll tell the brief story that the reason, one of the reasons I became a urologist was the relief on a man's face when he was finally able to pee back to normal and get back to out rid of catheters. Yeah. That is a life changing event for somebody. And you know, until you've experienced it, you can't describe it. Let's

Speaker 2: 9:03

Talk about treatments for benign , um, prosthetic enlargement. Sure.

Speaker 3: 9:06

So there's two medications that have been around for a long time. Uh, they're two different classes. One of 'em relaxes the prostate and one of 'em tries to shrink the prostate, but they have some side effects that you need to talk to a practitioner about, and they are lifelong. So once you start 'em , you're not probably coming off of 'em . Um, the other thing about them is that, you know, they're not going to fix the problem long term . They can delay problems that can arise, the presence of symptoms, urinary retention, being unable to be, they can delay those, but not completely eliminate them. And again, this is a problem that's been around since antiquity. This is not new. Men have had prostates forever. They've been getting bigger forever. So , uh, you know, what I joke about is that there have been treatments for this that are surgical since like the 1910s , uh, where people try to go in and scrape out the prostate. And some of those very surgeries are still the same today. They've obviously improved a lot, but now they're trying all sorts of different energy modalities. Is that the turp ? That is the turp , the TURP. But now people are trying every single type of energy you can imagine, water vapor, steam, water , jets , uh, microwaves, heating, freezing.

Speaker 2: 10:09

Are you trying to get rid of the prostate tissue itself there or just make the tube bigger?

Speaker 3: 10:13

Uh , yes and yes. So the prostate has two distinct zones and that central portion is the part that is growing the biggest, that is the part that's usually obstructing the urine the most. So that's what we're trying to get rid of. So

Speaker 2: 10:24

Talk about some of the downsides to these treatments, the medications like side effects and the procedures. What are some of the side effects, if you will, of

Speaker 3: 10:32

Those? So the medications , uh, side effects, I'd say are generally limited. Some of them , uh, can cause people to get dizzy. It's called orthostatic hypotension. And that just means you stand up and you get dizzy. And that can actually be really serious. Let's say you're a guy in your eighties and you're getting up to pee at night. If you get dizzy and fall over and hit your head on the table, well your prostate's just caused a life-changing event. So those are serious things we have to take into consideration for the surgeries themselves. A lot of it's a perioperative risk risks like bleeding in your urine for a while afterwards. So you have to take it easy during the recovery time. But in general, the risks are very low. The risks of ejaculatory changes, erection changes are all in increasingly low, especially with some of the modern techniques.

Speaker 2: 11:11

How long is a recovery from some of these procedures? People ask me that all the time. Well, how long am I gonna be in pain or having problems? When am I gonna be back to normal?

Speaker 3: 11:18

You know, what's amazing about it? So the pain question I get all the time, and people are generally nervous because it's a sensitive area that we're operating on. Yeah. But I can say really with good confidence that most of the time when you do a turp , people don't even need pain medicine. They're surprised. They think, wow, I thought this was gonna be so painful. But there's really no pain nerves in the bladder at the base where the prostate is, there's a sensation of needing to go to the bathroom more frequently, but not so much of a pain. So , uh, you do have to limit your lifting and activity for four to six weeks afterwards. So you can't lift anything heavy. But if you take it easy for that four to six weeks, you'll really be stable after that. And there's really not, not many long-term side effects.

Speaker 2: 11:54

Sounds good. So that's big prostate. That's big prostate. Let's , let's move on to , uh, incontinence. Sure. And , and , and primarily in men, but what is, what causes , uh, incontinence in men?

Speaker 3: 12:04

So in men, it , it doesn't exist a lot. I mean, it's only in a five to 15% of all men. And it generally is older men. Um , there's two broad categories, urge incontinence, which means like, I gotta run to the potty really fast and I can't make it. Uh, and then there's stress, which is you cough, you sneeze, and a little bit comes out. I guess technically you could even create a subset of that called post void dribbling, where you go to the bathroom, you think you finish, and then a little bit comes out at the end. So, you know, it kind of breaks down into, broadly into those three categories. What

Speaker 2: 12:32

Can be done about it?

Speaker 3: 12:34

Uh , well again, we could talk for a long time about this, and it really depends on which of these three, 'cause they're so broadly different. For urge incontinence, we have medications and those are the main treatments. Some of those medications are taken orally, but they have side effects. We're trying to relax a smooth muscle in your body. And with that we can cause dry mouth, dry eyes, constipation. And those can be overwhelming too. The

Speaker 2: 12:55

Smooth muscle being the muscle of your bladder.

