The Health Curve

Prostate & Urinary Health: What Every Man Should Know | Dr. Wilson Sui, University of Michigan

• Dr. Jason Arora • Season 1

Share episode

As men age, urinary symptoms and prostate changes become increasingly common — but most people aren’t sure what’s normal, what’s not, or when to seek care. In this episode of The Health Curve, urologist Dr. Wilson Sui (University of Michigan) explains what the prostate actually does, why symptoms like frequent urination or weak stream develop, and how doctors evaluate these issues using simple tools such as symptom scoring and blood testing.

We talk about BPH (benign prostatic hyperplasia, or hypertrophy), how it differs from prostate cancer, and the main treatment paths available — from lifestyle strategies and medications to today’s minimally invasive procedures. We also discuss how symptoms can impact sleep, relationships, and daily life, and why seeking care earlier can preserve long-term function and quality of life.

This is an evidence-based conversation for men and the people who care about them — focused on understanding the body, making informed decisions, and improving health over time.

Subscribe for more science-based conversations that help you make sense of your health. And - if someone in your life would benefit from this episode, please consider sharing it with them.

SPEAKER_01:

As men age, urinary problems and prostate issues become increasingly common. Yet they're too often ignored until they get really bad. In this episode, I'm grateful to be joined by Dr. Wilson Suey, a leading urologist at the University of Michigan, and we're going to talk about what's normal, what's not, and what men can do to protect their prostate and urinary health in the long run. It's great to have you here, Wilson Suey. Thank you so much for joining us. We're very, very lucky to have you here. This is a very common problem, and I think, you know, I saw it clinically, but I've seen it more and more amongst family members, friends, parents, those sorts of things. From my understanding, by the age of 60, about half of men already have an enlarged prostate. And by I think it's age 85, that number climbs up to 90%. And of course, this sort of shows up in the symptoms of having problems, you know, basically going for a wee, right? Can you tell us a bit more about just how common this is?

SPEAKER_00:

Yeah, I mean, BPH or benign prostatic hyperplasia is probably one of the most common urologic conditions we treat as urologists. I think the statistic is something like 20%, 30% of new patient visits are related to voiding, to peeing, or I guess going for a wee, as they say across the pond. And so it's it's ubiquitous. It's probably a little bit even underreported because many of the men that we end up seeing in urology have worse symptoms and they're coming to us because their symptoms have progressed, things have gotten worse at home, and that's why we're seeing them in a specialist's office. But men who just deal with it and never go to the doctor, men who go to their doctor and deal with it for a long time, we never see those patients. And so it's very common, and pretty much like he's described anyone who's who has older parents, friends, at a certain age, this becomes a topic of conversation at the dinner table.

SPEAKER_01:

Yeah, fun, right? So if you will, it's typical of I think men not to seek care when they need it or not to seek help when they need it, right? This is a stereotype, but it rings true. And I think that's that's one of the reasons men present so late with these kinds of issues. Just to back up a little bit, can you tell us what the prostate is, what role it plays in the body, and how it relates to urination?

SPEAKER_00:

Absolutely. And so the prostate sits in the pelvis between the bladder and the urethra or the tube that you empty your bladder through. Its main job is to produce fluid for ejaculation. So its main job is not to help with peeing, its main job is not to make the peeing aspect better. It's it's for reproduction. And so after a certain age, for most men who aren't trying to have children at later stages in life, the prostate becomes somewhat useless because it's its job has sort of been fulfilled at a younger age, if you will. And so it sort of just becomes a nuisance after a while. It will grow. We think it has to do with with hormone production. And so in some men, as they get, or most men as they get older, the prostate will continue to grow bigger and bigger. In some men, it doesn't grow very much. In other men, it goes from a walnut to a small clementine or tangerine and it gets massive. And are there genetic factors, lifestyle factors, environmental factors that play a role into that? Absolutely. We don't know what they are, though. And so it's hard to predict who is going to come in off the street to our clinics and how big their prostate's going to be.

SPEAKER_01:

And so when men are struggling to pass urine, what exactly is happening with the prostate?

