The Enlarged Prostate: What every man needs to know | Nicholas Donin, MD | UCLA Health

all right everybody thanks for coming so I'm Nick Donen this is very informal by the way so if you have a question feel free to just raise your hand or interrupt that's fine so what we're going to talk about today is we're going to talk about enlarged prostates and the reason I decided to talk about this topic is it's a very very common thing that we see in the urology clinic and there are some kind of misconceptions about about it and I thought that it would be a relevant topic that is of interest to a lot of people so the title of the talk is the enlarged prostate what every man needs to know so we'll start with some of the basics where is the prostate gland so the prostate gland is located at the base of the bladder so this is the urinary bladder and the urinary bladder is in the front of the body down here towards the pelvis and the prostate gland is is attached to the the base of the bladder and the first part of the urethra which is here runs through the prostate gland mm-hmm this is sort of another look at it this is a look at it from the side so this is though we're looking at a person who's facing to the left and you can see this is the prostate gland here so again here is the bladder here's the beginning of the urethra and it runs right through the middle of the prostate gland the rectum is behind the prostate gland and this is the pubic bone which is in front this is an illustration of a rectal exam and a lot of people are familiar with the fact that the prostate gland is a gland is examined through the rectum and this is sort of a diagram of why you have to go through the rectum to feel the prostate because the rectum is right in front of the prostate gland and so you'll see here the physician has got his finger in the rectum it's feeling the back of the prostate gland and so that's a sort of diagram explaining why you have to have a rectal examination to examine the prostate gland it really has nothing to do with the rectum it's just that that's the only place where you have any access to feeling the prostate gland and as you can see here you can really only feel the back of the prostate gland when you do this so rectal examinations really only feel kind of a proportion a portion of the the back side of the prostate gland so here's a little diagram I made up that the prostate gland is in fact it's a doughnut the pictures I was showing you before were cross-sections of the prostate gland but it's a doughnut-shaped organ and this is a cartoon of the bladder and you can see the first part of the urethra runs right through the center of that doughnut and that's really relevant for why the prostate gland can cause issues well it's it's a it's it's that's a complicated question so the urethra the part of the urethra that runs through the prostate is really kind of affixed to the prostate so with that part that in that area they really are kind of one in the same I can go back to the first picture here but you can say that there's no connection but this is the urethra it's affixed to the prostate gland here so we refer to this part of the urethra as the prostatic urethra and the prostate is affixed to the bladder it is affixed to the bladder but my purpose in drawing that diagram is that this prostate gland runs completely around 360 degrees around the urethra they're kind of one in the same at that point though that would be pretty rare you'd have to have a very dramatically enlarged prostate I've never seen a prostate that was large enough that I was sure that it was getting in the way of bowel movements but there can be some encroachment on the rectum for the reasons that we discuss here if it enlarges this way post eerily enough in theory although I've never seen a patient who I was confident that that was actually happening so not always not always not always so I'll show you a couple pictures so so continue with just sort of the basics of the prostate so what is the purpose of it well probably its most critical function is that it does produce some of the fluid that is part of the ejaculation part of the semen and those components that are produced by the prostate the part of the semen that is produced by the prostate helps the sperm fertilize an egg so without the secretions of the prostate in the semen it would be much much more unlikely for a sperm to be able to fertilize an egg the other thing that it does is it is a contributor to urinary continence so you have several kind of sphincter mechanisms that prevent the urine from getting out of the bladder and the prostate and where it meets the bladder is kind of a component of that so that's that's what the purpose of the prostate is it helps contribute to urinary continence and it produces some of the material that's in the semen that allows for fertilization so a lot of people have heard this term BPH what is BPH well BPH stands for benign prostatic hypertrophy what does that mean what is benign prostatic hypertrophy benign means non cancerous prostatic means prostate and hypertrophy just means growth so BPH just means non cancerous prostate enlargement it's just a fancy way of saying an enlarged prostate so that's what BPH is and one of the very important concepts that i want to communicate to you all today is an enlarged prostate is not a cancerous prostate those are two totally totally separate things prostate cancer and BPH or benign state and largeman are completely separate so here's a sort of a diagram of what BPH might look like here again on the left is our normal-looking prostate gland and on the right is our enlarged prostate so what you can see is the enlarged prostate where you used to have kind of an open urethra channel here the enlarged prostate pushes on that urethra and