Neil Thornbury (Host): Welcome to Pulse and Perspectives, the show that brings you the heartbeat of healthcare innovation and the vantage point of industry leaders. I'm your host, Neil Thornbury, CEO at T.J. Regional Health. In this special podcast episode, I'm joined by a seasoned Urologist here at T.J. Regional Health, Dr. Mitchell Wiatrak. Today, we'll be discussing an exciting breakthrough in urology called aquablation. This cutting edge minimally invasive treatment is for benign prosthetic hyperplasia, or better known as enlarged prostate. And with that, let's start and thank Dr. Wiatrak for joining me today. I'll just fire into the first question, Dr. Wiatrak, and just share what is aquablation?

MItchell Wiatrak, MD: Aquablation is a new surgical approach for men with an enlarged prostate. It's for men who have been on medications before, but the medications aren't working or they're no longer working. And it's one of several surgical options, but it's a newer option that involves robotics and it eliminates a lot of the risks that were present with the previous surgical options.

Host: So, tell me a little bit about as a consumer, who's the ideal candidate for aquablation? What are some of the concerns or conditions that I would be experiencing to say this treatment may be something that I can ask my physician about?

MItchell Wiatrak, MD: Sure. FIrst of all, enlarged prostate is a very common condition, 50 percent of the population obviously are men and all men have prostates and virtually every man eventually is going to start having problems as a result of their prostate. The prostate is a gland that's involved in fertility.

 Once we're done having children, it's not really doing much of anything for us except getting in the way. Because when men urinate, when they pass the urine, the urine leaves the bladder and it goes through the middle of the prostate. I like to describe it like going through the hole of a donut. And as we get older, the prostate gets bigger.

It's been growing since we were about 14 or 15 years of age. And as it gets bigger, sometimes that hole starts to get smaller. And when the hole gets smaller, that's where the problems occur. And it creates symptoms. And there's a lot of symptoms, such as waking up at night to urinate, and urinating more frequently during the day, urinating with a weak stream, having to wait to get it started. The stream may start and stop. You may have to kind of push to get the stream going. You may have to push to empty. You may not empty your bladder all the way. You may go with urgency, meaning you have to rush to get there, and sometimes you don't get there on time.

So those are all the typical symptoms of an enlarged prostate. The first line of treatment is medication. And fortunately, the medication works very well for most people. But it doesn't work on everybody. And for some people, it works for a number of years, but eventually, as the prostate continues to grow, the medication becomes less effective.

And when the symptoms are significantly bothersome, that's when surgery becomes indicated, and this particular surgery, the aquablation, would be indicated for most men who need surgery with an enlarged prostate.

Host: So again, just walking through the process, if I'm thinking from a patient's perspective, I'm identified as a patient that will be a good candidate for this. Uh, I come to the hospital. What are my expectations as far as how long the procedure will take? Am I gonna have to stay the night? Is it, what's my recovery? Those type of questions.

MItchell Wiatrak, MD: The first thing I would say is you've got to come see me in the urology clinic. We've got to make sure you're a good candidate for the surgery. We've got to make sure there's no prostate cancer, because this is not for prostate cancer. It's for men with an enlarged prostate who don't have cancer.

But if you're a candidate for the surgery, we would schedule you for surgery and it involves spending one night in the hospital. The surgery itself takes about an hour. It really doesn't take very long. And after the surgery, there is a catheter or a tube that's placed inside the bladder. And we run water in and out of the bladder on that line.

The biggest risk with prostate surgery is bleeding. Cause there's no way to put sutures in the blood vessels there. So we use a catheter and we run water in and out to make sure the bladder doesn't fill up with blood clots overnight. Most men, the catheter comes out the first morning after surgery and they go home.

Host: So, I get the procedure. What is my once I'm home, what's my general recovery time where I would consider, hey, I'm seeing some improvement or I'm getting back to what I would call normal. What's that look like?

MItchell Wiatrak, MD: Sure. The restrictions after the surgery are you have to be careful with lifting for about a month again, because there's a big raw surface area inside where the prostate has been, sort of removed and that area is prone to bleeding again.

