Joey Wahler (Host): It is an advanced urological procedure treating a large prostate. So, we're discussing aquablation. Our guest is Dr. Varun Talanki. He's a urologist with Southwest Healthcare. This is Southwest Health Talk with Southwest Healthcare, building relationships that touch the heart. For more information, please visit swhealthcare.com. That's swhealthcare.com. Physicians are independent practitioners who are not employees or agents of Southwest Healthcare. The hospital shall not be liable for actions or treatments provided by physicians. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Talanki. Welcome.

Varun R. Talanki, MD: Thank you, Joey, for having me.

Host: Great to have aboard. We appreciate the time. So first, you specialized in advanced treatments for benign prostatic hyperplasia or BPH as it's sometimes called, but commonly known of course, as enlarged prostate. So, what are the symptoms of that and the effects of that condition?

Varun R. Talanki, MD: It's a great question. So, the most common symptoms that a man may present with initially or may develop over time as they get older can be more frequent urination, a weak urinary stream, a lot of urgency, frequency, more frequent restroom trips. Occasionally, men can develop even some urinary leakage as the problem progresses.

 One of the primary reasons some of these men will see me is because of what's called nocturia, which is frequent restroom visits at night. So, this can really affect a man's quality of life, their sleep, their energy levels, their ability to step out of the house, do normal activities because of how the bladder and the prostate is affected by BPH.

Host: You touched on it and we hear about these frequent bathroom trips, particularly at night. What's going on at night with the prostate that worsens that?

Varun R. Talanki, MD: That's a good question. So, there's a lot of information, a lot of studies that are still being done to better understand that aspect of it. But what ultimately occurs is that the increased pressure on the bladder from the prostate, the prostate is an organ that sits just beneath the bladder, and at night, it can place more pressure on the bladder just by gravity. And by doing this, a man will have more urgency, weak stream at night. A lot of the symptoms really start at night and then they can progress to the daytime as well. So, it's really that enlargement of the prostate, putting a lot of pressure on the bladder, giving that sense of a full bladder, even though it may not be can really affect a man's quality of life.

Host: Absolutely. But the good news is one treatment you offer is aquablation. For those unfamiliar, in a nutshell, Doctor, what exactly is it and how does aquablation differ from traditional surgical options for this?

Varun R. Talanki, MD: Aquablation is a minimally invasive treatment. It's done under anesthesia. And through this procedure which requires no incisions, no cuts, no scars on the body, a high-pressure water jet is used to reduce the obstruction from the prostate gland. It helps relieve the pressure from the prostate on the bladder. It can help with nearly all of these symptoms related to BPH. The benefit of aquablation that we find in our practice is we see fewer side effects, such as sexual side effects, fewer urinary side effects, quick recovery, not much pain associated with it. So, we get very happy patients, very good outcomes that we see with this procedure. Patients do extremely well. And we're proud to be one of the only centers in the area that can offer this treatment.

Host: And so just to be a little more clear, during the procedure itself, you mentioned water is involved, hence the name aquablation of course. And so, what exactly are you using and how?

Varun R. Talanki, MD: There's a small scope that's inserted directly into the bladder through the urethra, and there's a very fine water jet. The diameter of this water jet is about the diameter of a hair. It's a very fine instrument. And using this, the prostate is actually reduced in size. So, the actual tissue is removed with the water jet. It's done in a very safe manner. We watch this visually. The surgeon is actively watching every step of this process.

The other benefit is there's a lot of artificial intelligence that's used when we do this in terms of mapping, understanding the anatomy of each individual prostate. It really can differ pretty dramatically depending on the man. We are able to watch this visually as well as with an ultrasound. So, we're watching this live as the work is being done. For most men, the actual treatment is about eight minutes or less. So, it's a fairly quick procedure. Really, I believe the latest and greatest in terms of treatment for the enlarged prostate in a man, and it is because of ease of use for the surgeon. Good outcomes, good standardized outcomes, and patients do well with minimal side effects.

Host: Yeah, sounds very high tech, very futuristic, right?

Varun R. Talanki, MD: Yeah. I would definitely agree. And I think that urologists, and a lot of these urology procedures on a whole are constantly changing. And this is a sensitive area that you're working on and you want to preserve function in all aspects in these men. So, that's really high on our priority list. So for that reason, it really does take the latest and most innovative technology to achieve this.

Host: Absolutely. So, you mentioned there that not all prostates are the same. They differ man to man. So, what kind of a patient benefits most from aquablation? How do you know who's a good candidate for this?

Varun R. Talanki, MD: So, there are a lot of studies that we do. We speak to the man. We get a good understanding of what's worked, what hasn't worked, has this gentleman been on medications. A lot of that helps clue us in on is this a prostate problem or is there something else? And so with that information, we do some diagnostic testing including ultrasound, urine flow measurement testing, and cystoscopy in the office to better understand is this a prostate problem or is there something else that's causing these issues.

 A very important aspect of these tests is understanding measurements of the prostate. So, a prostate starts around about 25 to 30 grams, which is maybe a little smaller than a grape. And over time, it can actually grow. So, over time, it can reach the size of even avocado, quite large. And so, the benefit of aquablation that we've seen is that it can treat men with nearly any size prostate gland, any shape, size. Because of the use of ultrasound and individual mapping that we perform during this procedure, it really fits almost any man with these problems.

Host: So post procedure, typically in terms of results, is there merely improvement or can someone be good as new again?

Varun R. Talanki, MD: It does vary depending on how severe the problem is to begin with. If you can catch this issue and treat it in a timely manner before it becomes very severe, a man can achieve normal urination afterwards. I have had tens of hundreds of men that have come to me who've had treatments, and they urinate like they were in their 20s and 30s again because of how significant this blockage was and treating this at a time where it has become less severe.

