Fibroids & Prostate Issues: Can You Avoid Surgery? | Surgeon Captain Rochan Pant VSM
Author Name:Zahra Jani
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Title: Fibroids & Prostate Issues: Can You Avoid Surgery? | Surgeon Captain Rochan Pant VSM
Author Name: Zahra Jani
Description: What if surgery isn’t always the only answer?
Welcome Surgeon Captain Rochan Pant. VSM (Partner and an Interventional Radiologist at C3 Medicare), as we discuss fibroids, infertility, prostate enlargement, prostate cancer and the role of Interventional Radiology in modern healthcare.
From uterus and menstrual health to Charles Dotter, “Mad Charlie,” and the first angioplasty, discover how medical science and healthcare innovation are creating new treatment possibilities.
If you enjoy conversations that make healthcare easier to understand, Like, Share & Subscribe to Zahra Jani Show for more.
About the guest:
Today’s guest is Dr. Surg. Caption Rochan Pant (Partner and Interventional Radiologist at C3 Medicare) with an MBBS & MD (Radiodiagnosis) from AFMC, Pune and extensive clinical experience as a former Armed Forces Surgeon.
A specialist in vascular & non-vascular IR procedures, he performs advanced image-guided treatments including PAE for prostate enlargement, UFE for fibroids, varicose vein treatments, pain management, and cancer-related interventions.
Instagram handle:
https://www.instagram.com/c3medicarei...
About C3 Medicare:
Mumbai’s specialised Interventional Radiology & Cancer Care Day-Care Centre
They provide minimally invasive, image-guided procedures through small access points, often under local anaesthesia, helping patients avoid prolonged hospital stays and recover sooner.
Their Interventional Radiology services include treatments and interventions for enlarged prostate (PAE), uterine fibroids (UFE), haemorrhoids, varicose veins, arterial blockages, diabetic foot and vascular conditions, selected liver cancers, and chronic pain.
Address:
C3 Medicare Clinic, 901 Shrikant Chambers II, VN Purav Marg, Nxt to RK Studio, Union Park, Chembur-71
Contact:
24*7 Helpline number: 022-48972433
Website: www.c3medicare.com
Chapters:
00:00 — Introduction
02:21 — What Is a Fibroid?
04:39 — Fibroid Symptoms and Warning Signs
06:51 — Fibroids: Surgery or Non-Surgical Treatment?
10:23 — Discovery of Uterine Fibroid Embolization (UFE)
12:04 — How Uterine Fibroid Embolization (UFE) Works?
16:24 — UFE Recovery Time and Results
17:42 — UFE vs Surgery: Recovery and Benefits
22:53 — Cost of Fibroid Treatment
24:10 — What Is Prostate Enlargement?
27:07 — Why Does Prostate Enlargement Happen?
28:25 — What Are the Symptoms of Prostate Enlargement?
31:01 — Risks of Untreated Prostate Enlargement.
32:00 — What Happens If Prostate Enlargement Is Untreated?
35:36 — What Is Prostatic Artery Embolization (PAE)?
37:03 — TURP vs PAE: Treatment Comparison
39:02 — Can Prostate Treatment Affect Sexual Health?
41:28 — Prostate Cancer Awareness
42:33 — How Should Patients Choose a Treatment?
45:06 — Closing Remarks
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About the show:
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Transcript:
(00:00) out of uh 100 women almost 20 to 30 will have fibroids. The most common things I would say would be excessive bleeding and pain. This excessive bleeding can be so heavy that the women lose so much blood. Fibroid they can cause problems infertility. We had a patient recently her hemoglobin was down to six and five.
(00:19) She was so scared of surgery. She was offered surgery she refused it. Then she came to us. We said okay we can sort it without that also. fibroids treat without actually you know cutting people cutting people open generally doctors suggest uterus no problem but it comes at a cost >> today's [music] guest has gone from being a surgeon in the armed forces to using tiny instruments and medical imaging to treat conditions without traditional surgery Dr.
(00:57) Roachin Punt, senior interventional radiologist at C3 Medicare, is here to tell us how and why this could change the way we think about fibroids, [music] prostate problems, and more. Let's shift the focus from women's health to men. Most of them don't want to get treated for prostate because that it can permanently affect a sex life [music] of a man.
(01:20) Is that true? According to the US data, 9 to 10% of patients can have this uh erectile dysfunction. PE does not have that problem because we are touching nothing over there. [music] >> Welcome to Zarajani show. Now before we begin the conversation, my team showed me something really interesting. Most of you who watch ours haven't subscribed to our channel yet.
(01:46) If you're enjoying these conversation and love the incredible guests we bring on, I would love for you to hit that subscribe button. It's a small click for you, but it helps us bring you more amazing guests. And with that, let's begin. Welcome Dr. Ochin Pan to Zara Show. >> Thank you so much for having me here. >> Absolutely.
(02:10) And I am really looking forward to this chat because we're going to talk about something which nowadays most women and men face uh that is fibroids and prostate respectively. But treatment there is an immense lack of information. So I'm going to be like a curious student today and going to ask you the most basic question and currently you're the senior interventional radiologist at C3 Medicare.
(02:38) >> Yes. >> So um start that we are going to talk about fibroids and prostate. So let's start with fibroids. >> What exactly is a fibroid? And I don't want the medical explanation for this fibroid. Okay. What is a fiber? >> Okay. To the body is made up of cells. Many different kind of cells. It's not a cancer. A fibroid is a collection of cells.
(03:26) the same cells which make up the muscles in the wall of the uterus. >> Okay. >> And they are abnormally formed. So fibroid technical term it's like lot of people have moles in the skin. Not all of them are cancer. Not all of them need treatment. Sometimes they become abnormal. Sometimes they're not.
(03:48) Fibroids are benignut and what it can do is it can cause problems to the patient sometimes. If you look at data analysis out of 100 women almost 20 to 30 will have fibroids. fibroid very commonly seen all women under a fibroid. So fibroids symptoms
(04:40) 20 to [clears throat] 30 women out of 100 >> can have fibroids >> can have fibroids and I feel the every second woman I know has fibroids or knows someone who does. >> Yes. >> So what are the like symptoms which problem? So yeah you're absolutely right. My mother had fibroids. [laughter] She underwent surgery long time back.
(05:02) But the thing is fibroids problem usually fibroid when they are large what can it cause because they're large and they're vascular tumors they have a lot of blood supply they can cause excessive bleeding very commonly during periods the bleeding can become very heavy >> sometimes they can cause pain again during periods or even otherwise they can cause press upon other organs nearby like the urinary bladder constipation otherwise sometimes they can because not so commonly but sometimes they can cause problems in fertility
(05:37) because fibroids are abnormally distorting the uterus. >> Okay. >> So these are some things which the fibroid can cause. The most common things I would say would be excessive bleeding and pain and this excessive bleeding can be so heavy that the women lose so much blood. We had a patient recently her hemoglobin was down to six and five. Thank you.
(05:57) >> Any kind of effort would be really difficult for her. >> But she was so scared of surgery. She was offered surgery. She refused it. Then she came to us. We said okay we can sort it without that also. But point being >> these symptoms sometimes get taken as normal. That's the other part. Pain during periods is normal.
(06:16) It may or may not be. It can also be because of fibroids and there are other conditions which can cause it. I would really say that if you find your life is becoming difficult because of these things, you should definitely see a doctor, get it sorted. >> Absolutely. And I guess I guess there is no need to make our life uncomfortable.
(06:47) >> Definitely. So my next question is key if a woman has fibroids is the only solution that she has to go through surgery. >> No not at all. Um even if the fibroids are causing symptoms there are many solutions. Any given solution is not perfect for everyone. I mean people are not the same. You're not the same as me.
(07:08) I'm not the same as somebody else. Everybody is different. >> Everybody has different needs. Everybody is at different time in life. >> Yeah. So fibroids problem fibroids problem is a unique problem in the sense that it occurs in women of childbearing age because fibroids grow under the influence of this hormone called estrogen which as you probably know and most listeners know is the female hormone without estrogen you cannot be female.
(07:34) So like men cannot be men without testosterone. >> So it grows under the influence of estrogen. So once the estrogen levels fall which happens at menopause the fibroid stops growing. And the problems can also go away. So depending on which stage of life you are >> and what the problem is the solutions can be different for different people.
(07:54) >> I mean for some people rare. >> I I will say your surgery is the only option for you. There is no other option. >> So basically speaking fibroids problem and we need to treat what are the approaches? One approach excessive bleeding. M >> block the bleeding by hormonal therapy and the problem goes away >> for a short period of time.
(08:21) This is of course practical. Supposing you are near menopause, you're having this problem, you have fibroids. We tied you till menopause by giving you medicines and at the menopause point your symptoms will go away. So you are fine. You did not undergo surgery. Your problem went away and for a short period of time those drugs are safe to take.
