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September Urology Awareness Month- BPH & uro-lift

September is Urology Awareness Month. Dr. Loh-Doyle would like to go over BPH and uro-lift.
September Urology Awareness Month- BPH & uro-lift
Featuring:
Jeffrey Loh-Doyle, MD
Jeffrey Loh-Doyle, MD, is a specialist in complex surgical reconstruction of the male urinary tract, male urinary incontinence, erectile dysfunction, sexual health, urethral stricture disease and Peyronie’s Disease. He joins the USC Institute of Urology after completing his urology residency at USC and further fellowship training in male genitourinary reconstructive and prosthetic surgery under Dr. Stuart Boyd, a world-renowned reconstructive cancer surgeon and authority on reconstruction of the lower urinary tract and urologic prosthetics.

Born and raised in Los Angeles, Dr. Loh-Doyle completed his undergraduate and medical school education in the prestigious Baccalaureate/MD program at the Keck School of Medicine of USC, where he achieved degrees in biological sciences, international relations and doctor of medicine.

Dr. Loh-Doyle’s areas of clinical and research interest include erectile dysfunction, male urinary incontinence, Peyronie’s disease, reconstruction of the urinary tract and urologic oncology. In addition to urology, he also has a keen interest in health policy and quality improvement and participated in a two-year health care administration scholars program run by the Los Angeles County Department of Health. He was awarded a grant to improve the peri-operative patient experience at Los Angeles County+USC, and he is an active participant in several committees aimed at improving the delivery of sophisticated healthcare to the underserved.

Dr. Loh-Doyle’s other interests include entrepreneurship, cooking, traveling, music and skiing.
Transcription:

Prakash Chandran: September is Urology Awareness Month. And its goal is to raise awareness into urological diseases and their associated treatments and cures. One of the most common conditions that affects over 42 million men in the US is benign prostatic hyperplasia. And we're going to learn more about it today. Let's talk about it with Dr. Jeffrey Loh-Doyle. He's an Assistant Professor of Urology at the University of Southern California and a urology specialist at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital podcast. My name is Prakash Chandran. So Dr. Loh-Doyle, really great to have you on today. I'd love to start by understanding a little bit more about the most common diseases and disorders that you see in urology.

Dr. Jefferey Loh-Doyle: Thanks for having me today. Well, urologists, we're really the masters of the urinary system. So we basically treat all conditions that relate to the urinary system. So those are the organs that involve how we make urine, as well as the reproductive organs on the male side. So that means we treat all disorders of kidneys, the bladder, the prostate, the urethra, the penis, the testicles. Basically anything you can think of that needs surgery, we are the surgeons of the urinary system. So what we most commonly treat, especially in male patients, is cancers of the prostate, of the bladder, of the kidneys, as well as just benign conditions of those organs. And so one of the most common conditions that we treat is prostate enlargement or just bothersome urinary symptoms.

Prakash Chandran: Yeah. You know, my dad actually had prostate reductive surgery. And while it took him a little while to heal, his life has gotten significantly better since. So I imagine this is something that you see quite a bit, right?

Dr. Jefferey Loh-Doyle: Yeah. I mean, we're basically quality of life doctors. I mean, much of the things that we do, all right, is not life-threatening unless we deal with the cancer stuff. But we just deal with a lot of issues that men go through as they get older. And our goal is just to make people better and just so that they can just live life with a little bit more gratification.

Prakash Chandran: Absolutely. And I definitely see that with my father. You mentioned that you treat some benign disorders and one of the things that we're talking about today is the benign prostatic hyperplasia. Can you talk to us a little bit more about what that is?

Dr. Jefferey Loh-Doyle: So BPH, which is basically the abbreviation for benign prostatic hyperplasia, is just a fancy way of saying that your prostate is just getting bigger. And a prostate is something that all men have that we're born with. And as we get older, it really becomes useless to us except for it gets larger and it just starts causing urinary symptoms. And so, as we all get older, everything gets smaller except for our prostates. And as that gets bigger, it starts to occlude and block the urinary system. It basically blocks the urine from leaving the bladder.

Prakash Chandran: Yeah. And as I mentioned at the top of the episode, this affects so many men, not only in the US but really worldwide. And I remember as my dad has been going through this, just thinking about, "Hey, is there anything that we can do to be proactive or to do anything to set up preventative measures to really prevent the prostate from getting larger?

