Paul Szmal: I want to reference back to something you mentioned at the top of the conversation where we're literally blocking off, it sounds like, blood flow in certain areas to get the prostate to shrink. Does that blockage remain, or does the human body eventually work its way around that blockage and blood starts flowing again?
Dr. David Schnapp: Well, again, that's another long-term question, but certainly you always have the presence of potential collateral circulation. But when you're actually doing the angiogram, you can see pretty much where the main arterial feeders to any organ are, in this case, the prostate. So you can be fairly certain that if you get the main vessel, you've pretty much done the job. Could there be some collateral circulation? Of course, the prostate doesn't disappear after the procedure. It does shrink, and you don't need the prostate to disappear to improve symptoms. You just need it to atrophy enough to allow the passage to open. So could there be a recurrence based on failure to obstruct a sufficient amount of arterial flow? I suppose yes, but I think in most cases that wouldn't happen.
Paul Szmal: And you said this procedure is relatively new. It's come about in the past five years, and I have to imagine that there have already been improvements to this treatment plan based on the data that's come back here in the first few years of actually doing these types of procedures.
Dr. David Schnapp: Well, of course, as with anything we do in medicine, the more experience you have, the more volume of treatment, the more volumes of treatment patients that you perform, you begin to refine what you're doing. And of course, you start to see various circumstances. Every patient is different. Anatomy is different. So again, the more experience you have as in anything that we do, the more you can refine the procedure.
Paul Szmal: And I think this is an important question probably for people listening and thinking about this. It's something that comes to mind. Usually when you're treating BPH, there is always the risk of some type of sexual side effect. But that's one of the reasons that this procedure is becoming more known and more practiced, because it actually decreases the risk of some of the side effects that would come with other forms of BPH treatment. Is that a correct statement?
Dr. David Schnapp: Yep. That is correct. So there is a low incidence of sexual side effects associated with this procedure. Again, because you're not affecting the actual passage way. In other words, if you have a terp, or if you scrape out the prostate, one of the main side effects that you can get after a terp or transurethral resection of the prostate is you can lose the ability to ejaculate. You can develop what's called retrograde ejaculation, or loss of ejaculation, because you're removing the bladder neck area. And when you ejaculate, the semen sort of finds the path of least resistance. And instead of coming out, will actually go back into the bladder. So those types of side effects typically aren't seen with the prostate artery embolization procedure.
Paul Szmal: Now, for people that want to find out more information about this, what's the best process for them to go through?
Dr. David Schnapp: Well, they can certainly call our office and make an appointment for a consult. We'll see them here. We can see them in Auburn and evaluate them. And if it appears that they're a good candidate for the procedure, we would then refer them to our interventional radiology team. And that team would then do their evaluation, assess the patient's clinical circumstances, and make a determination as to whether or not they feel the patient is a good candidate, and proceed from there.
Paul Szmal: And this is a relatively short procedure in procedural terms. It only lasts, what, somewhere between one to four hours, depending on the circumstance?
Dr. David Schnapp: Yeah. Yeah. I mean, of course, it depends on the ease of the case, how easily the interventional radiologist can gain access to the artery, then find the artery. But generally speaking, you know, most of these types of procedures are done in under an hour.
Paul Szmal: And the discomfort level that a patient might feel is greatly minimized with this type of procedure versus some other ones?
Dr. David Schnapp: Yes. I mean, the discomfort is relative. And of course, there can be some discomfort when you're placing an intravenous-type catheter in an artery. But certainly, the level of discomfort from having catheters and scopes put in through the penis is a different type of discomfort than that of having a catheter put in an artery in your groin.
Paul Szmal: Now, if people want to find out more about this, Dr. Schnapp, or maybe they just want to get a general examination and consult, it's something important, especially as people get older. How do they reach you at your office?
Dr. David Schnapp: Well, they can just call our number. You know, they call the number here at the Auburn office, which I'm sure you guys have and can give it to your listeners, and they can make an appointment for a consult. I'll see them here in the office. We can examine them, make sure that we do a thorough evaluation, screen for prostate cancer, and then if it's appropriate, potentially refer them to the interventional radiology team for a consult in order to consider possible prostate artery embolization as a treatment option. And of course, most important of all is if you notice anything unusual, it never hurts to make an appointment and have that initial consult because you never really know what might be happening, and it's good to find out.
Paul Szmal: Correct.
All right, Dr. Schnapp, as always, thank you so much. We'll have the phone number here for you in just one second, so you can reach out to AEMP Urology in Auburn as well if you'd like to talk to Dr. Schnapp or any of his team members. Dr. Schnapp, thank you for filling us in on PAE, prostatic artery embolization, and enjoy the rest of the day, sir.
Dr. David Schnapp: Thank you. Thanks.