(08:40) M >> but if the patient is 35 years old >> it is not a practical solution to give hormonal therapy to control the bleeding for the next say 20 25 years >> so situation you have two basic approaches >> surgically speaking surgery no problem but it comes at a cost when you lose a uterus and there are certain side effects to it we are still researching what all the uterus does.
(09:11) So we don't really know enough about the human body yet and maybe we never will. Life is a fascinating thing >> but >> it comes at a certain cost in terms of recovery period possible complications of surgery all of this. Okay. But in a given situation that may be the best solution for the patient that should be discussed with the doctor.
(09:29) >> Other option is myomectomy uterus fyroid. This is a little more complicated because uterus surgery comparatively but myctomy fibroid you have to dig into the wall of the uterus and take out the fibroids. >> Okay. Now there are multiple fibroids it becomes more difficult to treat the smaller ones. >> But momectomy is also an option given the situation. Okay.
(09:54) So [snorts] depending on the patient these are the surgical options. >> Now what are the other options? Now supposing the fibroid is there but I kill it inside problem solve. So what we can do is one which is the oldest established non-surgical method because this started way back when in the late 80s and that is also a story.
(10:14) >> We are here to listen tell us all [laughter] about >> okay I'll tell you about the story. So this happened in Paris in France late 80s when they were doing myomectomy problem obviously there can be a lot of bleeding because this is something we do we block blood vessels from the inside. It's a standard interventional radiology procedure.
(10:39) This is which we started doing long time ago. So they would ask for an imolization which is the process of blocking the blood vessels from the inside to reduce the bleeding during myomectomy. M now this patient this lady was to undergo myctomy underwent imolizationtomy but for some reason that hospital went on strike or something that surgery got cancelled said okay we can't do it today we'll call you back when we ready for you we called her back she said I don't have any problem anymore I don't want the surgery okay this was done by this
(11:08) doctor French doctor called Ravina >> so this was done and this was published back then so people realized the problem of fibroids can be taken away by blocking the blood supply of the fibroid so that the fibroid shrinks and the symptoms go away. This was called uterine fibroid imilization became popular increasingly in the west >> and because it's relatively non-invasive early recovery all these advantages lot of research lot of papers so now at this point of time in the national health service of UK it is an accepted option
(11:38) for treating fibroids >> so I have a couple of questions fibroids treat without actually you know uh >> cutting people open >> cutting people open sorry for the lack of better words to explain. It's a good good description. It's [laughter] a good description >> and you know first question is explains fibroids. Exactly. We call it angioraphy.
(12:15) That is angioraphy. So what do we do? >> We generally give local anesthesia. Say we are doing we normally do it from the left wrist nowadays. So we we'll give a small injection on the left wrist. >> This part will become numb. So about 3 4 cmters of the wrist will become numb. We put a needle into the artery.
(12:30) >> Usually under ultrasound we place a small tube which is about 2 mm in size. Once you enter the artery now the thing to understand is people ask me this question. >> Exactly. >> All arteries come from the heart. All the arteries eventually connect to the heart. So they all come to one place together. That means they're connected to each other.
(12:52) >> So once I come in from one artery, depending on the direction I want to go, I can go to almost any other part of the body. >> Given that I have the right tools, the machine is a bit expensive that I have to use to see inside the body to guide me where to go. But we go from the groin to the brain.
(13:11) We go from the wrist down to the uh lower parts. we can go from um u the lower leg up into the body. So blood vessels are like roads which carry blood. Through that we can go to almost any organ in the body. >> So this is the basic thing. From here we go in we take the tube we can see under the X-ray machine is called an angography system and we go to the arteries supplying the uterus called the uterine arteries which is in the pelvis lower down in the lower abdomen.
(13:43) Got it. >> And then once we have identified where we are and where the blood supply of the fibroid is, special Okay. So fibroid shrink normally procedure patient is awake only local anesthesia. Sometimes for some patients who are apprehensive after [clears throat] the procedure it's not that we have done nothing the fibroid inflammation there are no stitches you can walk you
(14:34) can do everything else normally pain is to be managed and then we follow Usually bleeding problem starts coming up. There is a size limit in this. I mean we can do it but it may take multiple sittings. So it may not be right for you. But usually it's also in women who are no longer looking at having children.
(15:11) So given that circumstances we advise the patient what is the best option for them. A lot of patients we tell them >> you need to undergo surgery. There can be patients like there are patients where we say this is too much. >> You cannot treat this by these means. This requires you to have a hyctomy. >> Okay.
(15:30) Sometimes in infertility patients, infertility patients maybe fibroidization, it has worked. Some of my patients did become pregnant. But we still don't recommend it as an option for treating infertility. It does not affect the fertility. But if the problem with infertility patients is infertility is a complicated thing. It may not just be the fibroid.
(15:52) I cannot promise you fibroid sol. >> Yes. Absolutely right. It's complicated as you know. So that is why I say we don't have a master plan for every patient. Every patient has to be looked at individually. >> Yeah. >> Everybody is different and like you said every person is in a different phase of life.
(16:12) So it needs to be treated that way. >> Correct. Absolutely. >> Um UF which is the uh >> acronym. Yeah. Urine fibroid emilization. >> Exactly. Which is the non-surgical way of treating the fibroid. Uh it's recovery time. example treatment >> and within how many hours the patient can go back? >> We can send the patient back in 2 hours. That's not a problem.
(16:39) We take them outside. Since we punctured an artery artery is a high pressure vessel till that is okay. Say an hour. Patient has to pass urine, eat and drink something. Once they're able to do that, they can go home. >> Yeah. We normally say dayare when you are living close enough to us that you can come back to us if anything is needed but usually that is not necessary.
(17:05) What can happen after this is you can get pain, you can get some nausea, you can get some vomiting. We gave drugs for all this variable which patients absolutely fine and we used to admit them because you know I'm sick of [laughter] the hospital. I want to go home. Some patients take a few days to recover from the pain you know some other things but most people by four days are back to being nearly normal.
(17:34) >> So again I know uh my questions might be overlapping but I I want to stress on this uh because UF side effects. So let's compare >> uh UF and a traditional surgery uterus >> again because this is you know spread procedure fibroid obviously with a disclaimer body that's the disclaimer always but let's just compare the you know the recovery time pros and cons for both so that people understand medicine advance and we can have an
(18:19) easier treatment. >> Okay. To give you a rough, it's a very rough analogy because bypass surgery was the only way to treat hearties bypass recovery period is a month plus right you are fine. you come out of the ICU and you go home. >> Practically speaking, you can actually do it as if you know [snorts] but it is not right for every patient.
(18:56) Yeah. >> Right. So similarly hyctomy obviously is a major surgery. You don't have to cut open but there is a recovery time. Yes. That has to heal. But you cannot really compare hyctomy with uterine fibroid emilization because uterine fibroid emilization you do not lose the uterus. You still have it.
(19:25) Whereas hyerectomy you lose the uterus. Right? Now um any major abdominal surgery certain number of people will have some bleeding. They can have bleeding later. Some will need blood transfusions. Some can get infections. All these are known things for any major surgery. The thing you can actually compare u to is probably myomectomy more than hyerectomy because myomectomy also you preserve the uterus.
(19:50) >> That is a more uh say fair comparison because the uterus is still there. >> Once you remove the uterus there is no question of failure of treatment because you're not going to get fibroids now. The uterus is not there. >> Uress is gone. >> Yeah. But also you you lost an organ. So >> that is also there.
(20:07) So but myomectomy again you're keeping the uterus >> but taking out the fibroid. Now what what is the comparison between the two? Again my momectomy can be done laparoscopically even robotically. So the incision may not be big. >> So incision but still bleeding can be quite a bit. >> Uh fair number of patients will need blood transfusions myomectomy or after myctomy.
(20:27) Blood transfusion also comes with certain amount of risk. Again because you're operating inside the body and you are you know cutting into things and all there is a possibility of infection. minor chance of injury to other organs you know these are safe procedures they have been perfected over a long period of time but still there are risks right >> comparatively UF may the complication rates of infection bleeding etc are practically zero >> the only problem with UF is that because the uterus is still there fibroids can still recur but the same is true of
(20:59) momectomy >> that is not different recurrence rate in myctomy actually is slightly higher >> oh is it Because you cannot remove the small fibroids >> and >> and you cannot treat all fibroids in one go. In UF you can treat all fibroids in one go because you're blocking the blood supply to all fibroids. >> Right? >> So it is not that you cannot do it.
(21:20) >> What is the difference? Uh I would say the only thing where there is still some doubt is regarding patients who have infertility. That is the only group. But if you look at the studies which have been done actually fertility rate when you take it by age etc in scientific studies >> that said that doesn't mean it will translate into your treatment >> because one every patient is different two every hospital country doctor is also different.
(21:47) >> Absolutely. So everything comes with its own disclaimers ifs and buts. >> There are variations there is there are possibilities and people who do surgery are doing a very good job. It is that that technology may be right for you given your circumstances or this technology may be right for you given the circumstances.
