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

In this video, 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. Kuang is a urologist and CEO of the MD for Men Team in Albuquerque, New Mexico.

Transcription:

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.

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