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Articles

FDA grants priority review to 89Zr-DFO-girentuximab for kidney cancer imaging

"At ASCO GU, we presented the final analysis of the study, which confirmed the superiority of a combination over the TKI monotherapy in terms of both progression-free survival as well as overall survival," says Camillo Porta, MD. 

Camillo Porta, MD, offers key takeaways from CheckMate 9ER trial in renal cell carcinoma

YOLT-203 was granted an Orphan Drug Designation and a Rare Pediatric Disease Designation in September 2024.

YOLT-203 shows promise in early phase 1 trial for primary hyperoxaluria 1

Myriad is planning to launch its first AI-driven prostate cancer clinical test later this year.

Myriad Genetics, PATHOMIQ enter agreement for usage of AI platform for prostate cancer

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Clinical Focus

2025 GU Satellite Symposia in San Francisco

Case-by-Case: Application of HIF-PHIs for the Treatment of Anemia in Patients with CKD

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

 discusses notable data on the UroLift System for the treatment of patients with benign prostatic hyperplasia (BPH), which were presented at the 2023 American Urological Association Annual Meeting in Chicago, Illinois. Gange is a urologist at Summit Urology Group in Salt Lake City, Utah as well as an Associate Medical Director for Teleflex. He discusses the following abstracts:

MP76-03: "Procedural Complications Associated with MIST and Invasive Surgery Compared to Disease Progression with Medical Therapy"

PD41-06: "Pooled analysis of 330+ subjects treated with the Prostatic Urethral Lift (PUL) reveals undertreatment impacts durability"

MP76-17: "Successful Outcomes in Acute Urinary Retention (AUR) Patients Treated with the Prostatic Urethral Lift (PUL) are Associated with Earlier Intervention"

The data were presented at the recent American Urological Association Annual Meeting. 

Dr. Gange discusses data on the UroLift System for BPH

® Assistant Editor Janelle Hart spoke with 

 He discusses the stigmas associated with enlargement of the prostate, or benign prostatic hyperplasia, and why more education is necessary to absolve these misconceptions. McVary is a professor of urology at the Stritch School of Medicine and director of the Center for Male Health at the Loyola University Medical Center in Maywood, Illinois.

“Even though there [are] many therapies that one can do, it's not a sign of anything ominous for most men,” says Kevin T. McVary, MD, FACS.

Destigmatizing Urology: Dr. McVary discusses enlarged prostates

paper, New Endoscopic In-office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review, for which he served as senior author. Lee is an Associate Professor of Urology and Healthcare Policy & Research at Weill Cornell Medicine Department of Urology in New York City.

The study encompassed the prostatic urethral lift (UroLift), water vapor thermal therapy (Rezum), and temporary implantable nitinol device (iTIND).

Study: New BPH treatments demonstrate efficacy

"Sometimes, there is more than a single answer to a question; this certainly applies to patients with benign prostatic disease," writes Gopal H. Badlani, MD.

SoBPD: How many ways can you treat BPH or BPD?

The Expander-2 trial is intended to provide data that will support submission of the device for regulatory approval. 

Enrollment goal met in trial of Urocross Expander Implant for BPH-related LUTS

Catch up on all the notable drug and device approvals in urology over the past year.  

2024 Urology Times pipeline report

As the year comes to a close, we revisit some of this year’s top content on benign prostatic hyperplasia.

Phase 1/2 trial launches of Focal One robotic HIFU for BPH

Dean S. Elterman, MD, MSc, FRCSC, gives an overview of the recent European Urology Focus paper “Reimagining Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Treatment: A New Approach to First-line Interventional Therapy.” 

Dean Elterman, MD, on the concept of “first-line interventional therapy” in BPH

paper “Reimagining Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Treatment: A New Approach to First-line Interventional Therapy.” Elterman is an associate professor of urology at the University of Toronto in Ontario, Canada.

Please share some key points from this paper.