(22:04) But you should realize there are options. >> You can discuss the option. Choose the one you prefer. >> I I love that this conversation because we are not judging anyone. We are just saying that of course not why should we >> awareness >> it is your life and your body. I tell every patient is your life and your body.
(22:20) You are the one who bears the risk of the procedure. I will go home. >> The risk is yours. So you need to understand you need to ask me all the questions you want because it is it is not I am not God. I haven't you know I have no way of controlling everything in the world. I cannot >> even when all doctors will tell you this the only person who doesn't have problems with with procedures is one who doesn't do any.
(22:43) >> Absolutely. I'm going to ask you a tough or an uncomfortable uncomfortable question. >> Sure. >> Um do you think money is also the factor? Of course. surgery you know uterus that will I'm assuming will cost more than like a non-surgical procedure >> not necessarily see in India there are many price points of everything [laughter] as you know so actually a hyerectomy may be cheaper in terms of just the surgery >> but in terms of the overall experience and recovery period it will carry that deficit also which is not accounted for
(23:20) >> like I said it depends on the patient the patient's choices and the patient circumstances. See, as of now, is UF cheaper than all hyerectomies? No. It is cheaper than hyerectomies in some hospitals. >> It can be more expensive than hyerectomies in some other hospitals. >> It's not marketkedly different in cost.
(23:40) >> Okay? And it's an approved procedure by the government of India. It's on the Aish man list for that matter. >> It's available under the Aishman scheme. It's a state subject. So different states apply it differently but it's available under government schemes as it's recognized as a daycare procedure by the government of India.
(23:58) So that is not the problem here. The question is of information and choices and I feel that the patient should get the information and make the choice. >> Okay. So I guess we've spoken enough about fibroids. Now let's shift the focus to men and their health. Um generally older men they suffer from prostate. Prostate enlargement actually.
(24:21) >> So men get what's called prostate problems. >> Yes. >> Prostate problem is unique to men because prostate is unique to men. >> So women have uterus, men have prostate. Both are hormonally linked. The prostate grows under the influence of the male hormone which is called testosterone. So when you're born it's like 5 g.
(24:39) As you become older it keeps growing because of testosterone. And unfortunately in some cases it keeps going going on growing till it's extraordinarily large and because of its location it then causes problems. >> So where is it located exactly the prostate? A lot of people don't realize what the prostate is what it does.
(24:57) >> So the prostate is located just under the urinary bladder where the urine is stored. >> So urine is kept in storage till you are ready to pass. So that storage system is the unary bladder >> and the passage which goes out is called the urethra. The the tube which urine comes out of.
(25:13) The prostate surrounds the urethra just below the bladder. >> Okay? >> So it sits there. So when it becomes big, what it does is it's one, it squeezes the urethra. >> So the urethra becomes narrow. It becomes more difficult to pass urine. >> It won't come out fast. It will take time to come out. >> It also squeezes the base of the bladder.
(25:30) So you keep getting the urge to pass urine because the nerves in the bladder >> are quite rich in that area and the sensitivity and then you keep getting the urge to go again. It's called urgency. So all these things are what we call prostatism. They're very common in men. >> So at about 60 it's about 50% of men. They'll have symptoms of prostate.
(25:50) By 80 it's almost 90%. >> Wow. >> Yeah. Now all of them may not need a procedure because uh earlier there were not there was nothing else you could do but surgery. So there's a famous thing which was said by a surgeon in UK long back Lord if you take me let it not be through the bladder because it makes the patient so miserable the bladder getting obstructed >> that he said don't take me through the bladder whatever you do this was a surgeon >> the other thing which used to happen there was because when the urine gets
(26:20) obstructed they had to pass a tube to get it out what we call catheterization so people would actually carry catheters with them >> to you know get in and take out the urine >> but Then why surgery was avoided? Because prostate surgery early on was extremely difficult and very risky because it's a vascular organ in a difficult place and if you try to do open surgery and remove it, it used to bleed a lot and lot of patients would actually not make it out of the OT.
(26:48) >> Mhm. >> But then over time things evolved and nowadays there are drugs which can help and lot of patients are absolutely fine taking the medication. Take a tablet every day and you are okay. M >> so this is very common but lot of patients will suffer from it >> some of them will be okay with medication some will not >> okay so we'll get into the treatment part but again a basic question prostate enlargement what like what causes the prostate enlargement >> that's a very good question >> so the earlier assumption was that
(27:19) testosterone is the only factor testosterone hey >> prostate responds to testosterone therefore prostate will grow. >> Okay. But it doesn't happen in all men and testosterone levels exact correlation. Nobody really understands completely but we know certain things. for example. But we know now that sedentary lifestyle, diabetes, u diet, overweight, all these will have far more problems because of prostate
(28:03) than men who are active, not overweight and have a healthy active lifestyle. >> So it is not one thing only, it's many things. But eventually there's only so much you can control in your life, right? >> So >> given that there is so much prevalence of prostate, >> it's a it's a very common problem for men to have >> and urg.
(28:27) So generally men who have the prostate issue is it that simple or men are ignoring other symptoms. So things can it can be more than that. For example, um um what happened to one of our patients went to Canada on leave went to Canada and then one day suddenly he couldn't pass urine.
(28:55) Probably maybe it happened because he had a long flight and he did not want to use the washroom in the flight. So he held on too long but he couldn't pass urine at all. Now he's in Canada. He's an Indian citizen and was he could not get treatment there. >> Yeah. So we had to come back get a catheter placed then the they try to remove the catheter.
(29:13) What usually is done in this you place a catheter drain the urine out hopefully the swelling in the prostate or the bladder will go down and you'll be able to pass urine normally in time. That's what happens with most people. This patient still couldn't pass after a week two weeks trial of removal couldn't pass. He was now on catheter.
(29:30) So this can happen and there's more than one patient with this story that we've had and it is known thing. It happens sometimes. Unfortunately, we can't predict go. >> So, this is something that can happen with enlarged prostates. Usually with larger prostates, not so commonly with smaller prostates. Usually with larger prostates, this can happen and sometimes it can lead to a complete dependence on catheters especially in older patients.
(29:53) >> Sometimes patients are going for some emergency surgery, a tube is placed for the surgery and then the tube doesn't come out. So that is also another story which happens. So can prostate lead to worse problems? Yes. M >> the other part is prosthetic enlargement is also associated with another far more serious problem which is prostate cancer >> okay >> so one thing is for sure if you have an enlarged prostate or if you're older please don't ignore it get checked you may or may not have cancer I'm not saying cancer is very common it's not
(30:22) it's one of the five big cancers in the world prostate cancer but it's not as if everybody has prostate cancer not like that prostitic enlargement does not mean prostate cancer but you should get checked so you should not ignore the problem. You should get checked and in certain situations not treating it can create complications.
(30:42) For example, >> exactly that was my question because see again not generalizing but you know men have this thing delay problem. >> All people try to avoid unc I avoid dentists. [laughter] [gasps] >> So they have this thing. Uh so let's take a situation if a man has prostate and he doesn't get it treated. >> Mhm. >> What can be like the worst scenario? >> Worst scenarios are complete obstruction, catheter dependence which is a pretty horrible thing to have and the worst problem is in that scenario uh you may keep getting infections because
(31:17) there's a foreign body. Now >> uh it can sometimes have bad influence on the kidneys. Kidneys can get damaged. >> You can lose renal function also. It's not very common but can happen but basically your quality of life can really really go down. Like I say it is not usually life-threatening >> but it can certainly make your life less worth living.
(31:39) >> So misery is not a good thing to live with. So >> it is to be considered >> and u getting a checkup is not so difficult. >> I mean I know India does India generally there's no custom of going to the doctor for checkups. very few people do it but for certain things it's worthwhile to get this done >> okaystate let's talk about what are the general treatments or the usual treatments for prostate >> okay initially symptoms mostly we'll start the patient on drugs >> these drugs are a few drugs that are commonly used roughly similar drugs so
(32:21) most commonly used drug is something called an alpha blocker relaxing urine becomes easier. Most people are okay once you do this. Okay. Uh certainly works for most people and it has been the big change in prostate treatment as compared to way back when. Okay, that we can talk about that later. >> But um this this works.
(32:46) Then there are other drugs which can actually slow the growth of prostate. So um what directly affects the prostate is a is something which testosterone gets converted into called dihydrotestosterone. >> So this conversion if you block it seems to reduce the size of the prostate just a bit 10% or so and can slow the growth of prostate.
(33:06) Now you don't want to completely cut off testosterone that has a lot of side effects. >> Bone density can go down, muscle strength will go down. That is done only for patients who have prostate cancer not for others. Mhm. >> So uh these drugs are there and can be used and lot of patients they are all that is needed. >> Now I spoke to you about the fact that prostate surgery was very difficult early and challenging.