SPEAKER_00:

And so the because the tube that you pee through the urethra connects the bladder directly to the outside world and actually goes in through the middle of the prostate, what we think happens is the prostate as it gets bigger, the lumen or the tube you pee through will get smaller. Or maybe the prostate, as it gets slightly bigger in some men, the anatomy changes such that there's an area of the prostate on the inside that just grows into the middle of the tube, causing blockage. Or maybe the prostate gets harder. In any of these situations, it becomes harder and harder for the bladder to push urine out through an increasingly smaller tube. So you can imagine like it's like, hope no one's listening to this over dinner. But if you're trying to drink a milkshake, it's a lot easier to drink a milkshake through a big straw than a tiny straw. Same idea in physics, it's called Poisselle's law. But as the tube holding everything else constant, holding as the tube buys the diameter or radius of the tube changes, the pressure you need to generate to push urine through a smaller and smaller tube goes up at a rate of by the fourth power. So it even small changes in the tube size will make a huge difference in how hard your bladder has to work.

SPEAKER_01:

So is it that the prostate is growing and getting harder? So it squeezes on the tube and narrows the tube, or is it that the tube itself is actually getting smaller, or is it a combination of these things?

SPEAKER_00:

You know, that's an interesting question. We don't know. And there's a researcher here, his name is Shane Wells, who's interested in that very fact, very topic, which is, you know, is it that the maybe it's a combination of both? Is that when men are young, the prostate's nice and flexible and and can expand a little bit more? And that's why the urinations becomes harder as men get older in some men who don't have present with massive prostates, where we can't point to, hey, this prostate's really big, and hey, look, this tissue is jutting into the middle of the tube, making the tube smaller. It's actually that the prostate just can't expand as it used to. And because of that, the pressure will go up in the bladder too. And so that's certainly an area of active investigation. But for most urologists, we think of it as an issue of anatomy, issue of tissue growing into or making the tube smaller that causes the primary symptoms.

SPEAKER_01:

Okay, so we we've talked about the anatomy and the physiology a bit, but let's talk about the etiology and the epidemiology. So who tends to get this more? What are some of the risk factors for getting it? We hear people talk about, you know, men with high testosterone tend to have this problem more. Can you unpack that a bit and address a few of the myths there too?

SPEAKER_00:

Absolutely. Because of how ubiquitous it is, it's hard to know or how common it is in most men. It's hard to point to risk factors. Have I seen men who come in and they say, hey, my dad, my grandpa, my brother, my uncle, they all kind of big prostates. We've all prostate issues. Absolutely. But do I also see men who come in who say, hey, I'm the first guy in my family to need to get surgery for my prostate, even though like my dad had prostate issues or peeing issues, but I need to get surgery for some reason. Absolutely too. And so I would say that in general, there's not too many things that men can blame themselves for doing when they're younger that would cause this at a later stage in life. We can't really point our fingers at any specific cause of BPH, like we can for say lung cancer and smoking. There is not a causal link that we know of. The testosterone hypothesis is an interesting one. There's this concept of sneaky T, but have I seen plenty of patients who are, say, bodybuilders who don't have prostate issues? Absolutely. And on the flip side, have I seen men who are older who are who have low T or who have hypodonism who have big prostates or prostate issues? Absolutely, too. So in terms of the myths, I would say that there's a lot of myths out there, but there's also not a lot of direct answers to demystify them. And so that's why they probably persist.

SPEAKER_01:

Well, this is exactly why we need more high-quality research and why we need fantastic people like you helping us answer these questions, right? There's a lot about the human body we don't know, even though we observe these things very commonly. I want to move on to how this sort of thing shows up in everyday life. So I've heard a lot of patients and friends and family friends, etc., say things like, I can't sit through a movie or a drive. I don't want to drink water because I don't want to have to wake up at night more and more, or I have to get up six to eight times every night. This is more than an inconvenience, right? It affects how people live. And then there is this slow creep on personal cost of this. Can you tell us a bit more about how this disrupts everyday life? You see lots of patients, you know, with this, you are doing research in this. What are some of the broader personal and psychological aspects of this?

