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Scott Webb: Urology is a broad field that often requires that urologists help to treat patients both medically and mentally, and in some cases may even save some marriages. Joining me today to tell us about urology and how he helps patients is Dr. Ryan Griggs. He's a urologist with Salinas Valley Health Urology. This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. So Doctor, thanks so much for joining me Today we're gonna talk about urology and you're gonna give us all the answers hopefully, that's why we have the experts on, so as we get rolling here, let's start here. What is urology? What does it cover, and what do you in particular specialize in?

Dr. Ryan Griggs: All right. Urology is the study and function of the urinary. It covers everything from anatomical abnormalities and cancer of the urinary tract to benign conditions such as kidney stones, difficulties with peeing, erectile dysfunction, curvature of the penis, testosterone replacement, leaking urine, urologic prosthetics, and male infertility. I particularly specialize in men's health, which deals with some of these facets such as enlargement of the erectile dysfunction, curvature of the penis, testosterone replacement, leaking urine, particularly in males and urologic prosthetics and male infertility.

Scott Webb: Yeah. So obviously it's a fairly broad field and then there's some specialization as you're saying, you, you deal with mostly male issues. So let's talk about this a little bit. Problems like urinary incontinence and other issues, I know can be embarrassing and stressful for people, men, otherwise, perhaps. So what do patients tell you when they finally do come to see you, how do they sort of explain things to you and how do you help?

Dr. Ryan Griggs: What they generally come in is They come in with a general complaint. , doc, My urine stream is weak, or, they come in and they say that I'm wearing pads and I'm changing pads multiple times per day. And it's really up to me to kind of suss out and see exactly what the issue is because there's actually different forms of urinary incontinence, and erectile dysfunction.

Scott Webb: Yeah. And I think I'm 54, doctor, and so some of the things that you, in your list of things that you deal with, I've dealt with some of. Myself and had to have those conversations with my primary and they can be a little embarrassing and a little bit stressful. And, one of the things I've been reading about is some of the devices that you can use. So whether that's urologic, prosthetics, urinary sphincters, slings, testicular implants, there's a whole bunch of cool, science and technology out there. Maybe you can just kind of go through some of these and tell us a little bit about each of them.

Dr. Ryan Griggs: Your larger prosthetics is kind of the broad term for all the aforementioned devices there. But urinary sphincters are usually, for post prostatectomy, patients who have had prostate cancer and their prostates removed and they suffer from Stress urinary incontinence where you leak urine with cost, knees, lap bending, straining, etcetera. And that will act to replace the urinary sphincter that the male has, in order to keep them more dry. And the key is more dry. The goal is not to be completely dry. That's kind of a misconception of patients. A urinary sling works in a similar fashion. The difference is, is it's not a multifaceted implant like a sphincter, which is consistent of three components.

The urinary sling usually consists of a mesh material that's implanted and elevates the urethra and works in a similar fashion to compress the urethra during, , periods of stress that would cause men to leak. Testicular implants are kind of a unique facet where a patient may have history of testicular cancer, for example, and have a orchiectomy, there's a fancy term of having your testicle removed. Or maybe they're a younger adolescent and they have testicular pain and they wait too long to tell their parent and then their testicle dies and has to be removed. And patients who desire symmetry, , that is a elective surgery that they can go through to have a saline of appropriate size and planted into the scrotum.

Scott Webb: Yeah, that's a good way to put that. I have a friend who desired some symmetry and went through the procedure that you're discussing. So, good to have your expertise and kind of go through this stuff. And we touched a little bit about how embarrassing and stressful. This stuff can be, what's your general advice to folks, men and women who maybe just are a little bit embarrassed, even to bring it up with their primary, but then to actually see someone like yourself and really explore some of these really amazing treatment options.

Dr. Ryan Griggs: I guess what I would say, to everybody is that you're not alone. And I think people find comfort , in a cohort of people , if they know that they're not suffering alone and they have , a community, that is kind of suffering from similar symptoms, that they have a support system. And we're physicians and we're very well educated in the treatment options of these conditions. We are experts in basically making patients feel comfortable about this because this is what we deal with on a daily basis.