(33:27) So somewhere on after the second world war >> this new procedure got invented called TURP trans urethral prostthetic resection. A lot of words >> basically you go through the urary passage and you remove part of the prostate to take away the blockage it is causing. >> Simple. It is something like you have a coconut and you scrape out the inside something like that.
(33:48) But obviously this was a huge improvement on the earlier procedure. The risks really came down and it's a very good surgery >> in the sense that complications have become less and less common, very uncommon as time goes on but there are still some complications >> but um overall that has been the main stay of prosthetic surgery.
(34:05) Now that is what is mostly done. There are variants of the TURB procedure like laser based procedure. Instead of using a tool uh what we call a dissecting cry instead of that you can use a laser to remove part of the prostate. You can even use steam, you can use other things but basically you remove that part of the prostate which is causing the obstruction while not damaging anything else.
(34:26) >> Well, sometimes you can damage other things. It can cause you know uh you lose control of keeping the urine inside. It keeps leaking. Things like that can happen. They're not very common but they are known complications of prostate therapy. >> So TURP and its light procedures the main stay.
(34:46) Now what happened was that how I got into the picture of treating prostates is because >> they used to have patients with prosthetic problems who would have bleeding and then they would get or after surgery they would bleed. I've also done these procedures where bleeding is happening after surgery. So to stop the bleeding you do imilization like >> we spoke about fibroids similar thing >> you would imilize.
(35:07) What they found was the prostate would actually shrink after you emulize. So the gentleman in Portugal said key why don't we do this as treatment then? >> Yeah. >> Okay. So they did the trials they did the treatments and now to cut a long story short >> at this point I was speaking to my colleague from the US who runs a set of clinics to do this.
(35:25) So they did last year they did 15,000 cases of prostatic artery emilization. It is that common now >> so prostatic artery emilization is a similar procedure as to what we do for fibroids only for prostates >> and it's actually much better tolerated >> because it's one it's smaller organ to not so richly innovated >> so there isn't that much pain or anything like that it's it's definitely a daycare procedure so we go in again through the wrist travel to the artery supplying the prostate now there's a big difference here prostate being much
(35:55) smaller the artery is also much smaller so much more difficult to get into to find. So it's it's a fair bit more complicated than UF. >> Okay. >> Um and once you embolize the blood supply stops, the prostate shrinks. Most patients that we have had, we've had more than quite a few patients by now. Within one month, they say their symptoms are gone and like I put it to them, we don't remove your trousers, we treat your prostate.
(36:22) So it is really very comfortable. >> Is it right for everyone? Again, I would say it is not right for everyone. There are patients where I'll say no you need surgery. >> You're not going to benefit from this procedure. There are patients where I would say it's right for you. >> There are patients I would say you need to test for other things.
(36:38) So on and so forth. So every patient is not right for every procedure. You have to pick the procedure as per what fits and what is the best option for the patient keeping in mind and taking into account the patient's own choices. >> Yeah. So that is what we have now. So treatments prostate which is one was Tur and the second was P A.
(37:02) >> Yes. >> Let's compare both of them. >> Ah hard to compare both of them because they are so different. >> So TURP actually is from just after the second world war. >> Pretty old well established a good procedure a great procedure for the time I would say. So basically they put in something called a rectocope like a >> through the passage under anesthesia of course patient is under anesthesia and then they take something called electrocottery and shave out that part of the prostate which is causing the blockage. You have to be very skilled
(37:34) and good at surgery to understand exactly you remove the wrong thing will create huge problems for the patient. >> But urologists are well trained. They spend many years learning to do this. So they are good at it and the procedure has good results. It has certain it can have certain complications which we know over the years um not very high complication rate >> about 10 to 15% of patients as per the American data they can have you know erectile dysfunction leaking of urine sometimes temporary sometimes can last for a very long time
(38:05) or even be permanent some patients can get what's called a stricture scarring because So because of healing and scarring it becomes narrow and that can be a problem complicated and there are various other side effects >> but that is the surgical thing I think similarly pae is for the right patient with the right kind of prostate is a procedure where it's minimally invasive no general anesthesia no hospital stay at all I do not place a urinary catheter in fact I like I said I don't remove the patient's trousers so it is um very well
(38:43) tolerated and low risk and can be done in patients where uh conditions like heart disease etc prevent them from undergoing normal surgery they can still undergo this procedure. >> You mentioned that uh to a risk side effect is erectile dysfunction. Yes. Now um the biggest fear in menarch most of them don't want to get treated for prostate because that it can permanently affect a sex life of a man.
(39:14) Is that true? Can surgery do that? >> See it's a complicated question again like we spoke about infertility. This is also a complicated question. um erectile dysfunction or sexual uh dysfunction can have multiple causes. >> Uh first of all a lot of patients because of the fact that the prosthetic problem is troubling them so much and occupying so much of their brain space that itself can cause problems.
(39:40) >> But yes, it is recognized that there is an association between undergoing surgery and having some degree of erectile dysfunction. There's also another side effect related to the sexual function which is what we call retrograde ejaculation. >> So the semen doesn't come out, it goes back into the bladder.
(39:59) And this is very common. This is about 70% of patients will have this. It has no bad consequences. But a lot of patients feel very upset about it. So I I try to tell them look that is not really a problem. It's it doesn't affect anything else but they are affected by it. So we take that into account. uh these these are the things which can happen are they very common according to the US data which which which uh we know about it's about 10% 9 to 10% of patients can have this uh erectile dysfunction >> PA does not have that problem because we
(40:30) are touching nothing over there erectile dysfunction chances but people who have that will not necessarily improve because we did a PE >> because it like I said it's a complicated subject but there are patients who claim that they are better off after PE because partly because they are getting more sleep at night probably >> because a lot of patients their biggest problem every 2 hours I'm getting up and going >> so that is one of the biggest problems a lot of them are saying I have to plan my day according to where's the washroom so
(40:59) >> it is that big a problem >> it can become that bad yes >> like you said it can really affect the quality of the life >> oh yes so my one of my first patients was like I can't play golf because I have to keep going back to the washroom >> so I can't finish my 19 my 18 holes of golf so I need to do something about it.
(41:16) So >> in fact uh in my research it also came that prostate cancer is actually the second largest cancer uh in men. >> Men yeah if you talk about men yes true so it's one of the five big cancers in the world and very common. >> Um so as we know as people live longer cancers become more common and obviously prostate cancer is occurring in older men.
(41:38) >> The problem is prostate cancer it has zero symptoms >> until it really spreads. Oh, >> so one of the side effects of dealing with prostate patients has been that we frequently picked up prostate cancer early and gotten them into treatment and the treatment is not PA for prostate cancer >> but we gotten them into the right treatment early.
(41:58) So what I really recommend for all men is please check your what we call PSA levels >> prostate specific and it's a simple blood test. Anybody will come home take a sample and most health screening you know testing test bundles will have that included for men. >> So PSA should be done every year and if the PSA is high then you should get checked.
(42:18) >> If you have unusual symptoms again you should get checked some I mean mostly PSA is high in prostate cancer but not 100%. >> It is not 100%. So if you're having problems please get checked up. >> Absolutely. And uh you know that brings me to the last uh question and here is where I would like to end.
(42:37) Can you speak directly to the person watching this right now and tell them what do you wish every patient knew before choosing a treatment? >> That's a big question. >> I cannot say I have not thought about it. I have thought about it because I it's part of my job to think about this. Patients need to realize that their health is partly their responsibility and knowledge and awareness are very very important.
(43:12) If you have well unfortunately I wish nobody had to go through it but the fact is all of us go through it. I did uh friends, relatives, parents get bad diseases. M >> you have to go through a complicated healthare scenario. What I want to tell people is you should not go there feeling that you know that you cannot ask questions.
(43:36) You should always ask questions. Listen to the answers. In fact, I would say you should carry a book, write down your questions, ask all the questions. And please, it is the doctor's job to answer your questions. Anybody who doesn't answer your questions is is not doing the right thing. They should answer your questions.
(43:56) And two, listen to the advice of the doctor. >> Okay? Most doctors that I know, in fact, almost all doctors I know, nobody wants the patient to come to a harm. And believe me, it makes no difference whether the patient is rich or poor. That is not what counts. >> No procedure is different for a rich man and different for a poor man.
(44:15) That's not how it works. What does happen is that you make bad choices because you have received incorrect information or inadequate information or you have not focused on the information that you should get. So please think, interact, take charge of things and control your own destiny, your body and your health because your life is yours.
(44:37) You get to take the decisions. So it is your right to ask questions and to take the decisions. That's what I think everybody needs to know about healthcare. That's a fabulous fabulous advice. Thank you so much doctor. Uh absolutely loved our chat and it was very very informative. Um if we can create little bit awareness about these common problems like fibroids and prostate I guess our job is done here.