SPEAKER_00:

Yeah, that's a great question. And it's it's exactly all those complaints and more that usually drives patients to come see a specialist. And the comment around it being a creep is also very important. And your earlier comment about how men are stubborn. Men don't want to come and see a doctor or admit anything's wrong. And that all plays a role into seeing men sort of at later stages in the disease. And so, I mean, the most common way this starts is, you know, you're in the car, every exit, you're looking making sure, okay, it's 10 miles away. I think I can make it. Or, you know, the next one's not for 60 minutes. We gotta, you know, either put the pedal to the meadow or we're stopping on the side of the highway. And so many men will change their behaviors. They'll drink less coffee, they'll drink less water, they'll, especially before bedtime, men who are used to drinking lots of water at dinner or or beverages at dinner afterwards, they they stop that. Or they continue it and then they have to wake up five, six, seven times a night. And, you know, there's nocturia where the symptom of needing to wake up at night is very complex. There's lots of things that go into it. There's lots of other outside of the process in the bladder, other reasons why uh men and and women, but in this case, men will make more urine at night and need to thus get up more often. But we think of at least in the subset of men that I see with BPH, that as the process gets bigger, and we've all experienced this, it's overnight waking up to pee, for whatever reason, it's harder. It is, it's things aren't don't work quite as well. And so as the system that's already struggling then has to wake up at night over and over again, it struggles more. And that becomes more and more symptomatic. The emptying is less efficient, and then it's sort of as a vicious cycle. You wake up and you're not well rested. We've all seen sort of the stereotype of the grumpy grandpa. And this perhaps plays a role. You're not sleeping well, getting up to pee at night all the time. And so that certainly plays a role in the decreased sleep quality, can really impact someone's life. There's a social aspect of it too, where men say, hey, I'm I want to go out golfing with my buddies. I want to go drink a few beers, but either I don't drink beer or every other hole I gotta go run off, get in the golf route, run off and find a bathroom. Or I'm trying to, like you said, sit through a movie and I can't. You know, I got to dehydrate myself. In my other world of kidney stone disease, where we where fluid intake is encouraged and we really want to make people drink more, when I see men with BPH too, it becomes a very hard conversation because on one hand, we're trying to prevent kidney stones, but on the other hand, we're trying to keep the quality of life reasonable, where the average person, when they need to drink more water, has to pee every three, four, five hours. These men are peeing once every 45 minutes to an hour. And so then it becomes a discussion of do we go after this and treat this to try to balance things.

SPEAKER_01:

And there might be some men listening who are younger and maybe experience this kind of thing too. Does this tend to show up earlier in life as well?

SPEAKER_00:

Yeah, there's plenty of men who we see, say in their 20s and 30s with urinary issues, who who tell us, hey, I've been I've been peeing this way my whole life. I for some reason, all the time I gotta go to the bathroom, um, and and I've been looking for the bathroom since I was a kid. And those men I would say are are less common. We certainly see that sort of presentation. And those we think have more to do with one of two things, either a sort of constellation of symptoms called pelvic floor dysfunction, where we think the muscles and the connectivity of the pelvic floor, something is is up. And so those patients we will commonly send to see physical therapists to work on relaxing the pelvic floor and helping things, helping them hold their urine for longer amounts of time, versus is there an anatomic issue? Is it possible that the prostate in some men has just grown uh in a certain configuration to cause blockage at an early age, such that it didn't need to grow very much to cause that? Absolutely. But I would say that's a less well-researched area. And most urologists probably have, including myself, are very hesitant to do a sur offer a surgery or procedure on someone who presents like that because of the possibilities that it may not help or issues with complications over time, just because you're treating someone at a young age. But certainly the the typical age that men start to present is in their 40s and 50s, and it's insidious. It starts with, oh, I wake up one more time at night to pee, or oh, I notice, and now I have to go stand at the at the urinal or the toilet a little bit longer, or I have to push a little bit harder. But then it just worsens slightly over time, over years and years and years. And so that's where it becomes very difficult. It's not as though it happens overnight where you say, hey, okay, this is an acute problem. I'm gonna go for an acute fix. No, it's it's been going on for 10 years, and you've been sort of dealing with it. And at a certain point, tipping point, maybe you will see someone, maybe you don't, maybe you just keep dealing with it. And so that's why the presentation is gonna be quite variable.

SPEAKER_01:

Okay, so we've covered how this tends to come up for people and what is happening, you know, under the hood, if you will. So someone comes to see a urologist, a doctor that specializes in this area. What should they expect? What does the workup look like? What's gonna happen in that first appointment? Just walk us through that.

