Scrotal Abscess, Adult Circumcision, and Buried Penis–OH MY!: Dr. Mistry and Donna Lee Answer Listeners’ Questions
Speaker 1:
Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here as always with my cohost Donna Lee.
Donna Lee:
Hello everybody.
Dr. Mistry:
Hello. It’s high energy day.
Donna Lee:
It’s high energy day.
Dr. Mistry:
Excellent. Excellent. I had a patient tell me this week that I’m so lucky to have you Donna Lee, and then you’re so lucky to have me.
Donna Lee:
Oh really?
Dr. Mistry:
Yes.
Donna Lee:
How did that go?
Dr. Mistry:
Two peas in a pod, I guess.
Donna Lee:
Was it our new friend, Carl?
Dr. Mistry:
I don’t know.
Donna Lee:
Oh. Hi Carl!
Dr. Mistry:
It’s a real pleasure for you to join us today. This is a men’s health show–the Armor Men’s Health Hour. It is brought to you by our urology practice NAU Urology Specialists, a urology practice that’s been in Austin since 2007.
Donna Lee:
That’s right. And why is it NAU?
Dr. Mistry:
It’s NAU because it used to be North Austin Urology, but then we had to change it because we got a South Austin and Dripping Springs office, and it got confusing. So it is confusing. We are NAU Urology Specialists.
Donna Lee:
I remember when I worked at a family practice group before joining you and we had our patients that you were trying to win over, of course, and we wouldn’t send them to North Austin Urology because we were convinced you were not in South Austin, even though you were in South Austin.
Dr. Mistry:
God forbid going below the river. They don’t even want to see that North Austin in your name. I’m Dr. Mistry. That is my real name, even though I’ve been accused of differently. I’m a board certified urologist, also a self-described expert in men’s health, which to me means an expertise in not only urologic conditions like kidney stones and prostate cancer and urinary frequency and urgency, but also kind of those global men’s health issues that men suffer as they age, especially low testosterone, erectile dysfunction, and any number of hormonal and nutritional difficulties.
Donna Lee:
Last week didn’t we decide to start calling it high T?
Dr. Mistry:
That’s right? We’re no longer a low T clinic.
Donna Lee:
We’re a high T clinic!
Dr. Mistry:
We’re a high T clinic.
Donna Lee:
Come and get your high testosterone!
Dr. Mistry:
That’s right. That’s right. We have eight providers in our practice: four physicians and four PA and nurse practitioners. We have sex therapy in our office. We also have biomechanical or pelvic floor physical therapy. And what I think is an absolute full range of services that goes even beyond what you imagine your urologic surgeon might have,
Donna Lee:
Like what? Sleep coordinator, maybe?
Dr. Mistry:
That’s right. Even a state coordinator. Yes. Your questions are what keep this show going. We really appreciate all of your feedback. Donna Lee, why don’t you tell people where our practices are located and how to get ahold of us?
Donna Lee:
You can reach us during the week at (512) 238-0762. Our locations are in Round Rock, North Austin, South Austin, and super cute Dripping Springs.
Dr. Mistry:
That’s right. So you want to hit us up with how people get ahold of us?
Donna Lee:
Oh, I thought I did.
Dr. Mistry:
Oh, I’m sorry.
Donna Lee:
Armormenshealth@gmail.com. I told them how they can call us. But you can email us armormenshealth@gmail.com. You can go to our website as well, armormenshealth.com and send an inquiry or a question right there.
Dr. Mistry:
Well Donna Lee, why don’t you give us our first question?
Donna Lee:
It says “Hi doctors,” because I am Dr. Donna, now.
Dr. Mistry:
You’re not Dr. Donna. I’m not going to the medical board for you.
Donna Lee:
Says “Hi, dearest Dr. Donna Lee.” No, it does say “Hi doctors. I’m a 75 year old male, good health, I think. Starting about a week ago, I noticed a little pain and discomfort in my left testicle radiating in the general area. The pain has gradually increased now with mild nausea. I took a look and there seems to be a small sore on the surface, slightly raised and reddish. Would your practice be the proper location for an evaluation?” Yes.
Dr. Mistry:
First of all, Donna Lee, I hope we didn’t wait for that question to be answered on the radio before we got back to that person, because absolutely, absolutely that person needs to be seen. It sounds to me like they may be developing something called a scrotal abscess. You know, people have different kind of descriptions for it. When I was in medical school, people always thought they got bitten by a spider because it would cause like a welt that would develop [inaudible] material inside. We handle those kinds of abscesses on the scrotum, on the penile shaft, on the inner aspects of the thighs and the groin, even some right on the buttock. And so those are all kind of areas that we would probably feel very comfortable treating. Those kinds of localized infections of the skin first begin with some kind of redness generally and pain. As the confined space fills with more and more pus, it can cause lots of pain and even rupture. So those things need to be lanced or treated with antibiotics. And they can make you sick. Every single day, we’re called by the hospital for somebody who had got illness from such an abscess. A lot of times they need to be treated emergently in the operating room. Many times the patients that are getting sick are diabetics or have some other underlying medical condition. There are some patients that continually get these things because maybe they have sweat glands that are predisposed to getting clogged, and they come in very frequently with these kinds of abscesses and have to get frequently lanced or opened up. A lot of times we can do that here in the office. If you go to the emergency room or an urgent care center, a lot of times they may not feel comfortable messing with your yin-yang and your…
Donna Lee:
Ding-a-ling?