[Dr] Steve Kaplan and I have come up with a new concept, almost a new category, of BPH treatments. We're calling this first-line interventional therapy, or FIT. The termMISTs [minimally invasive surgical treatments] came out a couple years ago. I introduced a term called T-MISTs or true MISTs. And now, first-line interventional therapy is really this paradigm that bridges the gap between medications and surgery, and it aims to be an effective, minimally invasive treatment that allows for rapid recovery, minimally invasive side effects, and the ability to keep future options open. Really an ideal FIT is going to be something that will be outpatient, that will give a durable, long-lasting outcome, but also really be more patient centered with respect to outcomes. You want something that's going to be easy to have done to you, and also have an easy recovery. And so I think we may ultimately see a shift towards these FITs, where patients are going to want to opt to have these less-invasive treatments done earlier. They're going to be more patient friendly. And I think a lot of the prostate stents—there's about 5 of them that are currently under investigation—these are really what are going to fit into this category of first-line interventional therapies, or FITs.

This transcript was AI generated and edited by human editors for clarity.

Videos

"You want something that's going to be easy to have done to you, and also have an easy recovery," says Dean S. Elterman, MD, MSc, FRCSC.

Amy E. Krambeck, MD, discusses patient selection for holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia

Amy E. Krambeck, MD, on patient selection for HoLEP

 discusses patient selection for holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia. Krambeck is a professor of urology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

How do you approach patient selection for HoLEP, particularly in the context of large prostates or patients with a history of pelvic radiation?

Patient selection for HoLEP is probably the easiest of any of the surgical procedures for BPH, because there's no size limitation for HoLEP. You can do HoLEP on a 20-gram prostate, or you can do HoLEP on a 600-gram prostate, and anything that goes in between. As long as your scope can reach and you have the time to do the morcellation, you can treat the prostate. Post radiation is tricky. With post radiation, we have to be very careful about patient healing. I would say that's one of the few times that I really back off offering surgery for patients. If they've had radiation and they're having persistent bleeding, severe infections, or urinary retention, then we will talk about potentially doing what I call a half HoLEP, and that's where, instead of taking out the whole gland, we'll take out half the gland and leave 1 lobe behind, with the thought that that 1 lobe will provide a somewhat healthy surface for the new tissue to grow on. I found that if you do the whole HoLEP in a patient who's been irradiated, we run the risk of getting calcifications and scar tissue formation or poor wound healing. So we really try to limit the amount of tissue we resect and what we do in patients who've had radiation.

This transcription was AI generated and edited by human editors for clarity.

"We really try to limit the amount of tissue we resect and what we do in patients who've had radiation," says Amy E. Krambeck, MD.

Dean S. Elterman, MD, MSc, FRCSC, gives his perspective on the role of emerging technologies like robotic surgery and artificial intelligence in the future of minimally invasive benign prostatic hyperplasia treatment

Expert discusses emerging technologies, AI and BPH treatment

gives his perspective on the role of emerging technologies like robotic surgery and artificial intelligence in the future of minimally invasive benign prostatic hyperplasia treatment. Elterman is an associate professor of urology at the University of Toronto in Ontario, Canada.

What is your perspective on the role of emerging technologies like robotic surgery and artificial intelligence in the future of minimally invasive BPH treatment?

We've definitely made a lot of strides with respect to minimally invasive treatments, to allowing men to return to work sooner, and have a safer and better side effect profile. What we're really trying to see now is this integration of imaging and using it with respect to AI and planning. When we do old-fashioned surgeries or even modern surgeries, we kind of think we know where the device is going. We open up the prostate, or we resect or we remove tissue without really seeing. We're starting to see now techniques or technologies like Aquablation, for example, where you can see the prostate live with an ultrasound. And then, of course, you could think further, where you're taking multiple images to create machine learning and social intelligence to help create the plan. So ultimately, we're going to see more and more technologies that come out that will be able to customize, really, by scanning through the prostate, taking some imaging, and create a plan as to what prostate tissue should be removed, what prostate tissue should be left behind; ie, to preserve sexual function, ejaculation. And we're going to see more of these types of technologies come out both respect to diagnostics, which is also a really interesting area, like urodynamics, but also the the surgeries that we're going to be doing.