 On the flip side, if a man waits too long, sometimes the bladder can start to deteriorate from prostate issues. And so, the success rate may be a little bit less. They may have some lingering symptoms. But all in all, we generally see very high success rates. Men tell me that their symptoms are generally 90 plus percent improved with this treatment. I have some men that tell me a hundred percent improved. There's varying degrees, but we generally hear very good success from this procedure.

Host: Doctor, you mentioned earlier that potential side effects are not high from this, but which ones could occur?

Varun R. Talanki, MD: The biggest side effect or discomfort for the patient is requiring a catheter. So, that may be something new for most men. However, in almost all scenarios, a catheter would be temporary. It's left in for a few days, sometimes just overnight. And so, that would be a short-term side effect where you have some discomfort from needing a catheter.

Now, in terms of long-term sexual side effects such as sexual issues, ejaculatory issues, erection issues, those are very important to most men and very important to us when we are treating patients. And so, risks are very low for those sort of side effects.

 Other side effects such as incontinence, long-term leakage can also exist exceedingly low. And most side effects are generally resolved within a few weeks. Some can linger, some urgency and frequency symptoms can linger for a few months. But all in all, in most scenarios, those symptoms are minimal compared to what men are suffering with to begin with.

Host: A few other things. So, we're really talking here about lifestyle improvement. Turning back the clock, if you will, as you said earlier, do you recall, Doctor, perhaps your most rewarding case or experience from performing aquablation and seeing the before and after.

Varun R. Talanki, MD: I can recall many, many cases like this. And I treat patients with aquablation almost every week, and I see these men for years afterwards, after they complete their aquablation. And I have men that come to me. They give a hug after surgery. I have men who've haven't been able to step outta the house.

I have one gentleman that I've been treating for a while. His pastime is cycling, and he cycles on a daily basis. Part of it also is for his son who was recently deceased, and he does charity events and it was very important to him to regain that function, the ability to go to these charity events for his late son.

And after I did the aquablation, he cried to me after this procedure, because he got his life back. And unfortunately, in his situation, he had tried other prostate treatments from previous urologists, which had failed. And then, he came to me, we did aquablation, and almost instantly he had relief. So, that changed his life. And moments like those are really what I live for. And that's really what makes this an incredible career for me. And it gives me satisfaction at the end of the day to be able to improve a man's life so dramatically. that's why we love this technology. It's an easy technology to stand behind because it works.

Host: Well, that's a great story. We appreciate you sharing that. And speaking of technology, which you mentioned there, Urology, of course, rapidly evolving, how do you keep up with all these advancements, like aquablation and what would you say excites you the most about the future of these new technologies?

Varun R. Talanki, MD: So, I would say one of the things that attracted me to this field was were the advancements. I would say Urology is always on the cutting edge. We're always looking for the next best treatment, next more effective treatment, fewer side effects. And whenever a new technology is released, we are a little bit hesitant on fully adopting. We do wait a little bit to see how this plays out. We look at a lot of data and numbers to see how men are doing around the country. And we speak to colleagues around the country with their experience.

So, we're very careful before we fully adopt a new technology. It can be very tempting to jump on to the next technology. So, we did spend some time to really vet this treatment out, to understand if this was going to be the best treatment. Is it safe? Is it a procedure that patients do well with? Are they going to be happy with this? So, we speak to colleagues around the country, look at literature, understand if this is something that's going to be good for our patients.

And then, with the help of Southwest Healthcare Systems, we were able to bring this technology to the region. And I believe still to this day, we are the only center in this county that offers this treatment. And one of the busiest, if not the busiest practices, to offer aquablation. So we're very proud of that. We're very proud that we were careful in choosing this technology. To date, there are tens, if not a hundred different BPH treatments out there. So, they can be a little daunting for a man to make that decision. And a lot of those decisions are made based on what technology the urologist may have available to them.

We're proud to be able to offer this. It really is the latest and greatest. The company does a good job of constantly updating, listening to us, taking feedback from us. So we've been very proud of this therapy and I think it's going to be the future and continue to grow.

Host: Yeah, definitely sounds like that. And in summary here, for men joining us who may be hesitant to talk about urinary symptoms or consider surgical treatment, what's your advice?

Varun R. Talanki, MD: My biggest advice would be that you're not alone. There are men even in your neighborhood, your neighbors all around who are suffering with the same problem. And to give you some numbers, we probably do about 10 to 15 aquablations about a week and as a group. So, it's a very frequent issue.

 You don't have to suffer. And I encourage you all to speak to your medical professionals, see a urologist, to understand if your symptoms may be related to prostate issues. It's important that you realize, at the end of the day, this is not something that you are the only one suffering with. There are a lot of men suffering with this. And it's not just a lifestyle issue. These issues can lead to other long-term bladder and kidney issues. So, it's important to take this seriously, really put your own health as a priority.

So, I encourage you all to really think about your bladder issues, if you have any, and understand how it affects your quality of life, and realize that, in most scenarios, no major surgery is required. These are all minimally invasive treatments. You get back to your life, and you can enjoy the things you love.

Host: Great advice indeed. Folks, we trust you are now more familiar with aquablation. Dr. Talanki, keep up all your great cutting edge work, and thanks so much again.

Varun R. Talanki, MD: Thank you, Joey. I appreciate it.

Host: Same here. And for more information, please do visit swhealthcare.com. If you enjoyed this podcast, please do share it on your social media and check out the entire podcast library for topics of interest to you. I'm Joey Wahler, and thanks so much again for being part of Southwest Health Talk with Southwest Healthcare.