SPEAKER_00:

I would say the typical workup is we always start with asking questions. And oftentimes, though, you know, those annoying surveys we have people answer all the time in clinic. Well, actually, it turns out in this disease state, it's it's pretty important to answer those surveys because there's one in particular that we use to help define how bothered someone is and also define what types of symptoms they're presenting with. And so it's it's one of those times where I actually make most of my patients fill it out because I think it helps us track at baseline when they see me, okay, how how bad are things using the standardized metric. And then over time we can say, okay, if things are getting worse, then we'll do something. If things, if we do something, then we make things better. And so that survey we use is called the IPSS or AUA symptom score. Either way, it's a it's like a one-page survey we have people fill out that really helps us guide our management. So the first thing we ask the symptoms. Second is usually we'll do some sort of exam. And that part of that exam typically is a digital rectal exam or the urologist handshake. And so that's where we manually examine the prostate, and that will also help screen for prostate cancer. And then outside of that, we try to get a sense of how well someone's peeing. And so there's a few tests we can do for that, depending on what sort of is available in the clinician's office. But one of the tests is called a postboard residual, where basically we'll ask our patients to urinate, and then afterwards we'll scan their bladder with an ultrasound device to see how much urine is left over in the bladder. If there's significant urine left over in the bladder, then we worry that the bladder is not emptying routinely. And obviously there's some variability in how that's measured. Maybe a patient's nervous being at the doctor's office and it's a one-time thing. But over time, especially if I've seen a patient multiple times, we get a nice idea of the trend of how well someone's bladder is emptying at baseline. And there's some new devices. There's something called EuroCuff, there's something called urodynamics, where we they're a little bit more intrusive but and take a little bit more time, but they give us a sense of the rate at which someone pees. So the velocity and the speed, and also how well the bladder is functioning in the case of urodynamics. But those are all just tests to basically to see outside of measuring how much is left in your bladder, how fast the urine is coming out, what the pattern it is that it looks like as the urine comes out, and that can help inform some of the decision making too around surgery. The last test that we sometimes do in the office is called a cystoscopy. What that is, is basically we put a flexible camera into the bladder and we look around. We look at the prostate, we look at the urethra, the TBP through, and the bladder. And that can help inform whether there's some other risk factors. Are we worried about scar tissue inside the urethra? I can tell us about the anatomy of the prostate most importantly, and some of the procedures we do, depending on what the anatomy on the inside looks like. And then it's always good to just take a look around and we get a sense of how well the bladder is functioning, too, in the sense that we can tell whether or not there are what we call trabeculations. For trabeculations, those are basically as the bladder works harder over time to push against the blockage, some of the muscle fibers get replaced by collagen. And we see these ridges inside the bladder that we don't see in younger bladders, which can tell us, hey, this bladder's really been working hard for a long time to push against the prostate. Um, and so that's another sign that when I see that, I show my patients and I say, hey, it looks like your bladder's been working hard. We should probably think about doing something if if you're having such bad symptoms.

SPEAKER_01:

We'll get back to this conversation in just a moment. But if you're finding this episode helpful, here's a quick ask. Take a second to follow or subscribe to the Healthcurve Podcast wherever you're listening. And if someone else in your life would benefit from this episode or any of the others you've heard, please send it that way. All right, let's get back to it. Okay, so the patient will come in, they'll go through all this, will confirm or not confirm a diagnosis of BPH. What are the treatment options? And that there are more and more as time goes on, right? There are lots of options for patients, and it can be hard to decide with their doctor what is right for them. So can you walk us through that?

SPEAKER_00:

Absolutely. And there's one other test I should mention, or one set of tests, which is getting a sense of the prostate size. And so the size is the other critical measure we use to determine what procedures we can or we should or should not offer. And so the prostate size, there's a variety of ways to measure it. Sometimes we'll do with an ultrasound in the office. Sometimes patients come in with other imaging. So say they got a CT scan for belly pain or had an MRI done to their prostate because their PSA was high, et cetera. And using those tests, we'll get a sense of how big the prostate is because some of these procedures are really not as efficacious in big prostates. And on the flip side, some of these other procedures that we do, maybe we should try something else before we do a more major surgery on a smaller prostate. And so the landscape of the surgical treatment of BPH is quite varied these days. And if you look over time, really we see a lot of these procedures come and go over the last 20, 30 years. The gold standard, I would say the most commonly performed procedure for BPH is something called a transurethral or section of prostate. It's something that everyone is sort of colloquially knows as rotorutering the prostate or rotorutering the urethra slash bladder. And that's basically your we take a electrocautery device or it's sort of shaped like a U, and we use that to cut the prostate out from the inside, sort of strip by strip, and we open that channel directly. This is all done under under anesthesia. And after we do that, the channel that was blocked up is now open. And typically most urologists will put a catheter in afterwards just to make sure because the prostate is a very vascular organ or it's an organ that has a lot of blood vessels that go to it and come away from it, that we're not causing excessive bleeding and patients are able to pee okay afterwards. And so I usually we'll put a catheter in after that. And then the next day, if they stay overnight in the hospital or if they go home, they can take the catheter out in a day or two and then make sure that the patient's uh voiding okay. And so that's sort of the gold standard that most BPH procedures are measured against if you look at the medical literature. But there's sort of it's a spectrum. And so there is a a concept of procedures called amists or minimally invasive surgical technologies. And those we think of as the least invasive things we can offer. And some of these we offer in the office, and so they can really range from there's a suite of the near future coming out with these stents that they can put on the inside to help to hold the prostate open. And then sort of a step beyond that is these two procedures, which are very popular, called Urallift and Resume, where in Eurolift's case, uh these metal clips are put on the inside and they basically pull the prostate open. With resume, a small needle is used and hot water vapor is injected into the prostate, and that will cause the inside of the prostate to melt over time, and that will also that will open the channel. A step up from that, at least the way I conceptualize it, is then we start to get into resective procedures like the TERP. One of the modalities that's really gaining popularity these days is called aqua ablation. And basically, there it's it's called a robotic water jet, where this super fast water jet is used in addition to ultrasound imaging to basically resect the prostate very quickly. And then after that, the urologist will use a collary device to just stop any small bleeding and put a catheter in. So the prostate is similar to a terp, resected. And then the step beyond that, for bigger glands, we typically can use a robot or do an open approach, which is where we make an incision on the belly to remove the prostate. And that I would say it was more commonly done 20 to 30 years ago before this other procedure called a enucleation of the prostate with a laser or a hole up was conceptualized. And that is a size-independent modality, so it could be done on any size, but it's used to basically, if you imagine the prostates like an orange, carve out the fruit of the orange, leaving the rind in place to remove, especially in big prostates, the inner core that's causing the blockage without needing to make a big incision in most cases. And so that's sort of the spectrum of treatment. So, how how do patients choose? And how do providers choose? Two of the main complications with some of the resective procedures are one, this symptom called retrograde ejaculation, or when men have an ejaculation, they don't see anything. They're still able to have an erection, still able to have an orgasm, but they don't see anything come out. And that is happens for two reasons. One is we in the procedures that tend to cause it, we remove a lot of the prostate. So there's going to be less seminal fluid because again, the main job of the prostate is to make fluid. And number two is we we change the dynamics of how things work and sort of the way that the bladder is supposed to close and force semen to go forwards. Because we do these resective procedures, we think that semen can then more easily go backwards into the bladder. And so that's complication number one. And complication number two is incontinence or leakage of urine. On the more aggressive side of the procedures, such as the incision we make to remove the prostate or the nucleation or the terp, because we remove the prostate tissue and we sort of change the dynamics, by doing so, we we can sometimes we think stretch out the urinary sphincter, or it's this ring of muscular tissue that helps men stay continent or keep their urine. And because of that, men will have develop some leakage after surgery, and that will typically recover most patients. But for the short term, as in a few weeks or a few months, it can be pretty annoying to need to wear a pad or incontinence products because of the incontinence. But in most men, when we have them do kegel exercises or pelvic floor physical therapy, that gets better. And so on the other end of the spectrum, the mists and some of these other receptive procedures, such as aqua ablation, there's less risk of both of those. And so, because of that, some men who really value their their antigrade or their regular ejaculations may choose to try something less invasive, something less receptive initially. Or if they really would be bothered by a longer recovery period of their of incontinence, they would choose one of the mists or something like aquablation, which the published data shows has pretty good incontinence and antigrade ejaculation rates, especially compared to something like HOLA. And so there's it's quite a wide spectrum. The only other one to mention is something called prostate artery embolization, which is also becoming popular. That's a procedure where radiologists typically will inject little beads into the arteries that feed the prostates and basically embolize them or cut off the blood supply to the prostate to cause it to shrink over time. And so where all these procedures fit, should we be doing things in a sequential manner? Should we be offering procedures, more aggressive procedures up front to remove more of the prostate? Is it sort of up to the patient and the provider in the sense that for some men who really value, hey, I just want to have one surgery and I and I sort of never want to see you again. They may choose something like a terp, like a hole up, like a simple prostatectomy if their prostate's big and sort of be done with it. And but have to face some more complications long term potentially, versus another man who says, Hey, I don't want to have any retrograde ejaculation, or or I want to minimize my risk of that. Or I want a procedure that we can do in the office. I can come in, get it done. Maybe I deal with some short-term complications, but I hope that that'll make me better and and I'm okay with that. Then that's a whole other set of procedures we could potentially offer him. And so the other part of all this is not every urologist does every procedure. We got to pick the right procedure for the right guy, but it can be a tough decision because you know, I've been talking now for forever about all these different procedure options, and it's a it's it's a nuanced discussion, a somewhat complex discussion for, and there's not really a right answer in most cases. There's one more procedure that is also becoming popular, which is something called optolum. And that is where a balloon is inflated in the prostate and it's coated with this chemotherapy agent that basically will hold that in enlarged area open and help people feed better. And that's one that we think can be done and sort of falls under the missed category.