(45:06) Uh again thank you so much for being here. It's >> pleasure being here. Thank you so much for having me. Thank you. >> [music]
Author Name:Zahra Jani
Youtube Channel Url:https://www.youtube.com/@zahrajanishow
Youtube Video URL:https://www.youtube.com/watch?v=x6EFAm-xmQA
Title: Fibroids & Prostate Issues: Can You Avoid Surgery? | Surgeon Captain Rochan Pant VSM
Author Name: Zahra Jani
Description: What if surgery isn’t always the only answer?
Welcome Surgeon Captain Rochan Pant. VSM (Partner and an Interventional Radiologist at C3 Medicare), as we discuss fibroids, infertility, prostate enlargement, prostate cancer and the role of Interventional Radiology in modern healthcare.
From uterus and menstrual health to Charles Dotter, “Mad Charlie,” and the first angioplasty, discover how medical science and healthcare innovation are creating new treatment possibilities.
If you enjoy conversations that make healthcare easier to understand, Like, Share & Subscribe to Zahra Jani Show for more.
About the guest:
Today’s guest is Dr. Surg. Caption Rochan Pant (Partner and Interventional Radiologist at C3 Medicare) with an MBBS & MD (Radiodiagnosis) from AFMC, Pune and extensive clinical experience as a former Armed Forces Surgeon.
A specialist in vascular & non-vascular IR procedures, he performs advanced image-guided treatments including PAE for prostate enlargement, UFE for fibroids, varicose vein treatments, pain management, and cancer-related interventions.
Instagram handle:
https://www.instagram.com/c3medicarei...
About C3 Medicare:
Mumbai’s specialised Interventional Radiology & Cancer Care Day-Care Centre
They provide minimally invasive, image-guided procedures through small access points, often under local anaesthesia, helping patients avoid prolonged hospital stays and recover sooner.
Their Interventional Radiology services include treatments and interventions for enlarged prostate (PAE), uterine fibroids (UFE), haemorrhoids, varicose veins, arterial blockages, diabetic foot and vascular conditions, selected liver cancers, and chronic pain.
Address:
C3 Medicare Clinic, 901 Shrikant Chambers II, VN Purav Marg, Nxt to RK Studio, Union Park, Chembur-71
Contact:
24*7 Helpline number: 022-48972433
Website: www.c3medicare.com
Chapters:
00:00 — Introduction
02:21 — What Is a Fibroid?
04:39 — Fibroid Symptoms and Warning Signs
06:51 — Fibroids: Surgery or Non-Surgical Treatment?
10:23 — Discovery of Uterine Fibroid Embolization (UFE)
12:04 — How Uterine Fibroid Embolization (UFE) Works?
16:24 — UFE Recovery Time and Results
17:42 — UFE vs Surgery: Recovery and Benefits
22:53 — Cost of Fibroid Treatment
24:10 — What Is Prostate Enlargement?
27:07 — Why Does Prostate Enlargement Happen?
28:25 — What Are the Symptoms of Prostate Enlargement?
31:01 — Risks of Untreated Prostate Enlargement.
32:00 — What Happens If Prostate Enlargement Is Untreated?
35:36 — What Is Prostatic Artery Embolization (PAE)?
37:03 — TURP vs PAE: Treatment Comparison
39:02 — Can Prostate Treatment Affect Sexual Health?
41:28 — Prostate Cancer Awareness
42:33 — How Should Patients Choose a Treatment?
45:06 — Closing Remarks
--------
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Disclaimer: This video is intended solely for educational purposes and opinions shared by the guests are his/her personal views. We do not seek to defame or harm any person/brand/product mentioned in the video. Our goal is to provide information to help audience make informed choices.
Transcript:
(00:00) out of uh 100 women almost 20 to 30 will have fibroids. The most common things I would say would be excessive bleeding and pain. This excessive bleeding can be so heavy that the women lose so much blood. Fibroid they can cause problems infertility. We had a patient recently her hemoglobin was down to six and five.
(00:19) She was so scared of surgery. She was offered surgery she refused it. Then she came to us. We said okay we can sort it without that also. fibroids treat without actually you know cutting people cutting people open generally doctors suggest uterus no problem but it comes at a cost >> today's [music] guest has gone from being a surgeon in the armed forces to using tiny instruments and medical imaging to treat conditions without traditional surgery Dr.
(00:57) Roachin Punt, senior interventional radiologist at C3 Medicare, is here to tell us how and why this could change the way we think about fibroids, [music] prostate problems, and more. Let's shift the focus from women's health to men. Most of them don't want to get treated for prostate because that it can permanently affect a sex life [music] of a man.
(01:20) Is that true? According to the US data, 9 to 10% of patients can have this uh erectile dysfunction. PE does not have that problem because we are touching nothing over there. [music] >> Welcome to Zarajani show. Now before we begin the conversation, my team showed me something really interesting. Most of you who watch ours haven't subscribed to our channel yet.
(01:46) If you're enjoying these conversation and love the incredible guests we bring on, I would love for you to hit that subscribe button. It's a small click for you, but it helps us bring you more amazing guests. And with that, let's begin. Welcome Dr. Ochin Pan to Zara Show. >> Thank you so much for having me here. >> Absolutely.
(02:10) And I am really looking forward to this chat because we're going to talk about something which nowadays most women and men face uh that is fibroids and prostate respectively. But treatment there is an immense lack of information. So I'm going to be like a curious student today and going to ask you the most basic question and currently you're the senior interventional radiologist at C3 Medicare.
(02:38) >> Yes. >> So um start that we are going to talk about fibroids and prostate. So let's start with fibroids. >> What exactly is a fibroid? And I don't want the medical explanation for this fibroid. Okay. What is a fiber? >> Okay. To the body is made up of cells. Many different kind of cells. It's not a cancer. A fibroid is a collection of cells.
(03:26) the same cells which make up the muscles in the wall of the uterus. >> Okay. >> And they are abnormally formed. So fibroid technical term it's like lot of people have moles in the skin. Not all of them are cancer. Not all of them need treatment. Sometimes they become abnormal. Sometimes they're not.
(03:48) Fibroids are benignut and what it can do is it can cause problems to the patient sometimes. If you look at data analysis out of 100 women almost 20 to 30 will have fibroids. fibroid very commonly seen all women under a fibroid. So fibroids symptoms
(04:40) 20 to [clears throat] 30 women out of 100 >> can have fibroids >> can have fibroids and I feel the every second woman I know has fibroids or knows someone who does. >> Yes. >> So what are the like symptoms which problem? So yeah you're absolutely right. My mother had fibroids. [laughter] She underwent surgery long time back.
(05:02) But the thing is fibroids problem usually fibroid when they are large what can it cause because they're large and they're vascular tumors they have a lot of blood supply they can cause excessive bleeding very commonly during periods the bleeding can become very heavy >> sometimes they can cause pain again during periods or even otherwise they can cause press upon other organs nearby like the urinary bladder constipation otherwise sometimes they can because not so commonly but sometimes they can cause problems in fertility
(05:37) because fibroids are abnormally distorting the uterus. >> Okay. >> So these are some things which the fibroid can cause. The most common things I would say would be excessive bleeding and pain and this excessive bleeding can be so heavy that the women lose so much blood. We had a patient recently her hemoglobin was down to six and five. Thank you.
(05:57) >> Any kind of effort would be really difficult for her. >> But she was so scared of surgery. She was offered surgery. She refused it. Then she came to us. We said okay we can sort it without that also. But point being >> these symptoms sometimes get taken as normal. That's the other part. Pain during periods is normal.
(06:16) It may or may not be. It can also be because of fibroids and there are other conditions which can cause it. I would really say that if you find your life is becoming difficult because of these things, you should definitely see a doctor, get it sorted. >> Absolutely. And I guess I guess there is no need to make our life uncomfortable.
(06:47) >> Definitely. So my next question is key if a woman has fibroids is the only solution that she has to go through surgery. >> No not at all. Um even if the fibroids are causing symptoms there are many solutions. Any given solution is not perfect for everyone. I mean people are not the same. You're not the same as me.
(07:08) I'm not the same as somebody else. Everybody is different. >> Everybody has different needs. Everybody is at different time in life. >> Yeah. So fibroids problem fibroids problem is a unique problem in the sense that it occurs in women of childbearing age because fibroids grow under the influence of this hormone called estrogen which as you probably know and most listeners know is the female hormone without estrogen you cannot be female.
(07:34) So like men cannot be men without testosterone. >> So it grows under the influence of estrogen. So once the estrogen levels fall which happens at menopause the fibroid stops growing. And the problems can also go away. So depending on which stage of life you are >> and what the problem is the solutions can be different for different people.
(07:54) >> I mean for some people rare. >> I I will say your surgery is the only option for you. There is no other option. >> So basically speaking fibroids problem and we need to treat what are the approaches? One approach excessive bleeding. M >> block the bleeding by hormonal therapy and the problem goes away >> for a short period of time.
(08:21) This is of course practical. Supposing you are near menopause, you're having this problem, you have fibroids. We tied you till menopause by giving you medicines and at the menopause point your symptoms will go away. So you are fine. You did not undergo surgery. Your problem went away and for a short period of time those drugs are safe to take.