Speaker 3: 12:57

Exactly right.

Speaker 2: 12:58

Mm-Hmm, <affirmative> . So that's the kind, when you just can't get to the bathroom fast enough, the urge comes and you just can't get there fast enough. Right. Yeah . Okay . What about, what about stress incontinence? Super

Speaker 3: 13:06

Stress incontinence? It's mostly surgical. Uh, you can try conservative things that are not surgical, like wearing pads. They even make some clamps that you can wear. But in general, we have things like a sling or even an artificial sphincter where we install some moving parts in your body that take the place of your body's natural sphincter or muscle that holds back the pee control and it does it for you.

Speaker 2: 13:26

Wow. Artificial sphincters. Well, I think we've reached a, a , a good time for a break. We're gonna cover other urologic topics in other episodes. I did refer you back to our pelvic floor episode, which is already published. We're gonna talk about prostate cancer at a future one. And some of you have been asking about kidney stones. Well , we did an episode on that back in season two, episode 24 with Dr. Jennifer Wu . So I want to ask you to go to that episode to hear about kidney stones. So we're gonna take a quick break now, and when we come back, we are gonna tackle this subject of erectile dysfunction with Dr. Travis Pollara . He is a urologist in Hennepin Healthcare, right here in beautiful downtown Minneapolis. Stay with us. We'll be right back

Speaker 4: 14:05

When Hennepin Healthcare says We are here for life. They mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the West Metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis? Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 14:43

And we're back talking with Dr. Travis Pollara about men's urologic issues. And for the rest of the episode, I'd like to talk about erectile dysfunction. You deal with this a lot in your practice. I deal with this a lot in my practice with men and their partners , um, dealing with sexual dysfunction. So we're gonna talk about that. First of all, could you sort of define when is erectile dysfunction a problem? What is it?

Speaker 3: 15:04

Sure. I I , I think, you know, it's a funny definition, but it's problem when it's a problem for you or your partner. And that can be anything. So , uh, I think we've tried to broaden the scope to say that there is no exact definition. Like sure, there are scales that can tell us , uh, how hard are you getting? But that doesn't matter. What it really matters is personally to you and your partner. How much of a problem is it in your relationship?

Speaker 2: 15:27

Literally the best definition I've ever heard. If it's a problem for you and your partner, I guess it's a problem, isn't it? Yeah, that's right. In your practice, it's very common. It's prob and I, I hear about it a lot, but is there, do we have a sense about what percentage of the population struggles with erectile dysfunction?

Speaker 3: 15:43

Absolutely. Um, so we know that 30 million American men suffer from it. And that maybe is probably an underestimated number because it's not polling partners, it's just polling men. But if you ask female partners or male partners, is it a problem for your partner? They, they weren't being polled . Mm-Hmm . <affirmative> . So at least 30 million American men suffer from this. And we know that increases decade by decade. So by the time you've reached 50 years old, even 50% of men have at least experienced some episode of erectile dysfunction.

Speaker 2: 16:13

You've already , you've brought up age. I was gonna ask you about risk factors, like who is at risk for having this happen? Because I'll bet there's some men out there who are in their eighties are saying, Nope , that's never been a problem for me. And there's some people probably in their thirties and forties who have said, this is a problem for me, but clearly age is one of the risk factors. Could you say more about age and then what other risk factors are

Speaker 3: 16:31

There? Sure. And you know, I think that's an interesting point. You know, there are, I, I do see everybody. I see a patient once every so often who comes in at the age of 80 and says, no, I have no problems at all. And they're amazing to me. But what it is, is that it's not the age alone. It's the cumulative factors that exist for every decade older. You get the cardiovascular disease, the vascular damage, whether you had diabetes or just the American diet, which is bad probably for our blood vessels and causes clogging and atherosclerosis, you know, an unhealthy lifestyle with a out exercise, blood pressure issues, all of those, they just get worse with time. You know, it's a cumulative problem.

Speaker 2: 17:06

And maybe this is getting a little bit of the physiology of what causes an erection, but why vascular problems? Why is a blood vessels a problem?