SPEAKER_01:

What most listeners are probably thinking about now is how common are these complications? Because most men, if not all, may be feeling a bit skittish about having this kind of intervention, you know, in their nether regions. So what would you say about complications and what would you say to men who might be feeling a bit fearful about coming forward if they are having these issues?

SPEAKER_00:

Yeah, it's a great question. Complications after any procedure will happen to X amount of patients. And so the most common complications, depending on which procedure, but in general, after this sort of surgery, are hematuria or a little bit of blood in the urine. And that can really range. For some men, the hematuria looks like a little bit of pink urine. It can last for a day or two, it can last for a few weeks. And it's sort of like food coloring inside of a fluid or water, where one or two drops will stay in that urine red for a while. And so some of that hemateria can keep on going. It becomes a complication though when it's severe, as in the hemateria is forming little blood clots in the bladder and keeping men from being able to pee. And that's something where we have our patients come back to the clinic or to the hospital and we sort of flush the bladder out. Other complications that could happen after surgery are a transient or temporary increase in symptoms because of the irritation that we. We cause to the prostate in the bladder. Also, because of the irritation we cause to the prostate, men after surgery can be unable to pee and need a catheter for a little bit. We really sort of depending on the procedure, the sort of tree of complications that could happen after each one will expand from there. But I would say those are probably the most common in addition to having a urinary tract infection after surgery. Those are the three major complications with most of these procedures. The depending on other procedures, and it's it sort of can vary a little bit by which procedure you have as to what other sorts of complications. So I don't get into the weeds with those here, but those are the three main ones we tend to see after any of our BPH surgeries.

SPEAKER_01:

And how about men who might be feeling a bit skittish about coming forward, given this is an intervention in their nether regions, which we are, you know, in evolutionary terms, we're designed to protect those. What would you say to people who are considering coming forward but might just be a bit fearful?

SPEAKER_00:

Oh, absolutely. I would say that the complication rates in general are low. As in probably of those complications, they probably range 10, 15% of the time they will happen. And it goes back to our earlier discussion on shared patient decision making and how bothered is that it's a statistic, right? If it doesn't happen, great. But if it happens to you, it really sucks. And it can really impact the patient experience after the procedure. So I would say that for men who are a little skittish, is that yes, we're all, none of us want anything done down there. If we can go our whole lives, that would be perfect. But if you're very bothered, if the medications aren't working for you, if you're looking to try a procedure to help get some relief, it's part of the deal. There's no free lunch out there. And we wish that every procedure we did would have zero complications. But unfortunately, that's just not the reality of what we see. I would say that we do these procedures very safely. In general, our patients have good outcomes, but a certain percent may have a small complication after the procedure, a medium complication after the procedure. And so part of that initial decision making, initial worker has to be, hey, are you ready to go on this journey with me? Because for most people, it may be a smooth ride, but if you're unlucky, it could be a little bit bumpy afterwards.

SPEAKER_01:

And this is the case with any intervention, right? It's a risk-benefit calculation for people. You have to make a judgment as to is this enough of a problem for me to go and seek help to try to solve the problem, accepting that there might be some risks with that solution. Let's talk a little bit about the broader context here in terms of clinical research. And, you know, this is a very common issue for men. And there are lots of things we still don't understand. We have lots of good interventions, and we're able to, you know, perform those pretty routinely. But in terms of quality, in terms of consistency, in terms of understanding what's going on in the human body, there's a ton of work to be done there. So you're one of the leaders within a statewide initiative in Michigan that also has a national footprint, right? The Michigan Urological Surgery Improvement Collaborative or Music. And I actually wrote a case study about this over a decade ago. So time really flies. But specifically, you're one of the leaders for the BPH part of this, i.e., the bit we've been talking about today. Can you tell us a bit about where you think the field is going based on all this amazing work you guys are doing over there?

