BPH Patient Education: Focus on Shared Treatment Decisions

[Dr. Jose Silva]:
You mentioned resources and getting help from the industry. In my office, in every room, I have the diagram from UroLift about the different stages of bladder health, or at least the picture, which I showed the patient, "Hey, this is what we're trying to prevent. Once it's at the end, that's it." Most patients, "But I was never told this. I was told the PCP says that everything was fine."

…

[Dr. Wayne Kuang]:
The resources are critical. The number one resource is our minds. We have to come in to recognizing this is a mechanical problem, that this is a mechanical solution. Medications are part of the equation, but they are temporizing measures, and that we are going to be their guide, and we're going to get them the data. Number two, very simple, our eyeballs and our hands. When you look your patient in the eye, you hold up their IPSS with their handwritten IPSS score and their signature in the bottom, and you say, "Hey, Mr. Smith, this is a problem." That is a huge resource. That is a huge igniter.

When they hear it from someone they trust, "Oh my gosh, that's a problem?" "That's not fine, Mr. Smith." Right there. That takes care of that whole problem you talked about. Then our hands. I use a lot of gesticulation showing the prostate as a mini donut getting tighter, the bladder squeezing like an octopus. The reason why I bring it up is we have it all right here. Yes, those resources like the pictures of trabeculations help, but you don't have to always rely on those. If you guys do have that trabeculation photographs showing the progression from a normal bladder to a severely trabeculated bladder with cellulose, that is fantastic.

Quick tip, get two of them, one in the patient consultation room, get another one, put it on a foam board, attach it to the wall right next to the cysto, or hanging off the side of your cysto monitor so you can show exactly what their bladder looks like versus the one that you already taught them about in the pre-cysto counseling. The other resources out there, for example, ManVsProstate, we're trying to create flow charts, report cards, list of surgical categories, decision making aids for patients that should be coming out this spring, as well as flow charts for each types of practices depending on what you have, whether you have Cystotrust Uroflow, Cystotrust Urodynamics, Cystotrust Urocuff.

There's not one way to skim the cat. As long as you're presenting all the data about detrusor function, prostate size, prostate shape, and talking about the five stages of bladder health in however you want to do it, that could be very helpful. Then there are more formal avenues for resources. One that just came out is called bphtool.com. Based on a lot of data, especially the COMBAT trial, it lets you look at if you put someone in medications, Tamsulosin, Dutasteride, combination therapy, what can you expect their IPSS score to improve by, as well as what is the potential risk for acute urinary retention episode over the next four years?

Wow, now we have a tool. For medical legal, they say it's not a clinical tool, but take it for what it is. Now you have something to say, "Hey, look, Mr. Smith, that's your risk. We don't want that risk. Our goal is to keep you out of stage three, four, and five. This is something we need to think about." Other resources out there, just a big shout out to the Canadians. They have the decision-making tool for choosing types of surgeries, de-obstructing technologies that might best fit a certain patient for his prostate. That's also another great tool and resource.

[Dr. Wayne Kuang]:
How do they come up with that, choosing which technique is better? It's just based on the size of the prostate, based on the length. What are they using to–

[Dr. Jose Silva]:
Predominantly size, but it's something definitely to check out and see if you can incorporate it. I don't think it has all of the technologies, because as you and I both know, the technology are changing very rapidly. ManVsProstate is really working now to look at, how do we now personalize the therapy? What do by that? If we look at UroLift, it really is focusing on the roof and laterally. Many people have had issues as I coached folks up on the floor, that high bladder neck, moderate bladder neck. The way we solve that with UroLift, so you braise the roof, create an anterior box.

Then REZUM is a little bit different. It's working more laterally, not so much anteriorly, and it's a little bit on the floor. Then now we have iTind, for example, in the category of list, which is bringing in a combination of the roof at a twelve o'clock time, five and seven o'clocks, creating a relaxing incisions like a twip, allowing the lateral walls to relax away to the sides and dropping the bladder neck. Now, can we define that further, choosing surgical technologies based on the specific anatomy? I think we're going to get there. Then you have invasive surgical therapies in the category of IST and MOST, which is really a circumferential therapy. Looking at the surgical categories way past just size as a criteria, but really looking at shape and then bladder function.

[Dr. Jose Silva]:
Wayne, so you mentioned the resources on ManVsProstate. Any of us can go there, even can we direct patients there to the website?

[Dr. Wayne Kuang]:
Absolutely. They can go to the website, and they can log in. When you register, they'll get sent the five stages of bladder health, which is really plain spoken. I try to find that space in between too academic and too plain spoken. Then right now, we're coming out-- Last year we produced about 30 educational videos for patients that we're going to try now put out in the spring for patients to be educated about just a different approach or a different perspective for the BPH, BPO care pathway where we are prioritizing the preservation of bladder health. We are trying to put an end to the polypharmacy epidemic, and we are trying to prevent late stage BPH. That should be coming out. Then also we have an educational series for physicians as well and urologists. That'll be fun.

[Dr. Jose Silva]:
Oh, great. Wayne, anything else you want to add? I think we covered everything that you're doing. Definitely it's been years in the process, and I think it's great you're putting the word out, trying to, for us as physicians or urologists, change the way we talk to patients, change the way we approach this disease. I think it's incredible what you're doing. I think everybody should start thinking about bladder health instead of just the prostate.

[Dr. Wayne Kuang]:
Absolutely. I think if we do that-- I'll end with this. The world is dark right now. There are so many shadows now. It is rare that we as a tribe of Defenders of the Detrusor could use our cystoscopic swords and our pressure flow shields to fight for something that is so true. It is the light, a little bit of light, but it's so rare nowadays. It's for us to find something where everyone wins, patient, doc, the practice, the healthcare industry, healthcare systems. It can be a win for all. I think it's a real-- It's an experiment. As you know-- you may or not. During the pandemic, I wanted to learn how to face my own fear with playing music, so I started playing on the streets.

What it is really an adventure in sharing, giving, and receiving energy. Every time I get surprised by the ManVsProstate, is as we put out this energy, we receive it. It will disperse in a positive ripple effect that can affect positive change with our personal, professional, community, and global relationships. I ask everyone, I was just recently in Buenos Aires at Malba, the fine art museum there. They had an exhibit on habiting and transforming. To inhabit is such a word that we don't use that much. How do we inhabit our spaces? Really feel it, sit in it, breathe in it, touch it, smell it, and then transform it in a positive way and watch that positive ripple effect.

I think we can do that. I think it's a great social experiment. What can happen globally? How did the Italian Brigade start? How did the Scandinavian Brigade start? The Colombian Brigade now. Nephrologists there and general surgeons are catching on. They're not even urologists. That's fun. We need something like that. A little bit of light that we can hold in our hands and then share with others. Just a small thought, how do we inhabit and transform our space in a positive way?

[Dr. Jose Silva]:
I'm glad you're doing it. Every time I go to LinkedIn, I see your messages. They're definitely very motivating. I like being part of this movement that you have created. Like you mentioned, it's great expressing the change to the patient. That knowledge, having the patients change their mind. It's not about the prostate only, it's just preserving bladder health.

[Dr. Wayne Kuang]:
More so, it's about just guiding them and being their partner on their journey. Our goal is to let them be the hero in their own story, their own adventure, where they saved their own bladder from the villainous prostate. We're just there to be their guide.