Speaker 3: 17:13

You know, there was a great article a couple decades ago that talked about how urologists can save a life. And what I loved to , to preface that with is that the vascular supply to the penis that provides an erection, the blood flow that creates an erection. Well, those arteries are the third, the size of the arteries in the heart. And so there's good data in diabetic patients that Ed will predate a heart attack by five years. So if you're getting ed, and let's say you're a 45-year-old man with diabetes, you actually need to be referred to a cardiologist to get preventative workups. So what it is, is this , it's vascular damage that's happening systemically around your whole body. It's just , this is the first sign. It's the canary in the coal mine of heart disease.

Speaker 2: 17:54

That's a great way to think about it.

Speaker 3: 17:56

I can't say I thought of it myself. Sorry, <laugh> . Yeah.

Speaker 2: 17:58

But it is good though because it's, then you said the blood vessels are smaller

Speaker 3: 18:01

About the third, the size of your heart arteries. Exactly .

Speaker 2: 18:04

Which , which leads me to some maybe just really basic physiology 1 0 1. How does it happen? Oh,

Speaker 3: 18:10

Sure. So, okay, I, I always make the reference to , uh, the penis is like the kitchen sink, which is probably a weird analogy. Saying it out loud here , <laugh> .

Speaker 2: 18:18

That is, that is, I'm sure the first time anyone's ever heard

Speaker 3: 18:20

That. But imagine this, you have an inflow and you have an outflow. What's supposed to happen whenever anybody wants to get an erection as it starts in your mind. So the mind is like your hand turning on the kitchen sink. Okay? It all starts there. And that's why there is a thing called psychogenic, erectile dysfunction, meaning you're nervous, you're distracted, you're thinking about all the busy aspects of life, whatever it might be. And that can impair somebody who even has a totally healthy body, normal physiology. Now, what's supposed to happen is when you send that signal, when you turn on the kitchen sink, you're actually turning it on a lot more than just the casual dribble that's coming into the sink. And then it's actually supposed to happen so fast that flow comes in that it actually, imagine you have like a flexible drain at the bottom of the sink that just pinches off and then the water rises in the sink. That would be the formation of an erection.

Speaker 2: 19:05

Mm-Hmm . <affirmative> . So it is about blood flow. It is so clearly diabetes, heart disease, vascular disease, that blood

Speaker 3: 19:12

Pressure, smoking as well. Smoking. Smoking, definitely

Speaker 2: 19:14

A negative factors . And those all get worse as you get older. Yes. Talk a little more if you could, about the psychogenic factors. So what degree are stressors or mental health or relationship issues, what about any of that in the contribution to Ed?

Speaker 3: 19:27

They're, they're grossly underestimated. They're also poorly studied in terms of getting real numbers because this is one of the, the, the hardest parts about Ed to understand is like the shame spiral that people go down when they have it. They don't wanna seek out treatment 'cause they might be ashamed, they don't know who to talk to. People might not even have a stable primary care to have that sort of relationship that you have to be able to be comfortable with somebody to bring it up. But in the end, you know, if you have anything from depression and you're , you're on an , uh, an anti-depression medicine, that can also have side effects for ed. Or if you're just stressed, we , we think that people who are probably younger than 30, 90% of their ed is psychogenic. Mm-Hmm . <affirmative> , it's a really high number. Their blood

Speaker 2: 20:08

Vessels aren't bad enough yet.

Speaker 3: 20:10

No. Right. Unless they've been a type one diabetic for long, long time. So they've had a really bad vascular damage over many, many years.

Speaker 2: 20:16

And while we're on the sort of the mental health aspects of Ed, I'll bet there's effects on men and their male or their female partners as well.

Speaker 3: 20:25

I've seen it many, many times in my clinic. People come in saying this and you know, it's great when they come in together 'cause it's actually kind of heartwarming. You know, they'll come in as a couple and they say, this is straining us. It's not just the man sometimes it's just they're together in it and they want to find a solution. And they've heard that there is one that we can offer in urology beyond just the pills. Right.

Speaker 2: 20:45

So let's talk about that. Let's talk, talk about treatments. People have heard about the blue pill, they've heard about Viagra and Cialis and , uh, LA Vitra . They've heard about those medications. Talk about the various treatments if you could, including medications. How do they work? What are their side effects and who are they appropriate for?