"What we're really trying to see now is this integration of imaging and using it with respect to AI and planning," says Dean S. Elterman, MD, MSc, FRCSC.

, Dean S. Elterman, MD, MSc, FRCSC, gives an overview of his 2025 Desai Sethi Urology Institute Urology on the Beach meeting talk, "Tailoring MIST therapies in BPH for the individual." 

Dean Elterman, MD, on tailoring BPH MIST therapies for the individual patient

 gives an overview of his 2025 Desai Sethi Urology Institute Urology on the Beach meeting talk, "Tailoring MIST therapies in BPH for the individual." Elterman is an associate professor of urology at the University of Toronto in Ontario, Canada.

Please provide an overview of your 2025 Urology on the Beach talk "Tailoring MIST therapies in BPH for the individual."

This year, at the Urology on the Beach conference, I spoke about the various types of new BPH technologies and how we can really pick and choose them based upon a number of criteria. We know that a lot of men are dissatisfied with medical therapy or don't want to take medical therapy, so there's really been this birth of these minimally invasive surgical therapies, or MISTs. In the United States, we have Rezum, UroLift, Optilume BPH, and iTind, and of course, it's picking and choosing which patients should either get a MIST or not get a MIST, and then which of the 4 options available we should try to tailor to each individual man. That's the overall concept of it. I think when we get into it a little bit deeper, it has a lot to do with taking into consideration patient factors, prostate factors—size, volume, whether they have a median lobe—and then also personal preferences and values. A lot of shared decision-making has to do with, what is important to the individual man? Is it recovery? Is it side effect profile? Is it preserving sexual function? All of these things really go into tailoring the experience and tailoring the treatment.

"A lot of shared decision-making has to do with, what is important to the individual man?" says Dean S. Elterman, MD, MSc, FRCSC.

Amy E. Krambeck, MD, discusses the key advantages of holmium laser enucleation of the prostate

An expert on why HoLEP is a “platinum standard” procedure

 discusses the key advantages of holmium laser enucleation of the prostate. Krambeck is a professor of urology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Given the evolving landscape of minimally invasive prostate surgery, what are the key advantages of HoLEP that continue to make it a preferred option for many patients and surgeons today?

I would say that I have always touted HoLEP as being the platinum standard, and I still believe that it's true. Despite the fact that multiple new procedures have come to light, nothing has the same excellent outcomes as HoLEP. The benefits of HoLEP range in the short term—a lot of times, you can get the catheter out within hours of the surgery. Patients can go home the same day, they're urinating well immediately, and they can get back to their regular activities in the course of days to weeks. In the long term, HoLEP is one of the few procedures that we have 20-year data on, and we know that the retreatment rate is around 1% at 18 to 20 years after surgery, so it has that longevity aspect to it that you just don't see with newer era procedures. The only problem with HoLEP is that it's difficult to learn. It requires a certain amount of dedication and time on the part of the surgeon to learn the technique and to do it well, and I think that's always been the biggest barrier with HoLEP, and it still is a barrier today.

"Despite the fact that multiple new procedures have come to light, nothing has the same excellent outcomes as HoLEP," says Amy E. Krambeck, MD.

Amy E. Krambeck, MD, reflects on Northwestern University performing 754 holmium laser enucleation of the prostate (HoLEP) procedures in 2024

Amy E. Krambeck, MD, reflects on 754 HoLEP procedures performed by her team in 2024

 reflects on Northwestern University performing 754 holmium laser enucleation of the prostate (HoLEP) procedures in 2024. Krambeck is a professor of urology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.

You and your team performed 754 HoLEP procedures in 2024. Could you reflect on the significance of this and what factors led to such a high rate of completed procedures?