Dr. Jefferey Loh-Doyle: Well, I always recommend to men as they get older is to maintain or at least really adopt a healthy lifestyle. That includes regular exercise, weight loss as well as eliminating fatty foods and red meat from the diet, just everything really in moderation, as well as increasing fluid intake, especially water, as well as increasing intake of fruits and vegetables. All those things help you overall, but they can also help how you urinate. Unfortunately, though, there is a certain inevitability about someone's prostate getting bigger. There's only so much you can do to prevent that. And for the most part, if the prostate is going to get bigger, it's going to do it on its own time and it's own schedule.

Prakash Chandran: Yeah. And what do you typically see by way of like the age that BPH affects people and what are some of the symptoms that they might experience?

Dr. Jefferey Loh-Doyle: So I'd say that once men start reaching the age of 40, they may start seeing changes in how they urinate. They're just not peeing as well as they used to. And then by the age of 60, almost half of men will show signs of BPH, which would be frequency of urination, slow urine stream, dribbling, leakage of urine after they finish, inability to go pee in a urinal because of stage fright, all these issues can be kind of an indication that their prostate is getting bigger.

Prakash Chandran: Okay. So what age does this typically start affecting men? And when do they know that they need to do something about it?

Dr. Jefferey Loh-Doyle: Well, if they are above the age of 50 or if they have a family history of prostate cancer, the first thing that should be done is to have an exam of the prostate as well as to have a simple blood test drawn called a PSA. And the role of that is just to screen for prostate cancer, because prostate cancer, the symptoms of that can mimic prostate enlargement. So you just want to eliminate prostate cancer as a cause for any of these issues. And so these tests can be performed just by regular doctor, so you don't necessarily need a urologist. So let's say you've eliminated prostate cancer as a cause for these symptoms, well, then there's lots of tools in our toolbox to treat an enlarged prostate and they go from simple to invasive. And I always like to start off with simple. So medications are usually our first line therapy.

Prakash Chandran: And let's talk about some of those medications. I think my dad mentioned he was on like Flomax or something like that. Maybe talk about some of the medications people start with and then how it progresses.

Dr. Jefferey Loh-Doyle: So the first medication that we typically start off with is a medication designed to relax the muscle component of our prostates. And so if our prostate muscle is just too tense, it's going to block the urine from coming out efficiently. So we give medications to relax that prostate pretty specifically. And the most common one that your dad was on was a medication called Flomax. And that's something that can be started by regular doctors, that it's a very easy to tolerate medication.

There's also other medications that exists that are meant to shrink the prostate. So there's both a muscle as well as a non-muscle part of our prostates. And there's a medication out there that's actually very commonly used for hair loss called finasteride that's meant to shrink the prostate and so people can take those medications independently or in combination with each other, depending on the severity of their symptoms.

There's also another medication that we commonly use called tadalafil, which is a very commonly used erectile dysfunction medication called Cialis. And you can actually kill two birds with one stone. You can improve your erections and also improve your urine stream by taking a low dose of this medication daily. So there's kind of a lot of options available just depending on what a patient's specific goals are and what his symptoms are.

Prakash Chandran: So if people have tried medication and it just doesn't seem to be working, what is the next course of action for them?

Dr. Jefferey Loh-Doyle: So once medications just stop working or they just never work enough, then you have to have a discussion with your patient about other options. And there's lots of procedures, there's lots of surgeries available to treat an enlarged prostate. And so the traditional treatment options, they're all dependent on cutting away tissue. So cutting away tissue is still considered one of the gold standard ways of treating a blockage. It's like a plumber cleaning out a blockage using a Roto-Rooter. That's all we're doing.

And so, yeah, it's fantastic at improving the urine stream, but it's not without side effects. And there can be urine leak as a side effect, there can be erectile dysfunction as a side effect, there can be bleeding as well as hospitalization. And so because of that, minimally invasive techniques have been developed to eliminate those side effects, but also to improve how men pee. And one of the more popular ones that have come around is a procedure called UroLift. And that's been around for almost a decade now, but what we're seeing is that the results are durable, they're effective, and that just means that patients are seeing long-lasting results.

Prakash Chandran: Yeah. Maybe talk a little bit about the dynamics of how a UroLift system worked because, you know, my dad, I think did the traditional way. I think the reductive surgery where he kind of shaved off a piece of the prostate, but how does that work as opposed to something like this surgery.

Dr. Jefferey Loh-Doyle: So if you think of your prostate, like a donut hole, so you're trying to pee through a donut hole. And if you're donut hole is too small, then that's going to obviously block the urine from coming out. So what the UroLift does is that rather than cutting away part of the donut hole, we're actually just placing permanent pins or staples into the prostate to basically pry it open. It's almost acting like a stent, but rather than it being a full stent, it's just several sutures which we placed minimally invasively and that just pins open the prostate and makes the channel open.

Prakash Chandran: Interesting. And who's a good candidate for this type of procedure with the UroLift?