Speaker 3: 21:00

Yeah, so the, the pills have become much, much more prevalent. Right? There's now, I mean, I can't drive into work in the morning without hearing an advertisement for one of the mail order companies that offers you a discreet way to have a visit, get a diagnosis and pill sent to your door. And now they're, you know, 90% cheaper. Long story short, pills are very ubiquitous now, right? They're everywhere and they are generally very, very safe. I have not seen any of the negative side effects. Like they talk about in the commercials, an erection that lasts more than four hours and doesn't go down. I have never seen that with appropriately dosed pills. Not to say it's not possible, but hey, I've prescribed thousands and thousands of these and never seen someone come in from it when they fail. And they do actually fail a lot. They fail in 40 to 50% of patients, especially these men who are in the 50 to 80-year-old range. When they do, we have some more invasive options. We can offer an injectable material where you can actually inject the drug into yourself and 10 minutes later you'll get an erection and it works for another 20% of the population.

Speaker 2: 21:58

I'm gonna ask the question that for the listeners, where do you inject it?

Speaker 3: 22:01

You inject it into your penis, which obviously every time I've brought that up to a patient has led to a shaking of the head.

Speaker 2: 22:09

Thousands of men just cross their legs.

Speaker 3: 22:11

<laugh>. I know they do, and I've seen that look in their eyes. Okay ,

Speaker 2: 22:14

I lay our fears or , you know, 'cause it's an effective treatment and men can do this.

Speaker 3: 22:18

It is, it is. And I , we actually can offer you a test injection in the clinic to show you just how easy it is because obviously left to their own devices. If we just prescribed the medicine and sent you home with it, here,

Speaker 2: 22:28

Take this. Yeah .

Speaker 3: 22:28

99% of med would never take the leap of faith. But they come into clinic and we can do it and show them, and then I can guarantee you, I I've seen it. They're like, oh, you're done. That was it. I mean, this is the tiniest needle they make. It's the same one that a diabetic injects insulin with. Mm-Hmm . <affirmative> , you know , five to six times a day sometimes. So it really is not as painful as you might think.

Speaker 2: 22:47

Why would you do that as opposed to the pill ,

Speaker 3: 22:49

Uh, for efficacy. So it's mostly if the pill doesn't work, okay , then you can build up to that level of, of invasiveness or you know, that extra step. It's more expensive. Uh, it does carry more risks . I have seen people get what's called a priapism, one of those four hour erections with that sort of injection until they get the dosing properly done.

Speaker 2: 23:06

We also hear about, and I would like to just comment on, for men who are taking medicines for their heart nitrates, you know , let's say you're a guy who carries nitroglycerin around because you're, you know, you're getting angina, you're getting chest pain. What about that interaction?

Speaker 3: 23:20

It's a very good point, and it is one of the contraindications to the pills. So the pills, the main side effects, we know about it that it will lower your blood pressure potentially. Now, if you're on one of these nitro tabs for angina for chest pain, there is a, a warning will pop up to the doctor to say, you can't co-prescribe these. Because if you do happen to take a Viagra and then have a heart attack, if you take the nitro tab at the same time, it can actually make your heart attack worse. It can drop the blood pressure to various parts of your body. So we're supposed to be very careful about that. Not to say I haven't, you know, really talked to patients and said, Hey, have you ever used your nitroglycerin and it's been 10 years from your heart attack? And they're like, no, I never have. Then a trial of the pills is okay, but it needs to be done in a safe manner. Right.

Speaker 2: 24:04

Starting low dose. I've had that conversation. I have too . You've never taken your nitroglycerins in five years. Yeah, I carry 'em around Doctor on my med list.

Speaker 3: 24:10

Exactly

Speaker 2: 24:11

Right. But I never take it. But it's good to be aware of that. So if you are on nitrates for your heart , um, talk to your doctor about that. Okay. Injections, pills, what else?

Speaker 3: 24:19

So then we have some mechanical devices too. There's actually a pump that's been around for over 50 years. It's called a vacuum erection device. Uh, it actually pulls blood into your skin and then it gets trapped there by a rubber band that slips off the end. It's the old Austin Powers penis pump. Yep . If

Speaker 2: 24:34

You remember. Yep . We're all gonna go back and watch Austin Powers now. Yep . Uh , do they work?