narrows it and makes it narrow it can also kind of push upwards into the bladder a little bit and as you can see it can be kind of nodular and as you mentioned it's not always symmetric like this sometimes it's one side or the other and sometimes it grows more upwards and elongates other times it grows out more widely so there's a whole variety of ways that this can grow here's another kind of picture of it just so you can see again here's the sort of normal-looking prostate with the urethra running through it and here's an enlarged prostate you can see the portion of the urethra running through the prostate in this gland is much longer than it is here and it's much tighter and you can see the prostate kind of pushing up and indenting the base of the bladder there so enlarged prostates or BPH are very very common and it gets more and more common as men get older so in most men the prostate will get bigger as they get older so this is a diagram showing the proportion of BPH in different age groups so in men in their 40s only about 8% of men will have an enlarged prostate but it does start as early as 40 years old in some men men in their 60s about 60% of them will have an enlarged prostate and then in their 90s but 80% of men in their 90s will have an some some amount of enlargement of the prostate so as you get older it just gets more and more common why does it happen why does BPH happen well if that's a very very complex discussion involving biochemistry that to simplify it down it's basically a hormonal effect so dihydrotestosterone is the name of a hormone and really what dihydrotestosterone is is essentially it's essentially the the working active ingredient in testosterone testosterone in itself actually doesn't do the work what the testosterone is it gets converted into this thing called dihydrotestosterone and that's actually what has most of its effects around the body so when you think about testosterone where you're actually talking about is dihydrotestosterone and dihydrotestosterone and men also have low levels of estrogen that are present that plus time equals an enlarged prostate so it's basically just over time men have dihydrotestosterone in their body and over time it just causes this overgrowth our low levels of testosterone when low levels of testosterone would actually be protective against BPH would actually prevent BPH because you have you if you have low levels of testosterone and then in general you'll have lower levels of dihydrotestosterone and then you have less BPH growth increased levels can make BPH growth growth worse yes absolutely absolutely so this is a question I see all the time in clinic and this is another concept I want to communicate here so men will say is my prostate swollen is my prostate swollen and I try to answer that with the following so this child got bonked in the eye and now has a what an eye that I would say is swollen and what that means is something happened to this I got bumped into it got swollen quickly but within a few days or a week it'll be gone okay and the large prostate is not like that it doesn't swell up rapidly and then rapidly go away it's not like that at all and the large prostate is more like this so I wouldn't say that this man this man's belly isn't swollen well if this guy came in and said my belly is swollen maybe I should come back next week and you can see again maybe it won't be swollen no man this belly is just big it's just big so this stomach is not swollen so it's not gonna change in a week it's basically permanently like that and that's basically what BPH is like once it starts to slowly enlarge and enlarge and enlarge over time it doesn't generally go away or shrink back so some men will come in and my doctor a month ago said I had a swollen and a large swollen prostate I want you to recheck and see if it's gone down and I tell them it's not going down it doesn't it's not swollen it's just it's large it's that's how it is so so here's the crux of really what we're going to talk about which is is BPH Bal is prostate enlargement bad is it a bad thing my answer to that is not necessarily not necessarily and it really depends so the prostate can enlarge but the shape can vary somewhat so here's an example let's take let's say this is a prostate and again the prostates like a doughnut shaped organ let's say this is a prostate that's not enlarged okay let's say this is a prostate of a 25 year old man a not enlarged prostate let's say that this is a prostate of a 70 year old man but look how this prostate grew it grew bigger but the hole the channel in it also grew bigger proportionally so this person is not likely to have a lot of problems because the channel running through the prostate where the urine has to come through is still big and so this person probably doesn't have a lot of problems here's a different example this prostate got bigger but the channel got tighter too and this is a person who may have problems and so this is what we're gonna talk about why the prostate as it enlarges can grow can cause problems and it's all about how tight this channel becomes so here's our diagram again so this is the normal prostate and you can see the urethra is open here's this enlarged prostate and you can see the urethra is constricted and this constriction is generally what causes the problem the reason is that the urine starts in here and as the bladder fills up and fills up and fills up eventually it has to eject that urine out and when the bladder starts squeezing it squeezes and it ejects the urine out that becomes very difficult to inject eject that urine out through this tight tight channel and that's really the crux of the problem with BPH so what happens when this channel gets tight what what do men experience what's the prob with that well usually the first