I would say the fact that we performed 754 HoLEP procedures in 2024 is a reflection of the efficiency and the high quality of care that you receive at Northwestern. Yes, I am a fast surgeon, and the other 2 individuals, Dr [Perry] Xu and Dr [Amanda] Vo, also are fast, good surgeons, so that contributes to the volume, but you couldn't do that many procedures without an amazing team. That requires teamwork, starting at the pre-op level, with nurses that understand what we need for the surgery; at the anesthesia level, understanding that we need a certain level of anesthetic, but not so deep that it will take a long time to put them to sleep or wake them up, and then at the post-op recovery level with the nurses. And then to get that many patients in, we work with a full team of physician's assistants and secretaries and nurses that help to get the patients to see us, get them ready for surgery. It really takes an army to be able to have a program of this size.

"I would say the fact that we performed 754 HoLEP procedures in 2024 is a reflection of the efficiency and the high quality of care that you receive at Northwestern," says Amy E. Krambeck, MD.

Brendan M. Browne, MD, discusses which patients may be best suited to undergo HoLEP for benign prostatic hyperplasia.

Brendan Browne, MD, on patient selection for HoLEP for BPH

, discusses which patients may be best suited to undergo HoLEP for benign prostatic hyperplasia (BPH). Browne is an assistant professor of urology at Emory University School of Medicine in Atlanta, Georgia.

In terms of patient selection for HoLEP, there are a lot of patients who may benefit from that. The patients I find that have the most pronounced benefit are the patients with the very large prostates, or the patients who are catheter dependent with concern for neurogenic or myogenic bladder failure. Clearing out the prostatic urethra to reduce the resistance of urine exiting the bladder as much as you can in those catheter dependent patients, I think provides a large benefit for their long-term success. There are certainly other factors that come into it, whether you want to treat a bladder stone at the same time and you can use your laser, or if they've had lots of intra-abdominal surgery and maybe a simple prostatectomy, robotic simple or even single-port. Transvesical simple prostatectomy may prove challenging. That certainly has the benefits for HoLEP.

There are patients where it's not really a great idea. The biggest one that comes to mind is patients with urethral strictures where you may have a scope across that stricture for longer than you may desire, and it's a larger caliber scope and may exacerbate their stricture, and then you're just trading one obstruction for another.

“The patients I find that have the most pronounced benefit are the patients with the very large prostates, or the patients who are catheter dependent with concern for neurogenic or myogenic bladder failure,” says Brendan M. Browne, MD. 

Wayne Kuang, MD, discusses the importance of collaborating with other health care professionals when treating benign prostatic hyperplasia 

Wayne Kuang, MD, on multidisciplinary collaboration for treating BPH

discusses the importance of collaborating with other health care professionals when treating benign prostatic hyperplasia (BPH). Kuang is a urologist and CEO of the MD for Men Team in Albuquerque, New Mexico.

How should urologists collaborate with other health care professionals to manage patients with BPH with comorbid conditions such as diabetes, hypertension, or neurogenic bladder disorders?

The question about, how do we come together as a health care system as providers, and how do we collaborate to really take men's health to the next level, because it is very complex. One of the first things we did for the Man vs Prostate campaign was we actually surveyed all the urologists globally on LinkedIn to see, how do we want to think about Man vs Prostate and the male lower urinary tract symptoms when we put the bladder at the very center of the discussion. What was really important is that we needed collaboration with neurologists, endocrinologists, primary care doctors, pharma, the medical device industry, to all come together and really recognize that there's so many other contributing factors; for example, aging. As men get older, bladder muscles are also going to get older and get weaker. We need to factor that in. We need to factor in diabetes. How does the effect on diabetic cystopathy, pathologies on the bladder due to diabetes, influence lower urinary tract symptoms or neurologic dysfunctions like multiple sclerosis or Parkinson's disease, or the fact that we now, currently in America, have an epidemic of obesity. What's the impact when you have all that adipose tissue in the abdomen sitting on the bladder? So now the bladder has to work even harder trying to hold up all this abdominal fat. So as you can see, there are multiple etiologies that contribute to symptoms for voiding. Yes, BPH/BPO is a contributor, but we need to recognize all these other factors and really collaborate with each other. The collaboration starts with gratitude and a celebration. Thank you all the academics, community docs, primary care, the specialists, as well as even beyond that, our staff who are sitting with our patients as we're doing urodynamics or getting them ready for cystoscopy or the front desk, check in/check out, pharmaceuticals, medical device industry. We're all part of this equation. So thank you for coming together. If we synergize our efforts and our energy, as the level of the sea rises, all ships on the sea will rise with it.