Speaker 3: 24:38

They do. They really do. They , they. But I can say I don't have a lot of people who use them and then want to keep using them because they're so cumbersome. But

Speaker 2: 24:46

It does work. It's an option for some, it is

Speaker 3: 24:48

An option, especially for people who don't want to inject anything if they can't get over that fear or if they don't want to proceed with surgery . Some of these next, the next options we'll talk, go

Speaker 2: 24:56

Into it. What are the surgeries? So

Speaker 3: 24:57

Imagine that we're just trying to overcome this problem of physiology, of blood flow. And if we can't repair, because they've tried this for many years in many different attempts, they can't revascularize the penis. It just doesn't work. What we can do is replace those two balloons in the penis that fill with blood. And this is where an inflatable or malleable penile implant comes into play. They've been around for over 55 years, believe it or not, a little balloon. The , they're actually two balloons. We put two of them in the penis and it connects to a pump and to another reservoir that holds the fluid. So it's actually a fluid filled device that you can just reach down and pump up at any time and have an erection that will last as long as you want until

Speaker 2: 25:34

You let the fluid out,

Speaker 3: 25:35

Until you hit the deflate button. Exactly. The sensation is the same. So all that sensation and pleasure will be there. If you have any preexisting problems with that. It doesn't make that better, but about 96% of men report their erections and their satisfaction with sex are the same or better. Well , that's encouraging in the United States now, there've been over a million of these devices put in , uh, there's over 20,000 a year that are placed. And I'm proud to say that Hennepin just got , uh, the designation of me as a center of excellence, the first in the Midwest.

Speaker 2: 26:02

That's why I've got him on the show today. Um, Dr. Pari is an expert in these topics and I'm, I'm already picking up lots of tips here and I deal with this all day long in my practice. So this has been fascinating. What have we not covered on treatments? What

Speaker 3: 26:13

I really wanna focus on for people is that the, the stigma of ED is really hard and it's not talked about enough. And we need to get over that as a culture and as people and patients need to know, they can come to providers to ask for help because I like to tell patients that I can get you the erection if you're willing to go even to that last step of surgery. It just depends on how important it's to you. There's a really great series online called the Hard series, no pun intended, but that's what it's called. Uh, and you can go to ed cure.com and you can watch, and people have these testimonials where they and their partners are talking about this and it , the , the whole point of this series was to try to broaden the horizons of people and , uh, patients and providers toward the, the psychogenic burden that people are dealing with.

Speaker 2: 26:57

That website, again, it's one you recommend. Yeah,

Speaker 3: 27:00

Ed cure.com , it's a great website. Um, it is sponsored by one of the companies that makes these devices, but honestly, it has very objective treatment options and it provides all of the options that are available out

Speaker 2: 27:11

There. Before I let you go a little bit more about couples in relationships, you said that you like it when people come in as couples. What advice would you give to a man or woman when their , when their partner is, has edl ? How do you facilitate that among couples? Or is that beyond what the urologist

Speaker 3: 27:28

Does? No, I , it might be beyond the general urologist, but me as a specialist in prosthetics and Ed, I , I really do hone in on it. I'm happy when people come in with their partner because you're gonna take this journey together. Getting a surgery to re to repair your erectile dysfunction, that shouldn't be a surprise. You spring on your partner. Right. But in general, I like it because we're able to explain to the partner that it's not you. This isn't related to you and they're not attracted to you anymore. This is a physiologic problem. And I think that's where couples get into a lot of angst between the two of them. They get worried and self-conscious on both sides. And you know, there's a spiral there where two people who are feeling self-conscious about their own issues. Well then they stop communicating and when they stop communicating, I've seen couples end up on the verge of divorce. So really when they come in together to solve the problem together, I think we get the best outcome.

Speaker 2: 28:19

We've been talking with Dr. Travis Pollara about benign big prostates. We've been talking about incontinence and we've been talking about erectile dysfunction. Okay. Before I let you go, Travis, I understand you have an event coming up in June that is open to , uh, the public. Correct. Tell us about if

Speaker 3: 28:34

You could. Yeah, we're hosting a free webinar. It's nationally gonna be broadcast. It's on June 20th. Uh, it's gonna focus on a lot of these issues, specifically focusing mostly on erectile dysfunction and the available treatment options that are out there, but also touching on incontinence as well. We will

Speaker 2: 28:48

Put a link to that in the show notes. And listeners, I encourage you to go check out that link and be part of this conversation and learn more with Dr. Pollara . Travis, thanks for being on the show today.

Speaker 3: 28:58

Dave , thanks so much for having me.

Speaker 2: 28:59

And listeners, stay tuned for an episode with Dr. Pollara about prostate cancer coming up later in the season. That's all we have for today. I hope you'll check us out for the next episode. And in the meantime, be healthy and be well .

Speaker 1: 29:12

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At highball Executive Producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.