thing that happens is men start to notice that they're having urinary problems or urinary symptoms what are the symptoms that they have slow urine stream it makes sense right the bladder is trying to get the urine out through this very tight channel and it can't get the urine out so the urine is very slow patients feeling like they have to strain again it's hard for the bladder to get the urine out and patients feel like they have to bear down to get the urine out the bladder doesn't empty so a lot of times men's whose blood men whose bladders are filling up as they try to urinate the bladder will eject some of the urine but after after they're finished it doesn't get it all out and many men feel that they feel like they're not empty after they go frequently urinating so sometimes men will eject half of the urine in their bladder and then an hour later the bladder is kind of filled up again and they have to go again and the bladder is continuously trying to get the urine out but it can't feeling like I have to go soon after you just went and then there's even more severe things like you can form stones in your bladder people can develop bleeding these large prostates can bleed quite a bit when they become very very large people can start to get urine infections and some men can develop just the total inability of the urinate they'd simply can't go at all and the bladder gets fuller and fuller and fuller and it becomes very uncomfortable and I have to go see in emergency medical care so but what I will stress is not everybody will have these problems some men have a very large prostate and have none of this if you have a very large prostate and you have none of this it doesn't really matter that your prostate is big so what should I do about my enlarged prostate well again as I say potentially nothing okay if you don't have bothersome urinary symptoms if you're not having bleeding stones or any of the other issues we talked about it you're not bothered by your urinary symptoms then you don't have to do anything about it so this is another take-home message which is simply having a large prostate is not bad if it's not causing you any problems what if you are having problems like we talked about the slow stream and the difficult to go into the bathroom well there are a number of different things that we can can be done about that and that's what we'll talk about next medications and there's medications that relax the urethra and allow the prostate urethra to open up and there are medications that can shrink the prostate a little bit and try to kind of reverse time go back in time we'll talk about those and then there's surgeries and their surgeries and procedures that can a staff help to re-establish the channel through the prostate and allow men to urinate and we'll talk about that as well so what does your doctor do to evaluate if you go into a urologist and you say either I have a big prostate and I'm just here because somebody told me I have a big prostate or I'm having trouble with urination and it's I'm being bothered by my symptoms what's your doctor gonna do well the first thing I do is I ask men about their symptoms about all those things is your stream slow are you going off dinner you having trouble going we talk about your symptoms the other thing we probably do is measure your urine flow and I'll show you about how that works we oftentimes use a little ultrasound machine to see after you've finished urinating how much urine is left behind we will always check for an infection anybody coming in with bothersome urinary problems we'll do a little your analysis just to make sure an infection isn't you know part of the picture and we will do the digital rectal examination or d-r-e the finger examination digital is not in this case it's not mint doesn't mean zeros and ones and computers it means your digit finger digit that's what digital rectal examination is and it helps to determine the size of the prostate gland although it is notoriously inaccurate for the reasons I described earlier you only can feel kind of a corner of the prostate so but we get some sense of the of the size of it and it helps to make sure that cancer is not a concern the finger exam is also frankly not a great test for cancer either but those are the typical things that your urologist or your physician will do they'll talk to you we'll do a couple measurements examine the prostate that's the beginning of this sort of evaluation so how bad are my symptoms well your doctor is going to want to get some sense of how bad symptoms are and sometimes it's unclear from talking to a man exactly how severe they are so we neurologists have developed something called the International prostate symptom score and it helps your urologist get a quantifiable measure of how bothered you are and it's just a handout questionnaire and it asks about incomplete emptying of the bladder frequent urination intermittency of urination urgency weak stream straining nocturia and the final question is the most important question on this questionnaire and it is if you were to spend the rest of your life urinating the way that you do now how would you feel about it and that's the most important question because for most men whether or not we do something about their enlarged prostate is really just about how bothered they are so if a guy comes in with a big prostate but he's not having any issues and he's not really bothered and he tells me I'd be fine with the way I am now for the rest of my life most of those men I say then get out of here you're fine you don't have to do anything but what we're really trying to capture his guys who are really struggling and so this gives us a quantifiable measure gives us a spore of how bother they are by their by their urinary symptoms so this is something