Wayne Kuang, MD, on the evolution of his management of BPH

In this video, Wayne Kuang, MD, discusses how his management of patients with benign prostatic hyperplasia (BPH) has evolved over time. Kuang is a urologist and CEO of the MD for Men Team in Albuquerque, New Mexico.

Transcription:

How has your management of patients with BPH evolved over the past several years?

This is a fantastic question. We are all qualitative researchers. Every single time we're going into the emergency room to take care of that 70-year-old with retention because they can't get a catheter, and we're gathering the important data for us to evolve our clinical practices forward. For me, over the past 18 years, I've been in large urology groups, I've been in solo practice. I've been a little bit part time in a university, and together, I've been collecting my qualitative data and doing the inductive reasoning needed to make better decisions about how to care for my patients within a health care system, protecting bladders. We touched upon it. Who are we? We're educators, we're teachers, we're coaches. Let's be that Gandalf to their Frodo. Let's be that Yoda to their Luke, and let's guide them, not get them to do certain things, [but] help them make the best decisions for themselves, using the right dialog, the 5 stages of bladder health, understanding it's really about the bladder.

More importantly, as urologists, we need to understand that we are not just de-obstructing urologists or surgeons, but we are preventative interventionalists. It took me a long while to remember that the Hippocratic oath to do no harm, there are 2 ways that we can harm someone. One is by doing something that we should not have done, like surgery. But the other way we can harm someone is by not doing something that we should have done, like intervening at the right time to prevent late-stage disease of BPH/BPO. The second part for me in evolving the management of my patients is understanding, who is the modern man. In this golden age of medicine, 60 is the new middle age, right? When we think about that, how are we going to help men live the next 20, 30, years, once they reach 60, as the best version of themselves. We understand that men are Neanderthals, right? We come at things with a lot of fear, especially with medical care. I call it "IFS": "I'm fine syndrome." And it's not that they're fine, it's that they're scared if they tell you the truth that they're not fine, that now there's so much fear about what urologists are going to do to them, where we're going to put instruments, what holes are we going to go into in order to find out why they're not fine, and that fear is very great for so many men.

The other thing is the modern man, every day we wake up and we put on an armor of masculinity, and what we need to do as a urologists, as the Man vs Prostate tribe, is to shed light into the darkness with the right dialog and the right data to encourage men to take off that armor of masculinity and self-ignite and self-engage into this dialog to help find a mechanical solution, when warranted, for the mechanical problem of BPH/BPO. And so what we do now is we recognize there's a battle plan, and that's really where I've evolved into. It's a 2-part battle plan that we subscribe to as part of the Man vs Prostate tribe and as Defenders of the Detrusor. The first part is a evaluation, and there are 3 components. It's the right counseling, which is really highlighted by, hey, the bladder is not transplantable. Let's take care of it in the 5 stages of bladder health to highlight consequences of choosing not to take action.

The second part is triage. As a community of urologists, we're trying to come up with the right triggers for bladder health baselines so that we can identify - triage - which patients need that bladder health baseline because their bladders may be at risk for damage and dysfunction. And then the third part is getting that bladder health baseline with a minimum of cystoscopy up to a maximum of multi-channel advanced urodynamics. That's a whole other conversation.

We're now evolving away from the classification of urodynamics as just simply noninvasive and invasive, but actually moving to basic, enhanced, advanced. The reason is linguistic determinism. When we use the word "invasive," it strikes fear in the hearts of not just patients, but also in physicians, because it creates fear and reluctance to engage in the diagnostic pathway that's so critical for us to find solutions. The second part of the battle plan is finding the right de obstruction, and it's a real blend between shared decision making and what we call the Man vs Prostate trifecta - not just prostate size, but prostate shape and bladder function or detrusor function.

And when we all come to that table of shared decision making, Man vs Prostate calls it shared decision making 3.0. 1.0 is when the conversation was between the urologist and the patient. 2.0 is when health care came and said, "These are the resources you have. This is what's appropriate. We're going to help dictate what can be done and what can be offered." And then 3.0 is when we allow urodynamics -basic, enhanced, advanced - to be the translator for the bladder, so that the bladder can sit at the table of shared decision-making, be an equal partner with equal say in shared decision-making and surgical choice. And hence, we're asking the bladder to come have a seat and to give voice to surgical choice.

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