So to minimize the risk of bleeding, we say no heavy lifting, nothing more than 20 pounds or about a bag of groceries for the first month. But you can do all the walking that you want after you go home, you can drive if you don't have the catheter in place. In terms of improvement, most people will notice some immediate improvement right after that catheter comes out.

But the way the surgery works is there's a water jet. It's kind of like a pressure hose that you use on your driveway at home. It creates a very high pressure water spray, but it's very small and it's very precise. And it removes some tissue immediately, but the deeper tissue, sort of sloughs off over the period of a couple months.

So for two or three months, there is some, you may notice little pieces of tissue or cloudy urine, as you urinate. And as that tissue sloughs off over the first two or three months, the symptoms gradually get better and better and better. Usually by three months, two or three months, people are completely healed up. In terms of restrictions, after a month, you can do whatever you want.

Neil Thornbury (Host): Tell me, what are some of the side effects that we would see coming out of this type of surgery? If there were.

MItchell Wiatrak, MD: Well, you know, let me just kind of backtrack and tell you what the typical side effects are from prostate surgery and the limitations and the reason this is such a wonderful alternative. With prostate surgery, because the prostate is surrounded by other things that are responsible for sexual function; it was very common with other prostate surgeries to have a problem with erections or erectile dysfunction after surgery. And it was not uncommon to have a problem with incontinence or not being able to control the urine after surgery or not as well as you once had. And there's other sexual function where climax, could be hindered as well.

So sexual problems and urinary incontinence are not uncommon with the other prostate surgeries that are available. And those things have been mostly eliminated with aquablation. There really is no risk of causing a problem with erections and there is really no risk at all of causing incontinence. And the problem in terms of other sexual function is only present in about 10 percent of men who have had the surgery.

Host: Yeah, that is a much better option with today's process and procedure than the previous TURP process, which again is a, uh, kind of the, the older, I think this, if I'm right, really, aquablation has been around for a few years. It's starting to be more of the standard, but to your point, a lot better outcome and a lot better, if you will, kind of what I would consider a more functional outcome for the basic male who has some of these concerns and some of these issues as we age.

MItchell Wiatrak, MD: You're right about everything that you said. I've been following this for six or seven years, even before I came to T.J., it was just in the development phase then, but I saw it as a very interesting and promising innovation, but I wasn't real quick to jump on the bandwagon because I'm rather conservative.

So I waited several years until we had not only immediate results, but we had results after three and five years to make sure that not only were people getting better, they weren't having any sort of long term problems that, were known initially. So I waited a while, before coming to you and, the other members of the administration and saying that I think this might be something we want to look at.

And it's just been growing leaps and bounds. We were, uh, one of the first institutions in Kentucky, to offer this but all the others are catching on. They see what we're doing here at T.J. and it will become available in other places, I think, very soon.

Host: So, again now, I'm just trying to think from a patient's perspective and for most, again, people, males especially, we are not generally speaking, we're not the most advantageous or advocates for our health care. And it's a very personal conversation. Is this something that would normally start with your primary care physician of having that type of conversation? Or can I just again, pick the phone up and call the hospital and say, Hey, I've, can I be connected with you for example, for your clinic?

MItchell Wiatrak, MD: Both are true. I think most patients who I see come to me through their primary care physician. Because they can handle the initial evaluation and treatment of enlarged prostate and very often they will start the medications that we talked about earlier. But when the medications are failing, that's usually when they will make a referral to see me. But if you don't have a primary care physician or for some reason you're uncomfortable having that conversation with your primary care physician, by all means, contact the urology clinic and we would be glad to see you.

Host: Yeah. And again, I would go back to what we just said and you, you almost want to, and I know this is kind of a, gregarious way of saying this, but in healthcare, when you have a technology advancement like this, that can do so much good for men, aging men, that again, it's been one of those things that's just really created a lot of functional, potentially functional issues in people's lives.

You want to get up on the mountaintop and say, hey, you really got to take a look at this if you're having some of these potential symptoms. This is a procedure, it's a technology that is, very minimally invasive, very few side effects with some really great outcomes to your point.

And I guess that would be my final piece. I know you followed this for, and I feel like this has been FDA approved probably in the later parts, maybe 2017 or 18, but what is the research over six, seven years giving us? Is it saying, yeah, people that get this, is this something I may have to get again? Or is, what's happening in the long term research?