(08:40) M >> but if the patient is 35 years old >> it is not a practical solution to give hormonal therapy to control the bleeding for the next say 20 25 years >> so situation you have two basic approaches >> surgically speaking surgery no problem but it comes at a cost when you lose a uterus and there are certain side effects to it we are still researching what all the uterus does.
(09:11) So we don't really know enough about the human body yet and maybe we never will. Life is a fascinating thing >> but >> it comes at a certain cost in terms of recovery period possible complications of surgery all of this. Okay. But in a given situation that may be the best solution for the patient that should be discussed with the doctor.
(09:29) >> Other option is myomectomy uterus fyroid. This is a little more complicated because uterus surgery comparatively but myctomy fibroid you have to dig into the wall of the uterus and take out the fibroids. >> Okay. Now there are multiple fibroids it becomes more difficult to treat the smaller ones. >> But momectomy is also an option given the situation. Okay.
(09:54) So [snorts] depending on the patient these are the surgical options. >> Now what are the other options? Now supposing the fibroid is there but I kill it inside problem solve. So what we can do is one which is the oldest established non-surgical method because this started way back when in the late 80s and that is also a story.
(10:14) >> We are here to listen tell us all [laughter] about >> okay I'll tell you about the story. So this happened in Paris in France late 80s when they were doing myomectomy problem obviously there can be a lot of bleeding because this is something we do we block blood vessels from the inside. It's a standard interventional radiology procedure.
(10:39) This is which we started doing long time ago. So they would ask for an imolization which is the process of blocking the blood vessels from the inside to reduce the bleeding during myomectomy. M now this patient this lady was to undergo myctomy underwent imolizationtomy but for some reason that hospital went on strike or something that surgery got cancelled said okay we can't do it today we'll call you back when we ready for you we called her back she said I don't have any problem anymore I don't want the surgery okay this was done by this
(11:08) doctor French doctor called Ravina >> so this was done and this was published back then so people realized the problem of fibroids can be taken away by blocking the blood supply of the fibroid so that the fibroid shrinks and the symptoms go away. This was called uterine fibroid imilization became popular increasingly in the west >> and because it's relatively non-invasive early recovery all these advantages lot of research lot of papers so now at this point of time in the national health service of UK it is an accepted option
(11:38) for treating fibroids >> so I have a couple of questions fibroids treat without actually you know uh >> cutting people open >> cutting people open sorry for the lack of better words to explain. It's a good good description. It's [laughter] a good description >> and you know first question is explains fibroids. Exactly. We call it angioraphy.
(12:15) That is angioraphy. So what do we do? >> We generally give local anesthesia. Say we are doing we normally do it from the left wrist nowadays. So we we'll give a small injection on the left wrist. >> This part will become numb. So about 3 4 cmters of the wrist will become numb. We put a needle into the artery.
(12:30) >> Usually under ultrasound we place a small tube which is about 2 mm in size. Once you enter the artery now the thing to understand is people ask me this question. >> Exactly. >> All arteries come from the heart. All the arteries eventually connect to the heart. So they all come to one place together. That means they're connected to each other.
(12:52) >> So once I come in from one artery, depending on the direction I want to go, I can go to almost any other part of the body. >> Given that I have the right tools, the machine is a bit expensive that I have to use to see inside the body to guide me where to go. But we go from the groin to the brain.
(13:11) We go from the wrist down to the uh lower parts. we can go from um u the lower leg up into the body. So blood vessels are like roads which carry blood. Through that we can go to almost any organ in the body. >> So this is the basic thing. From here we go in we take the tube we can see under the X-ray machine is called an angography system and we go to the arteries supplying the uterus called the uterine arteries which is in the pelvis lower down in the lower abdomen.
(13:43) Got it. >> And then once we have identified where we are and where the blood supply of the fibroid is, special Okay. So fibroid shrink normally procedure patient is awake only local anesthesia. Sometimes for some patients who are apprehensive after [clears throat] the procedure it's not that we have done nothing the fibroid inflammation there are no stitches you can walk you
(14:34) can do everything else normally pain is to be managed and then we follow Usually bleeding problem starts coming up. There is a size limit in this. I mean we can do it but it may take multiple sittings. So it may not be right for you. But usually it's also in women who are no longer looking at having children.
(15:11) So given that circumstances we advise the patient what is the best option for them. A lot of patients we tell them >> you need to undergo surgery. There can be patients like there are patients where we say this is too much. >> You cannot treat this by these means. This requires you to have a hyctomy. >> Okay.
(15:30) Sometimes in infertility patients, infertility patients maybe fibroidization, it has worked. Some of my patients did become pregnant. But we still don't recommend it as an option for treating infertility. It does not affect the fertility. But if the problem with infertility patients is infertility is a complicated thing. It may not just be the fibroid.
(15:52) I cannot promise you fibroid sol. >> Yes. Absolutely right. It's complicated as you know. So that is why I say we don't have a master plan for every patient. Every patient has to be looked at individually. >> Yeah. >> Everybody is different and like you said every person is in a different phase of life.
(16:12) So it needs to be treated that way. >> Correct. Absolutely. >> Um UF which is the uh >> acronym. Yeah. Urine fibroid emilization. >> Exactly. Which is the non-surgical way of treating the fibroid. Uh it's recovery time. example treatment >> and within how many hours the patient can go back? >> We can send the patient back in 2 hours. That's not a problem.
(16:39) We take them outside. Since we punctured an artery artery is a high pressure vessel till that is okay. Say an hour. Patient has to pass urine, eat and drink something. Once they're able to do that, they can go home. >> Yeah. We normally say dayare when you are living close enough to us that you can come back to us if anything is needed but usually that is not necessary.
(17:05) What can happen after this is you can get pain, you can get some nausea, you can get some vomiting. We gave drugs for all this variable which patients absolutely fine and we used to admit them because you know I'm sick of [laughter] the hospital. I want to go home. Some patients take a few days to recover from the pain you know some other things but most people by four days are back to being nearly normal.
(17:34) >> So again I know uh my questions might be overlapping but I I want to stress on this uh because UF side effects. So let's compare >> uh UF and a traditional surgery uterus >> again because this is you know spread procedure fibroid obviously with a disclaimer body that's the disclaimer always but let's just compare the you know the recovery time pros and cons for both so that people understand medicine advance and we can have an
(18:19) easier treatment. >> Okay. To give you a rough, it's a very rough analogy because bypass surgery was the only way to treat hearties bypass recovery period is a month plus right you are fine. you come out of the ICU and you go home. >> Practically speaking, you can actually do it as if you know [snorts] but it is not right for every patient.
(18:56) Yeah. >> Right. So similarly hyctomy obviously is a major surgery. You don't have to cut open but there is a recovery time. Yes. That has to heal. But you cannot really compare hyctomy with uterine fibroid emilization because uterine fibroid emilization you do not lose the uterus. You still have it.
(19:25) Whereas hyerectomy you lose the uterus. Right? Now um any major abdominal surgery certain number of people will have some bleeding. They can have bleeding later. Some will need blood transfusions. Some can get infections. All these are known things for any major surgery. The thing you can actually compare u to is probably myomectomy more than hyerectomy because myomectomy also you preserve the uterus.
(19:50) >> That is a more uh say fair comparison because the uterus is still there. >> Once you remove the uterus there is no question of failure of treatment because you're not going to get fibroids now. The uterus is not there. >> Uress is gone. >> Yeah. But also you you lost an organ. So >> that is also there.
(20:07) So but myomectomy again you're keeping the uterus >> but taking out the fibroid. Now what what is the comparison between the two? Again my momectomy can be done laparoscopically even robotically. So the incision may not be big. >> So incision but still bleeding can be quite a bit. >> Uh fair number of patients will need blood transfusions myomectomy or after myctomy.
(20:27) Blood transfusion also comes with certain amount of risk. Again because you're operating inside the body and you are you know cutting into things and all there is a possibility of infection. minor chance of injury to other organs you know these are safe procedures they have been perfected over a long period of time but still there are risks right >> comparatively UF may the complication rates of infection bleeding etc are practically zero >> the only problem with UF is that because the uterus is still there fibroids can still recur but the same is true of
(20:59) momectomy >> that is not different recurrence rate in myctomy actually is slightly higher >> oh is it Because you cannot remove the small fibroids >> and >> and you cannot treat all fibroids in one go. In UF you can treat all fibroids in one go because you're blocking the blood supply to all fibroids. >> Right? >> So it is not that you cannot do it.
(21:20) >> What is the difference? Uh I would say the only thing where there is still some doubt is regarding patients who have infertility. That is the only group. But if you look at the studies which have been done actually fertility rate when you take it by age etc in scientific studies >> that said that doesn't mean it will translate into your treatment >> because one every patient is different two every hospital country doctor is also different.