I think we also need to recognize and emphasize that it's not shared decision-making only, but it's also shared care. We all have a part involved. We need to start communicating. Each health care system has different patterns for referrals that we need to figure out. Maybe in 1 system, urologists are happy seeing anyone with an IPSS of 8 and above, or perhaps in another health care system, they want an IPSS of 8 and above plus slow flow, Qmax less than 15 ccs per second. Most importantly is the right dialog amongst ourselves to understand the right referral patterns. How do we use the right technology to really streamline and allow a BPH/BPO care pathway that is simple, safe, effective, efficient, and personalized? And it will be different. What works for New York City is going to be very different than what works for me here in Albuquerque, New Mexico. And I think finally, what we need to be doing is really just shouting from the rooftops a universal message: uni-verse, 1 verse, 1 song, 1 message. Remember that, yes, it is about prioritizing the preservation of bladder health, preventing late-stage disease and ending the polypharmacy epidemic. And we all have a role, whether it's social media, whether it's helping someone to understand at check in/check out, why they're having that cystoscopy to look for prostate size, prostate shape, detrusor function. It's going to take academics, the AUA, the Urology Care Foundation, supporting research, supporting public health campaigns. It's going to take communities, cities, deciding, "In the urinals, let's put a little thing in there above the urinal that says, 'hey, if you're not peeing really well, or if you can't hit the back of the porcelain, go see a urologist, because something could be going on.' " Educating men on different ways, on busses, on billboards. Think about it. Prostate cancer affects 1 in 8 men. We all hear about it on the news, in newspapers, billboards, so forth. Colon cancer [occurs in] 1 in 23. We hear about that all the time. But we hear very little about bladder health that affects 1 in 3 men 65 years and older who have moderate to severe LUTS. It's affecting 1 in 3 men, and we don't hear about it enough. And I think that's where we're going. And I think it's going to be shared care, working together to write dialog and finding what fits your sphere of influence, your micro community for urologic care, interacting with health care providers and health care staff and pharma and medical device industry and coming together as the Man vs Prostate tribe.

"If we synergize our efforts and our energy, as the level of the sea rises, all ships on the sea will rise with it," says Wayne Kuang, MD.

Wayne Kuang, MD, discusses key factors health care professionals should consider when assessing the risk and progression of benign prostatic hyperplasia

Key factors to consider when considering risk and progression of BPH

discusses key factors health care professionals should consider when assessing the risk and progression of benign prostatic hyperplasia. Kuang is a urologist and CEO of the MD for Men Team in Albuquerque, New Mexico.

What are key factors health care professionals should consider when assessing the risk and progression of BPH?

The question about what should we be considering as health care professionals about the risk and progression of BPH/BPO is really important. It starts from a fundamental concept, which is that men are unreliable witnesses to their bladders. We put on our armor of masculinity. We suffer from "I'm fine syndrome," and we're not willing to really talk about the fact that we're not okay. And now, as urologists, and in that dialog, we need to let them know, "you're not okay because your bladder is talking to you, just like if, in the community, you're sitting down at Christmas dinner, holiday dinner, and your father-in-law starts having chest pain, shortness of breath. He starts to sweat. The pain goes down his arm. We know that the heart is maybe talking and your father-in-law may be having a heart attack. In the same way, we now need to get out urgency, frequency, nocturia, urge, incontinence. It's your bladder talking to you, Mr. Smith, and that's not okay. Your IPSS is 8 and above; your maximum flow rate, your Qmax is less than 15. There's something going on; we need to get the right data to figure out if there's an obstruction so we can do the right de obstruction when warranted." So I think that's really important to understand, to assess risk and progression, that we need to understand we cannot look to our patients to know if their bladder is at risk. We need to look to data.