SPEAKER_00:

Yeah, so on behalf of myself and my co-directors, John DiBianco from University of Florida, Sabury Mensor, and Jay Longsworth, who are here in the state. We're very excited about this new program within music centered around BPH because BPH is such a ubiquitous condition we see as urologists. And because exactly this is the landscape of BPH is constantly shifting. And there's such a spectrum of treatment options that it's become very difficult for any one person to be an expert in all of them. And so, as a quality improvement initiative, our goal is to make the whole process improve for our patients. And our initial program is to be centered around after surgery, how can we improve patient outcomes, specifically around coming to the emergency room, unanticipated visits to the clinic? And so, what we've initially found is that probably one in seven patients after any of these procedures on average will have one of those events. They'll have a procedure, procedure will go great, and then they'll go home and something will go wrong or something will pop up. You know, it could be something as small as some discomfort, some pink urine in the catheter afterwards, or pink urine in the urine afterwards that drives someone to seek care to something more major, requiring another surgery or a hospitalization. But we see that it's common and it's it's for all of our patients is can be a very distressing event to have to go to the emergency room, especially after a recent surgery, to have something troublesheeted or have something taken a look at that we could have otherwise avoided with better equipment that we send patients home with, better instructions that we send patients home with. And so that's what our sort of short-term goals are centered around. But thinking about the broader picture would be looking at all these different procedures. And can we help patients better choose which procedure is right for them? Can we characterize those outcomes better? Mainly because the data that all these procedures are currently based off of is are these large randomized trials, which is the gold standard for beta. But those are typically performed by experts, typically performed on patients in a relatively tightly controlled clinical trial environment. And so, what does it look like in the real world? What do these real world outcomes look like? And so that's what our primary goal is going to be for the music BPH program.

SPEAKER_01:

Amazing. Look forward to following that. So, what is your final message for men and their families for anyone listening? So, whether it's a man who's suffering in silence or a partner who's starting to notice all these nighttime bathroom trips, what's the one message you would want people to take away from this episode?

SPEAKER_00:

The one message would be is that you're not alone. Many, many men suffer from this. And what I find is that many men will delay their presentation, delay going to their family doctor, primary care physician, because they think it's just something that they need to deal with or that they have to deal with, or they're embarrassed to talk about, and that do not feel hesitant to go see someone and talk to them about these symptoms because there's probably medications that they can try. And if those medications don't work, or they have side effects, then there's procedures, and there's a whole spectrum of procedures that they could potentially be offered to help improve their symptoms, improve their quality of life, especially if we start to get to men at younger ages, it can really improve their quality of life later on in life because their bladder function will be preserved long term.

SPEAKER_01:

Some of our listeners might be wondering: are there any natural remedies to this that might just help relieve the symptoms enough such that no surgical intervention is required? Do we know much about that? Is there any evidence behind it?

SPEAKER_00:

I'll say that there's a lot of alternative medicines that are marketed towards prostate health and BPH. It's always hard to know whether or not any of these work. Some men, I will say, come in, they've been taking an extract called salt, an extract of salapometto, and they swear by it. But then when you take them off of it, maybe their symptoms stay the same or or don't get worse. So you question whether or not it was working in the first place. But I would say that in general, a lot of these alternative medicines, we don't really know if they work well. But there is anecdotal evidence by men in the community who say, hey, I've been taking this for 20 years and I swear by it. But whether I would recommend that as a, you know, part of an official medical recommendation is is is hard for me to recommend directly. But I what I tell my patients is, hey, if it's not hurting you, you might you can give it a shot. Give any of these a shot. The only thing it may hurt for a little bit is your wallet, but it's something that they can consider trying. But I would say that the data behind these alternative medicines is is mixed.

SPEAKER_01:

Dr. Wilson Suey, thank you so much for joining us. It's been a real pleasure, and I I look forward to following your great work in this field.

SPEAKER_00:

Thank you so much for having me. It's really a pleasure, and we're honored to be featured here. And we also look forward to what we do, and we're excited about what we can accomplish with Music BPH.