(21:47) >> Absolutely. So everything comes with its own disclaimers ifs and buts. >> There are variations there is there are possibilities and people who do surgery are doing a very good job. It is that that technology may be right for you given your circumstances or this technology may be right for you given the circumstances.
(22:04) But you should realize there are options. >> You can discuss the option. Choose the one you prefer. >> I I love that this conversation because we are not judging anyone. We are just saying that of course not why should we >> awareness >> it is your life and your body. I tell every patient is your life and your body.
(22:20) You are the one who bears the risk of the procedure. I will go home. >> The risk is yours. So you need to understand you need to ask me all the questions you want because it is it is not I am not God. I haven't you know I have no way of controlling everything in the world. I cannot >> even when all doctors will tell you this the only person who doesn't have problems with with procedures is one who doesn't do any.
(22:43) >> Absolutely. I'm going to ask you a tough or an uncomfortable uncomfortable question. >> Sure. >> Um do you think money is also the factor? Of course. surgery you know uterus that will I'm assuming will cost more than like a non-surgical procedure >> not necessarily see in India there are many price points of everything [laughter] as you know so actually a hyerectomy may be cheaper in terms of just the surgery >> but in terms of the overall experience and recovery period it will carry that deficit also which is not accounted for
(23:20) >> like I said it depends on the patient the patient's choices and the patient circumstances. See, as of now, is UF cheaper than all hyerectomies? No. It is cheaper than hyerectomies in some hospitals. >> It can be more expensive than hyerectomies in some other hospitals. >> It's not marketkedly different in cost.
(23:40) >> Okay? And it's an approved procedure by the government of India. It's on the Aish man list for that matter. >> It's available under the Aishman scheme. It's a state subject. So different states apply it differently but it's available under government schemes as it's recognized as a daycare procedure by the government of India.
(23:58) So that is not the problem here. The question is of information and choices and I feel that the patient should get the information and make the choice. >> Okay. So I guess we've spoken enough about fibroids. Now let's shift the focus to men and their health. Um generally older men they suffer from prostate. Prostate enlargement actually.
(24:21) >> So men get what's called prostate problems. >> Yes. >> Prostate problem is unique to men because prostate is unique to men. >> So women have uterus, men have prostate. Both are hormonally linked. The prostate grows under the influence of the male hormone which is called testosterone. So when you're born it's like 5 g.
(24:39) As you become older it keeps growing because of testosterone. And unfortunately in some cases it keeps going going on growing till it's extraordinarily large and because of its location it then causes problems. >> So where is it located exactly the prostate? A lot of people don't realize what the prostate is what it does.
(24:57) >> So the prostate is located just under the urinary bladder where the urine is stored. >> So urine is kept in storage till you are ready to pass. So that storage system is the unary bladder >> and the passage which goes out is called the urethra. The the tube which urine comes out of.
(25:13) The prostate surrounds the urethra just below the bladder. >> Okay? >> So it sits there. So when it becomes big, what it does is it's one, it squeezes the urethra. >> So the urethra becomes narrow. It becomes more difficult to pass urine. >> It won't come out fast. It will take time to come out. >> It also squeezes the base of the bladder.
(25:30) So you keep getting the urge to pass urine because the nerves in the bladder >> are quite rich in that area and the sensitivity and then you keep getting the urge to go again. It's called urgency. So all these things are what we call prostatism. They're very common in men. >> So at about 60 it's about 50% of men. They'll have symptoms of prostate.
(25:50) By 80 it's almost 90%. >> Wow. >> Yeah. Now all of them may not need a procedure because uh earlier there were not there was nothing else you could do but surgery. So there's a famous thing which was said by a surgeon in UK long back Lord if you take me let it not be through the bladder because it makes the patient so miserable the bladder getting obstructed >> that he said don't take me through the bladder whatever you do this was a surgeon >> the other thing which used to happen there was because when the urine gets
(26:20) obstructed they had to pass a tube to get it out what we call catheterization so people would actually carry catheters with them >> to you know get in and take out the urine >> but Then why surgery was avoided? Because prostate surgery early on was extremely difficult and very risky because it's a vascular organ in a difficult place and if you try to do open surgery and remove it, it used to bleed a lot and lot of patients would actually not make it out of the OT.
(26:48) >> Mhm. >> But then over time things evolved and nowadays there are drugs which can help and lot of patients are absolutely fine taking the medication. Take a tablet every day and you are okay. M >> so this is very common but lot of patients will suffer from it >> some of them will be okay with medication some will not >> okay so we'll get into the treatment part but again a basic question prostate enlargement what like what causes the prostate enlargement >> that's a very good question >> so the earlier assumption was that
(27:19) testosterone is the only factor testosterone hey >> prostate responds to testosterone therefore prostate will grow. >> Okay. But it doesn't happen in all men and testosterone levels exact correlation. Nobody really understands completely but we know certain things. for example. But we know now that sedentary lifestyle, diabetes, u diet, overweight, all these will have far more problems because of prostate
(28:03) than men who are active, not overweight and have a healthy active lifestyle. >> So it is not one thing only, it's many things. But eventually there's only so much you can control in your life, right? >> So >> given that there is so much prevalence of prostate, >> it's a it's a very common problem for men to have >> and urg.
(28:27) So generally men who have the prostate issue is it that simple or men are ignoring other symptoms. So things can it can be more than that. For example, um um what happened to one of our patients went to Canada on leave went to Canada and then one day suddenly he couldn't pass urine.
(28:55) Probably maybe it happened because he had a long flight and he did not want to use the washroom in the flight. So he held on too long but he couldn't pass urine at all. Now he's in Canada. He's an Indian citizen and was he could not get treatment there. >> Yeah. So we had to come back get a catheter placed then the they try to remove the catheter.
(29:13) What usually is done in this you place a catheter drain the urine out hopefully the swelling in the prostate or the bladder will go down and you'll be able to pass urine normally in time. That's what happens with most people. This patient still couldn't pass after a week two weeks trial of removal couldn't pass. He was now on catheter.
(29:30) So this can happen and there's more than one patient with this story that we've had and it is known thing. It happens sometimes. Unfortunately, we can't predict go. >> So, this is something that can happen with enlarged prostates. Usually with larger prostates, not so commonly with smaller prostates. Usually with larger prostates, this can happen and sometimes it can lead to a complete dependence on catheters especially in older patients.
(29:53) >> Sometimes patients are going for some emergency surgery, a tube is placed for the surgery and then the tube doesn't come out. So that is also another story which happens. So can prostate lead to worse problems? Yes. M >> the other part is prosthetic enlargement is also associated with another far more serious problem which is prostate cancer >> okay >> so one thing is for sure if you have an enlarged prostate or if you're older please don't ignore it get checked you may or may not have cancer I'm not saying cancer is very common it's not
(30:22) it's one of the five big cancers in the world prostate cancer but it's not as if everybody has prostate cancer not like that prostitic enlargement does not mean prostate cancer but you should get checked so you should not ignore the problem. You should get checked and in certain situations not treating it can create complications.
(30:42) For example, >> exactly that was my question because see again not generalizing but you know men have this thing delay problem. >> All people try to avoid unc I avoid dentists. [laughter] [gasps] >> So they have this thing. Uh so let's take a situation if a man has prostate and he doesn't get it treated. >> Mhm. >> What can be like the worst scenario? >> Worst scenarios are complete obstruction, catheter dependence which is a pretty horrible thing to have and the worst problem is in that scenario uh you may keep getting infections because
(31:17) there's a foreign body. Now >> uh it can sometimes have bad influence on the kidneys. Kidneys can get damaged. >> You can lose renal function also. It's not very common but can happen but basically your quality of life can really really go down. Like I say it is not usually life-threatening >> but it can certainly make your life less worth living.
(31:39) >> So misery is not a good thing to live with. So >> it is to be considered >> and u getting a checkup is not so difficult. >> I mean I know India does India generally there's no custom of going to the doctor for checkups. very few people do it but for certain things it's worthwhile to get this done >> okaystate let's talk about what are the general treatments or the usual treatments for prostate >> okay initially symptoms mostly we'll start the patient on drugs >> these drugs are a few drugs that are commonly used roughly similar drugs so
(32:21) most commonly used drug is something called an alpha blocker relaxing urine becomes easier. Most people are okay once you do this. Okay. Uh certainly works for most people and it has been the big change in prostate treatment as compared to way back when. Okay, that we can talk about that later. >> But um this this works.
(32:46) Then there are other drugs which can actually slow the growth of prostate. So um what directly affects the prostate is a is something which testosterone gets converted into called dihydrotestosterone. >> So this conversion if you block it seems to reduce the size of the prostate just a bit 10% or so and can slow the growth of prostate.
(33:06) Now you don't want to completely cut off testosterone that has a lot of side effects. >> Bone density can go down, muscle strength will go down. That is done only for patients who have prostate cancer not for others. Mhm. >> So uh these drugs are there and can be used and lot of patients they are all that is needed. >> Now I spoke to you about the fact that prostate surgery was very difficult early and challenging.