We also need to understand and remember that drugs are temporizing measures. They are not treating therapies, and that's important, that we can use medications to temporize the symptoms, urgency, frequency, urge incontinence, and sometimes we need those medications for chronic management strategies. But if there's a true obstruction, just like if you have a blocked kidney, we need to unblock that kidney to preserve kidney function. In a similar fashion, if we have a blocked bladder, we need to de-obstruct that bladder from a tight prostate to preserve bladder function.

The other thing we need to understand is the right data really matters. And we touched upon this a little bit, but in the battle plan for Defenders of the Detrusor/the Man vs Prostate campaign, that first part we talked about, the evaluation, the counseling, the triage, and the bladder health baseline, counseling, once again, bladder is not transplantable, the 5 stages of bladder health, the triage, that's something that's evolving. It's a living entity across the globe now, as we're receiving input from defenders from all over the globe. Currently, right now, we believe that for triage men who have a history of urgent continence stage 3, a history of spontaneous, acute urinary retention stage 4, an IPSS of 8 and above, alone or in combination with a slow flow, a high post-void residual, a thickened bladder, or a thickened detrustor 2 millimeters or more or unacceptable risk on BPHtool.com, those are all triggers for a bladder health baseline. For a bladder health baseline, at a minimum, urologists are offering a cystoscopy because we can gather so much information, not just about prostate size, prostate shape, but also about bladder health when we're seeing trabeculations, cellules, diverticula. In the bladder health baselines, that's the standard level using cystoscopy with basic urodynamic testing. And then you can elevate it and rise to an elevated level of diagnostic with things the things like urocuff, which allows information on the voiding phase, and you can elevate it even to the high level of diagnostics when we add multi-channel advanced urodynamics. And so now we're starting to see that this is a way we can assess who's at risk and more importantly, now we have the technology to see if men are progressing over time. Something I think is going to be really important for health care professionals, is really reinforcing this concept that we need screening protocols. We need bladder health screening. Man vs Prostate recommends around the age 50, because most men are already starting to think about that for screening for prostate cancer, colon cancer, and now we need to add bladder health screening to that armamentarium, or that list of things that we need to screen for, for men's health at this time. And I think finally, is really just putting that voice forward that the bladder needs to have a seat at the table of shared decision-making. And yes, a man may want minimally invasive, so forth, minimal risk, but maybe their bladder is at risk and the bladder needs maximal de-obstruction, but it's just part of that dialog and allowing them, bladder, the patient, the urologist and the health care system to really come together and have that conversation to find the best solutions, find the right technology for the right prostate, for the right patient at the right time. That's the last part I want to end with, which is what we call the window of curability. With the right data, basic, enhanced, advanced aerodynamics, we now can draw this window of curability to see whether or not, where is that bladder for that patient? Is it within this window of curability within which, if we intervene, we can potentially prevent the onset of damage or prevent damage that is irreparable? So this concept that we need to talk about, I think it's explained a little bit about the progression through the 5 stages, but now we can lay on it the right data to show us that window of curability and make sure that we're intervening at the right time within that window.

"We also need to understand and remember that drugs are temporizing measures," says Wayne Kuang, MD.

Wayne Kuang, MD, shares his thoughts on what advances in benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO) will be seen in the next several years. 