MItchell Wiatrak, MD: The long term results, it's sustained at five years, at least as well as the other prostate surgeries and better than most of them. The results are much better, in terms of improving the symptoms, the results are, there are some objective ways to describe this that we won't get into, but they're probably twice as good as the other prostate surgeries.

And, when you look at one year, three years, and even five years out, the results are still almost as good. So, it's very little, few people. who develop problems afterwards and usually it's because of scar tissue, it really isn't because of the prostate that's growing back, but we get out to 10 and 15 years, we're gonna see that, there's no doubt. Because the prostate doesn't stop growing and if you have this as a relatively young man in your 50s by the time you're 75 or 80, it wouldn't surprise me at all if you might need it again, but that's always been the case with prostate surgery as well.

And who knows, 20 years from now, we'll probably have something even better. I did want to also, you know, tell you, I agree with what you said. I've been in this business for well over 30 years now. I think this is the first time I felt like, being on top of that mountain top and shouting that, Hey, you know, take a look at this thing.

This is really a game changer. There've been very few game changers, I think, in the urology business, urology practice over the last 33 years. And this is definitely one of them.

Host: Yeah, and you beat me to my last two points where I would ask you, I mean, I think it's like, to your point, it's exceptional. I only see it getting better with technology and the more research we have, the better corrections and improvements to any of the imperfection that's out there.

But that would be my next thing. What do you see as the kind of the evolution of this, or is there other research out on the horizon or other technology that you see coming in to be more of a game changer?

MItchell Wiatrak, MD: I don't see anything new that looks like it's going to replace this anytime soon. I'm sure there are things that are in early development that I haven't even heard of. That are just too early to even bother looking at. What I'd like to see is more medication. Medication to sort of halt the growth prostate, of the prostate.

So when you have a surgery like this, then perhaps you could take a medication and you don't have to worry about it growing back in 15 or 20 years. That'll probably happen in the not too distant future. But not as of yet.

Host: Not as of yet.

MItchell Wiatrak, MD: And the last thing, getting back to a point that I never really answered your question having to do with sexual function, I wanted to comment that men are staying sexually active longer now, partly because of medications that are available for that. And just attitudes have changed over the last several decades, and again, this is an opportunity to preserve sexual function for men who are having problems that used to result in the loss of sexual function when they were treated. That no longer has to be the case.

Host: Yeah, and there's one piece that I know we would convey to everybody out there, those are, it's a very sensitive conversation for everybody. But, in the world of healthcare, it's a space for you to have that conversation so you can have a full, functional, independent life as long as you want to follow those passions, whatever they may be.

Right? Whether that's just basic urination issues, or is it sexual function? I mean, all those things are just vitally important to have a healthy life. And if you can't find a resource to have that conversation, have a space for that, we're that space, because it is vital.

 That's the business we're in, as I say, trying to make people independent as long as they possibly can so they can follow the passions they have in this life. So, any last thoughts for you? Any lasting thoughts you want to communicate over?

MItchell Wiatrak, MD: Well, I agree with everything that you just said. I think the last point I would make is that prostate issues, problems peeing, problems with sexual function, they're not the easiest things for a lot of people to talk about. And because of that, I believe, actually, I know that there are a lot of people living with problems and symptoms that they really don't need to just because they're too inhibited to reach out and try to get help.

And I would encourage you to do so. Discuss it with your primary care physician. If you're not comfortable doing that, just call and make an appointment to see me. You don't even have to say why. Just call and make an appointment to see us and this is something that my staff and I do every day and I promise you that we will make you as comfortable as we possibly can.

We just want you to get the help that you need.

Host: Well, thank you, Dr. Wiatrak. And again, thank you for tuning in to Pulse and Perspectives. It's a pleasure to have Dr. Wiatrak with us today, sharing his insights on healthcare innovation just like aquablation. For more discussions like this, make sure you subscribe to our podcast on your favorite platform, and please share it on your social media channels.

I'm Neal Thornbury, and until next time, keep your pulse on the future and your perspectives wide open. Thank you so much. Thank you, Dr. Wiatrak.

MItchell Wiatrak, MD: Thank you very much. It's been a pleasure.

Host: Yes, sir.