Dr. Jefferey Loh-Doyle: So the perfect candidate is the patient that has a prostate that isn't too big. So, you know, we have an arbitrary cutoff where it's between 30 grams to 80 grams. Well, that's where most prostates really lie. So most men are candidates for a UroLift, but really the only way you can truly determine whether someone's a candidate is to either look inside their bladder with a small camera before surgery, or just size their prostate with some sort of imaging technique, whether it be an MRI or CT scan. But there's a sweet spot, but that sweet spot is actually where most men lie. So a lot of men are candidates for a UroLift procedure.

Prakash Chandran: And so once they get the UroLift procedure, is this something that they have to continually, for example, have those like sutures updated over time? Or is it a set it and forget it type of thing?

Dr. Jefferey Loh-Doyle: It's meant to be set it and forget it. I mean, because it's relatively new, 20 years from now, we don't know how any of these UroLift patients are going to behave. But what we're seeing is that year after year, the results are durable and patients are still happy with how they pee. So it's not really meant to be done again, but it certainly can, you can actually add more of these clips if you need to.

Other advantage of UroLift with the other design is that the goal is to kind of reduce your dependence on medication. So we've got lots of guys that are maybe taking six or seven medications, maybe even 10. They're taking two medications for their prostate and they say, "Doc, you know what, is there another option where I can kind of reduce my medications, including those ones on my prostate?" And this is where a UroLift really has an advantage, which is that the goal is to kind of eliminate the need for medications.

Prakash Chandran: Wow, that sounds amazing. And talk to us a little bit about the efficacy of this procedure, like what type of results have you seen and maybe talk a little bit about the recovery time as well.

Dr. Jefferey Loh-Doyle: So I'd say that the vast majority of patients that we've done a UroLift on have had outstanding results. So we track their urine scores using objective questionnaires. And what we've seen is that there have been mean reductions in several symptom parameters that we kind of assess patients urinary bother. And it looks like it's improving urine stream, improving frequency, urgency as well as eliminating dribbling in a lot of our patients.

Now, is it perfect? Is it a hundred percent guarantee? No, absolutely not. But what we're finding is that the patients that are within that sweet spot range of a prostate size, those are the patients that really see benefits.

Prakash Chandran: Okay. So I guess the question then becomes why wouldn't everyone consider the UroLift system technique versus the traditional cutting method?

Dr. Jefferey Loh-Doyle: Well, I think what we're seeing now is that there's been a shift in our urology practice. And more and more, I think urologists, we're using these more minimally invasive techniques as our first line options for surgery just because it really doesn't burn bridges. Now, are there patients where they don't see enough of a result that will require something that maybe requires a little bit more cutting or removal of tissue? Absolutely. What we're seeing is that the UroLift doesn't really make that more difficult in any way. So you're not really harming a patient or at least setting them backwards in any way. You're giving them an option that, you know, it's worth trying first.

Prakash Chandran: Okay. Understood. So just as we close here, Dr. Loh-Doyle, is there anything else that you'd like to share with people or bring to their attention for Urology Awareness Month?

Dr. Jefferey Loh-Doyle: Well, what I would say is that if you're a male or even a female, and you're not happy with how you urinate now, there's lots of tools in our toolbox to improve quality of life. So don't really be hesitant about asking your regular doctor to refer you to see one of us. And, you know, we're all about just trying to make people happier.

And so we've got different techniques, different medications for whatever your symptoms are. And lastly, you know, what we are seeing in Ridgecrest in particular is that some of these symptoms can be an indication of something a little bit more insidious. And, you know, we definitely want people to come when they feel like something is wrong so that we can make sure that there's nothing like a bad cancer that's underlying. So, you know, don't be afraid of us. We're very happy people. We're very happy doctors and would be happy to welcome everyone new.

Prakash Chandran: Absolutely. And I think it's so important to be proactive about this, not only for cancer detection, but from that personal anecdote from my father, if urine builds up, it can also affect your kidney function. Isn't that correct?

Dr. Jefferey Loh-Doyle: Absolutely. Long-term blockage of your urine system can cause kidney stones, kidney failure, urinary tract infections, bladder stones, all sorts of bad stuff. You just don't want to let it just kind of fester for too long.

Prakash Chandran: Well, Dr. Loh-Doyle, very informative conversation. Thank you so much for your time today.

Dr. Jefferey Loh-Doyle: Well, thank you.

Prakash Chandran: That's Dr. Jeffrey Loh-Doyle, Assistant Professor of Urology at University of Southern California and a urology specialist at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital podcast.

To learn more, please visit our rrh.org, select treatment and care at the top of the page and search for urology. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.