An expert’s thoughts on the next several years in BPH management

 shares his thoughts on what advances in benign prostatic hyperplasia (BPH)/benign prostatic obstruction (BPO) will be seen in the next several years. Kuang is a urologist and CEO of the MD for Men Team in Albuquerque, New Mexico.

What advances in BPH/BPO do you anticipate over the next several years?

This is a fantastic question. I think it first starts with a celebration. We are now in the golden era of BPH/BPO for both diagnostics and therapeutics, and with that, things that we're going to start seeing which are really going to be game changers, one is point-of-care ultrasound in 3D. Imagine, with 1 or 2 swipes across the belly, we're getting information about the Man vs Prostate trifecta: bladder health, prostate size, prostate shape now in 3D. We're spinning it in 3 dimensions for showing it to our patients so they understand what's going on, but also for surgical planning if needed. That's really exciting.

The other thing that's coming down the pipeline is ambulatory urodynamics. As you know, currently, there's basic, enhanced, advanced multi-channel urodynamics, and with the multi-channel advanced urodynamics. They're now simplifying that so it can be ambulatory, and we can now get multiple testing events to see exactly how that bladder is working in both the filling phase and the voiding phase. That's exciting.

The third part of that is home diagnostics, remote diagnostics, sending men home with that phone app or hardware to put in their toilet and get multiple testings, because it's very common that in the office, guys have shy bladders. We're not getting a real assessment of their bladder health or their flow, but now we can send them home with technology, and we get real readings multiple times in a setting that's comfortable for them, because they're at home.

The fourth thing is the concept of a good biomarker for us to predict what bladders are at risk. What I'm seeing is that the future is not quite yet, where it's a blood test, but I think once again, if we can use these home remote diagnostics, whether it's a phone app or hardware, to measure maximum flow rates, Qmax, to be as a biomarker for Man vs Prostate. We think that the trigger should be when that flow is less than 15 ccs per second. But there's going to be some debate and controversy about the health care resources for us to manage this, but that biomarker of a maximum flow rate less than 15 is what we're looking for, just like we use a blood pressure to screen for hypertension or cardiovascular disease, or a hemoglobin, a1c to assess for pancreatic health or diabetes, or, for example, a PSA for prostate health. We're seeing that happen.

I think we're going to see a change in mentality for men for BPH/BPO. We envision a world where men see BPH/BPO like a prostate haircut. Shout-out to defender Scott Goldstein for this concept from the tribe, which is, it's no big deal. We don't get mad at our hairdresser if they cut our hair and it grows back. It's something that happens, and we just accept that when we find solutions to it to deal with when that prostate is going to grow tighter. I think we're also going to begin to accept the fact that medications for BPH are temporizing measures. Yes, they can be used as chronic management strategies, but the modern man wants to live their best lives chemical free, and so we're going to start recognizing that with public awareness that chemicals are not a mechanical solution to the mechanical problem of BPH/BPO Controversy alert, I think there's going to be a lot of discussion about that.

Another thing we're going to see is shared care. We talk about shared decision making, but shared care between all different types of physicians, health care providers, health care staff, to really accelerate this conversation about preserving bladder health. And then lastly, I think we're going to see an empowerment of the patient. Right now, so many urologists are engaging in social media, talking now about preserving bladder health, preventing late-stage disease, ending the polypharmacy epidemic, and I think that we're going to see patients understanding and coming in and being a part of that shared decision-making, going, "Hey, what about my bladder, Dr Smith? I'd like to know more about that, because I only have 1, and I really want to prioritize it, because I really don't want catheters. I don't want to be leaking down my leg, and I don't want a dead bladder." And I think lastly is going to be a change, slowly, but in an evolution of the guidelines, whether it's AUA, EAU, or NICE, to see them begin to incorporate this concept, this grassroots, garage-grown concept campaign to bring the bladder into the spotlight and allow the bladder to share the red carpet with the prostate.

"We are now in the golden era of BPH/BPO for both diagnostics and therapeutics," says Wayne Kuang, MD.

Benign Prostatic Hyperplasia

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