Scott Webb: Yeah, experts for sure. And we definitely don't want folks suffering, but definitely suffering in silence. And in doing my homework for this, read that you'd recently performed a penile press. Stasis surgery. So that sounds interesting and complicated. So I want you to tell us about the procedure. How long had the patient been suffering, perhaps in silence, how long does the surgery last, and how are things now? What were the outcomes?

Dr. Ryan Griggs: Yeah, so basically, the patient suffered from erectile dysfunction for several years and had tried, various modalities of erectile enhancement, for pills, vacuums, and injections. Those are some of the treatment, modalities available for erectile dysfunction. And he had failed those. And he had looked up the surgical procedure and he came in asking for that. And particular when I cancel patients about this surgery is that it comes in two flavors. There's an inflatable and there's a malleable. A malleable means something that you can bend.

And it consists of two components with a malleable, which are two cylinders that replace the cylinders of your penis that become erect during sex. And then the inflatable penile prosthesis consists of two cylinders that are saline filled with a reservoir that goes into the belly that you don't feel, and a pump in the scrotum, which you use to activate the device and deflate the device when you're done. The surgery for the malleable lasts approximately an hour and 15 minutes.

The surgery for the malleable or bendable prosthesis is about 45 minutes to an hour. They're both done through a single incision below the base of the penis called a penis scrotal incision. It's an outpatient surgery where you have the surgery, you come in, somebody drives you home. You go home the same day with a fully catheter and a addressing. You remove those yourself on post-operative day one, and the recovery period is approximately four to six weeks before you're having sex again.

However, the out of work time is usually less than a week of light activity. In reference to this patient that we did early November, he's doing very well. He's now sexually active with his wife, and he said that I quote, saved his marriage, so I can't really ask for a better outcome.

Scott Webb: That's amazing. Yeah. I'm just sort of shaking my head at the science and the technology, but also really quality of life, changing people's lives, saving marriages. It must make for some pretty interesting days for you, I'm sure. And I know you also treat and specialize in other disorders, male infertility, testosterone replacement, ejaculatory disorders, so many things you do. , how do you treat those disorders?

Dr. Ryan Griggs: Male fertility is probably the most complicated one. So I would just say that it starts with the detailed sexual history and physical exam of the patient and partner, which is really important because female, , age is the number one factor in, , partner infertility. And I think a misconception is that people always place the burden on females for being the issue. And in fact, About 40% of infertility is due to a male infertility factor. As many as one and two infertility cases could be due to a male issue and not necessarily female issues.

So I think that's really important to tell people. And the treatment is really based upon the physical exam and laboratory findings. And the lab could be blood, for your hormone access or, , semen findings and the SE analysis. And they can range from anything from timed inner course, and or medications all the way up to surgery or referral to a assisted reproductive technologist. Who would perform intrauterine insemination with semen that has been ejaculated or in vitro fertilization where they actually inject the sperm into the egg.

And for testosterone deficiency, I really only treat patients who are symptomatic and have defined testosterone deficiency, which is defined as 2EM testosterones before 10EM, less than 300. And, symptoms generally speaking of are fatigue, depression, erectile dysfunction, decreased bone mass, and muscle mass and an increase in fat tissue. And then I treat this with hormone replacement. It's in a variety of ways. There's a pill form, an intranasal form which has to be dosed multiple times a day.

There's gels. There's implants, there's injections, all sorts of things that we kind of curtail to patient' s lifestyle. And in regards to ejaculatory disorders, these are also a little complex because they involve a little bit of sex therapy, if you will. They actually require a co-management with a sexual therapist and urologist. They actually found that sex therapy, and medications have actually bound to be more beneficial than medications alone. Kind of similar to anxiety and you can treat medication, anxiety, but therapy and medication works better.

So it's kind of similar in that fashion. So, things that are generally simple like premature ejaculation, I can generally take care of that. But if there's a psychological component, I certainly employ the sexual therapist around Monterey County to help me out.

Scott Webb: Yeah, that's perfect. Well, I really appreciate your compassion, your expertise. Thanks so much. You stay well.

Dr. Ryan Griggs: Thank you. You do the same. Appreciate you.

Scott Webb: And to schedule an appointment with Dr. Griggs, call Salinas Valley Health Urology at 831-422-4500.