(33:27) So somewhere on after the second world war >> this new procedure got invented called TURP trans urethral prostthetic resection. A lot of words >> basically you go through the urary passage and you remove part of the prostate to take away the blockage it is causing. >> Simple. It is something like you have a coconut and you scrape out the inside something like that.
(33:48) But obviously this was a huge improvement on the earlier procedure. The risks really came down and it's a very good surgery >> in the sense that complications have become less and less common, very uncommon as time goes on but there are still some complications >> but um overall that has been the main stay of prosthetic surgery.
(34:05) Now that is what is mostly done. There are variants of the TURB procedure like laser based procedure. Instead of using a tool uh what we call a dissecting cry instead of that you can use a laser to remove part of the prostate. You can even use steam, you can use other things but basically you remove that part of the prostate which is causing the obstruction while not damaging anything else.
(34:26) >> Well, sometimes you can damage other things. It can cause you know uh you lose control of keeping the urine inside. It keeps leaking. Things like that can happen. They're not very common but they are known complications of prostate therapy. >> So TURP and its light procedures the main stay.
(34:46) Now what happened was that how I got into the picture of treating prostates is because >> they used to have patients with prosthetic problems who would have bleeding and then they would get or after surgery they would bleed. I've also done these procedures where bleeding is happening after surgery. So to stop the bleeding you do imilization like >> we spoke about fibroids similar thing >> you would imilize.
(35:07) What they found was the prostate would actually shrink after you emulize. So the gentleman in Portugal said key why don't we do this as treatment then? >> Yeah. >> Okay. So they did the trials they did the treatments and now to cut a long story short >> at this point I was speaking to my colleague from the US who runs a set of clinics to do this.
(35:25) So they did last year they did 15,000 cases of prostatic artery emilization. It is that common now >> so prostatic artery emilization is a similar procedure as to what we do for fibroids only for prostates >> and it's actually much better tolerated >> because it's one it's smaller organ to not so richly innovated >> so there isn't that much pain or anything like that it's it's definitely a daycare procedure so we go in again through the wrist travel to the artery supplying the prostate now there's a big difference here prostate being much
(35:55) smaller the artery is also much smaller so much more difficult to get into to find. So it's it's a fair bit more complicated than UF. >> Okay. >> Um and once you embolize the blood supply stops, the prostate shrinks. Most patients that we have had, we've had more than quite a few patients by now. Within one month, they say their symptoms are gone and like I put it to them, we don't remove your trousers, we treat your prostate.
(36:22) So it is really very comfortable. >> Is it right for everyone? Again, I would say it is not right for everyone. There are patients where I'll say no you need surgery. >> You're not going to benefit from this procedure. There are patients where I would say it's right for you. >> There are patients I would say you need to test for other things.
(36:38) So on and so forth. So every patient is not right for every procedure. You have to pick the procedure as per what fits and what is the best option for the patient keeping in mind and taking into account the patient's own choices. >> Yeah. So that is what we have now. So treatments prostate which is one was Tur and the second was P A.
(37:02) >> Yes. >> Let's compare both of them. >> Ah hard to compare both of them because they are so different. >> So TURP actually is from just after the second world war. >> Pretty old well established a good procedure a great procedure for the time I would say. So basically they put in something called a rectocope like a >> through the passage under anesthesia of course patient is under anesthesia and then they take something called electrocottery and shave out that part of the prostate which is causing the blockage. You have to be very skilled
(37:34) and good at surgery to understand exactly you remove the wrong thing will create huge problems for the patient. >> But urologists are well trained. They spend many years learning to do this. So they are good at it and the procedure has good results. It has certain it can have certain complications which we know over the years um not very high complication rate >> about 10 to 15% of patients as per the American data they can have you know erectile dysfunction leaking of urine sometimes temporary sometimes can last for a very long time
(38:05) or even be permanent some patients can get what's called a stricture scarring because So because of healing and scarring it becomes narrow and that can be a problem complicated and there are various other side effects >> but that is the surgical thing I think similarly pae is for the right patient with the right kind of prostate is a procedure where it's minimally invasive no general anesthesia no hospital stay at all I do not place a urinary catheter in fact I like I said I don't remove the patient's trousers so it is um very well
(38:43) tolerated and low risk and can be done in patients where uh conditions like heart disease etc prevent them from undergoing normal surgery they can still undergo this procedure. >> You mentioned that uh to a risk side effect is erectile dysfunction. Yes. Now um the biggest fear in menarch most of them don't want to get treated for prostate because that it can permanently affect a sex life of a man.
(39:14) Is that true? Can surgery do that? >> See it's a complicated question again like we spoke about infertility. This is also a complicated question. um erectile dysfunction or sexual uh dysfunction can have multiple causes. >> Uh first of all a lot of patients because of the fact that the prosthetic problem is troubling them so much and occupying so much of their brain space that itself can cause problems.
(39:40) >> But yes, it is recognized that there is an association between undergoing surgery and having some degree of erectile dysfunction. There's also another side effect related to the sexual function which is what we call retrograde ejaculation. >> So the semen doesn't come out, it goes back into the bladder.
(39:59) And this is very common. This is about 70% of patients will have this. It has no bad consequences. But a lot of patients feel very upset about it. So I I try to tell them look that is not really a problem. It's it doesn't affect anything else but they are affected by it. So we take that into account. uh these these are the things which can happen are they very common according to the US data which which which uh we know about it's about 10% 9 to 10% of patients can have this uh erectile dysfunction >> PA does not have that problem because we
(40:30) are touching nothing over there erectile dysfunction chances but people who have that will not necessarily improve because we did a PE >> because it like I said it's a complicated subject but there are patients who claim that they are better off after PE because partly because they are getting more sleep at night probably >> because a lot of patients their biggest problem every 2 hours I'm getting up and going >> so that is one of the biggest problems a lot of them are saying I have to plan my day according to where's the washroom so
(40:59) >> it is that big a problem >> it can become that bad yes >> like you said it can really affect the quality of the life >> oh yes so my one of my first patients was like I can't play golf because I have to keep going back to the washroom >> so I can't finish my 19 my 18 holes of golf so I need to do something about it.
(41:16) So >> in fact uh in my research it also came that prostate cancer is actually the second largest cancer uh in men. >> Men yeah if you talk about men yes true so it's one of the five big cancers in the world and very common. >> Um so as we know as people live longer cancers become more common and obviously prostate cancer is occurring in older men.
(41:38) >> The problem is prostate cancer it has zero symptoms >> until it really spreads. Oh, >> so one of the side effects of dealing with prostate patients has been that we frequently picked up prostate cancer early and gotten them into treatment and the treatment is not PA for prostate cancer >> but we gotten them into the right treatment early.
(41:58) So what I really recommend for all men is please check your what we call PSA levels >> prostate specific and it's a simple blood test. Anybody will come home take a sample and most health screening you know testing test bundles will have that included for men. >> So PSA should be done every year and if the PSA is high then you should get checked.
(42:18) >> If you have unusual symptoms again you should get checked some I mean mostly PSA is high in prostate cancer but not 100%. >> It is not 100%. So if you're having problems please get checked up. >> Absolutely. And uh you know that brings me to the last uh question and here is where I would like to end.
(42:37) Can you speak directly to the person watching this right now and tell them what do you wish every patient knew before choosing a treatment? >> That's a big question. >> I cannot say I have not thought about it. I have thought about it because I it's part of my job to think about this. Patients need to realize that their health is partly their responsibility and knowledge and awareness are very very important.
(43:12) If you have well unfortunately I wish nobody had to go through it but the fact is all of us go through it. I did uh friends, relatives, parents get bad diseases. M >> you have to go through a complicated healthare scenario. What I want to tell people is you should not go there feeling that you know that you cannot ask questions.
(43:36) You should always ask questions. Listen to the answers. In fact, I would say you should carry a book, write down your questions, ask all the questions. And please, it is the doctor's job to answer your questions. Anybody who doesn't answer your questions is is not doing the right thing. They should answer your questions.
(43:56) And two, listen to the advice of the doctor. >> Okay? Most doctors that I know, in fact, almost all doctors I know, nobody wants the patient to come to a harm. And believe me, it makes no difference whether the patient is rich or poor. That is not what counts. >> No procedure is different for a rich man and different for a poor man.
(44:15) That's not how it works. What does happen is that you make bad choices because you have received incorrect information or inadequate information or you have not focused on the information that you should get. So please think, interact, take charge of things and control your own destiny, your body and your health because your life is yours.
(44:37) You get to take the decisions. So it is your right to ask questions and to take the decisions. That's what I think everybody needs to know about healthcare. That's a fabulous fabulous advice. Thank you so much doctor. Uh absolutely loved our chat and it was very very informative. Um if we can create little bit awareness about these common problems like fibroids and prostate I guess our job is done here.
(45:06) Uh again thank you so much for being here. It's >> pleasure being here. Thank you so much for having me. Thank you. >> [music]
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