Key factors to consider when considering risk and progression of BPH

In this video, Wayne Kuang, MD, 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.

Transcription:

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.

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