Dr. Mistry:
…ding-a-ling. If they don’t feel comfortable dealing with genital type infections, you’re going to get referred to a urologist or transferred to a hospital so that a urologist can get called in. If you don’t have a fever and you just have mild nausea, then that’s the kind of thing that we should definitely see and take care of right here in the office. Now it’s possible that the testicular pain has nothing to do with the raised area on the scrotal wall. Maybe that that could be a red herring. Generally a slowly evolving, but worsening testicular pain associated with nausea in an older man is going to be more likely associated with the testicular infection also called epididymo-orchitis. It is also more common in people who have BPH or an enlarged prostate, more common in diabetics, and can lead to fever and major illness. So those are absolutely kinds of things that should be evaluated. Usually a physical exam is all that’s necessary. If it is orchitis, most of the time, it can be treated with oral antibiotics and get taken care of. But like I said, if you think that there’s a raised area on the scrotal wall, that needs to be treated, that’s absolutely the kind of thing that we should see you about right away.
Donna Lee:
That was a very detailed answer and I’ll make sure he gets in. Thank you for that question.
Dr. Mistry:
So Donna Lee, you got another question for us?
Donna Lee:
I do this one is from a listener the other day: “I recently had a circumcision and after I have developed a buried penis…” buried penis.
Dr. Mistry:
Buried penis.
Donna Lee:
I can’t say that word. “I found a doctor in Dallas that will help me by performing phalloplasty, but that is too far to drive. Do you know anyone in the Austin area that will perform that procedure? I’ve only found one, but they only help transgender patients.”
Dr. Mistry:
That’s a great question. So this is really a question of what do we do if the penis actually kind of goes into the body. And this particular listener feels that it was a result of the circumcision. And although that is possible, that is possible, we usually only see buried penis as a consequence of circumcision in children. In adults, usually it’s the condition that led to the adult circumcision like an inflammatory skin condition called balanitis xerotica obliterans or BXO that leads to tightening of the skin of the penis and during a circumcision that it may seem like the penis got buried, but in fact that was going to happen regardless. Buried penises can happen because the shaft skin’s too short or it’s diseased and it’s become shortened. It can also happen because of an increased size of the fat pad that’s right around the base of the penis and it can envelop the penis and actually suck it right in. So I know you make the joke, I’m a shower not a grower, but these people suffer from the most extreme form of this where they have a lot of trouble urinating, often times sit down to pee, and have lots of scarring of the head of the penis and problems of that nature. So that phalloplasty is usually performed by taking a lot of the skin off the shaft of the penis and putting skin grafts down and also taking a lot of that fat away from the top and the sides of the penis. And I perform that surgery along with my partner, Dr. Christopher Yang. We work with a number of different plastic surgeons in town to help us get the skin grafts and sometimes do the fat transpositions. But it is absolutely the kind of thing that we do take care of, and something that can give you a lot of relief in your life if you are suffering from this very private, very hard to handle kind of condition. It’s something that, you know, even a routine physical exam the doctor may not even mention is a problem. So only you’ll know if the head of your penis and the shaft of your penis has really retracted into your body, then that’s definitely something that we would want to have the opportunity to help you fix.
Donna Lee:
How do you say that word?
Dr. Mistry:
Buried.
Donna Lee:
Buried?
Dr. Mistry:
It’s just buried.
Donna Lee:
Is it like roof? Roof. Can you say roof.
Dr. Mistry:
I don’t even know if you were, I mean, you’re a native english speaker, right? I mean, you grew up in Lockhart for heavens sakes.
Donna Lee:
And there you go.
Dr. Mistry:
There you go.
Donna Lee:
Public school, thank you.
Dr. Mistry:
Oh my lord, we are going to get so much message from Lockhart. I don’t want to hear that.
Donna Lee:
I don’t think so. I don’t think they listen to the radio.
Dr. Mistry:
Would you shut up!
Donna Lee:
They’re just busy eating barbecue.
Dr. Mistry:
Oh my lord.
Donna Lee:
It’s true!
Dr. Mistry:
Sorry to our Lockhart listeners. You send all your hate mail to armormenshealth@gmail.com.
Donna Lee:
We’re probably all friends on Facebook. Well, thanks for those answers. We’ll get some more out soon. You can reach us during the week though. Please send us these questions because we don’t really have a job at KLBJ if you don’t.
Dr. Mistry:
That’s right.
Donna Lee:
So it’s armormenshealth@gmail.com. That’s our email address. Our website is armormenshealth.com, where you can see Dr. Mistry’s smiling, handsome face, and our locations are Round Rock, North Austin, South Austin, and Dripping Springs. And if you’re listening from out of state or out of the country or in another land, you can search by podcasts.
Dr. Mistry:
Like Luling.
Donna Lee:
Or Lockhart. We’re very podcastable. Thanks so much, Dr. Mistry.
Dr. Mistry:
Thank you.
:
The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.