called the uro flow this is the other thing one of the other things I talked about so what this is is we ask patients to come in we ask them to try to have a full bladder they pee into a machine that actually measures the speed of the flow measures how strong is their urinary stream and the way that racing works is this is time so this is as we go along and time in seconds so this is out to one minute 60 seconds is here and this on the y-axis is the speed of their urination the weight of their flow its measured in millimeter milliliters per second so this curve on the graph here is what would be considered a normal urine flow so the man starts peeing his stream increases pretty rapidly up to a peak of about 22 milliliters per second and then it kind of tapers off and stops and he's done peeing after about you know 30-something seconds this curve down here is a guy who's having some trouble going so he's he curve goes up the maximum flow-rate is only about seven it kind of has a flat curve he kind of goes goes goes goes goes and slowly tapers off and it takes them about more than 60 seconds to totally get the urine out so this is the kind of crave curves that we look at in the office to try to determine if a person is has kind of an obstructed urinary flow so this is called the uro flow and again the black one is a normal uro flow and this one down here is a typical euro flow and a person who's having urinary obstruction the other thing we talked about is measuring what's called the post-void residual which means post urination residual volume of urine and it lets your urologist measure okay after my patient has finished peeing how much urine is remains in their bladder afterwards and it's just a little ultrasound machine we just place it right over the bladder we press a button you don't feel anything and it gives us a little picture and gives us a number of how much urine is left in the bladder afterwards a normal number for a young person is usually somewhere but you know somewhere anywhere from zero to fifteen or twenty that would be normal in a young person a man in his 60s can be anything you know up to 75 or even a hundred milliliters is not dramatically elevated once you start getting over a hundred two hundred and then particularly beyond that you start to get concerned that wow this person is really consistently leaving a substantial amount of urine in their bladder and that may be cause for you know further workup so how do I know if I need treatment for my B pH and I've been kind of hammering home this point but first of all it obviously requires discussion with your urologist the most common reason for treatment are the elective reasons because the person is having bothersome symptoms and as I said before if the person feels totally fine they're not having problems they're not bothered you don't have to have any treatment if you're having bothersome symptoms then most patients at that point are bothered enough that they would like something done they're in there saying I have a problem and I'm looking for some assistance those are elective reasons there are some imperative reasons for treatment meaning reasons where the Derwood tell you I don't care what you're telling me I'm telling you you need to have something done and that's fairly rare that's fairly rare to have a situation that that's severe we don't often see men like that but for a man who was totally unable to urinate so that would be a guy who just couldn't go at all ended up in the emergency room they had to put a catheter in if that guy shows up in the office typically I'll tell a guy like that you need to have something and we'll talk about what that something is it could be just as simple as medications but those that's a person I'd say you've got a problem and you need something if somebody develops bleeding from the prostate that's a situation where I would advise them that they should really strongly consider doing something if their urinary retention meaning that volume that we see on the ultrasound if that was very high if that was like more than 400 I'd probably tell that person you need to have something done whether or not you're bothered by it or not I think you should probably think about having something done or somebody's having a lot of infections of the bladder of people having a lot of problems with urine infections again those are reasons where even if a patient said they they weren't overly bothered I would encourage them to strongly consider having something done so what are what is that mean something done well as I mentioned medications then there are some smaller procedures and then there are more kind of formal prostate procedures and we'll talk about that so medications so which treatment is right for me and we'll get into those but that's also kind of a complicated discussion so if you decide yeah I want something for my prostate something you know I'm having trouble I want to have a treatment what should I have will requires discussion with urologist it depends a little bit on what your symptoms are it depends on the patient's goals and preferences some patients say I don't ever want to have a procedure I'll only consider medications other patients are the opposite I don't want to take a medication I'd rather just have a procedure and not have to take medication depends a little bit on the size of the prostate and some of the anatomical considerations of the prostate and it depends on some other health conditions if there's a man who ought to have treatment but perhaps he's got a lot of other medical problems you're worried about an operation that he might not be medically fit for an operation medication might be the best option or a small procedure if there's a man who doesn't tolerate any of the medications takes them they make him feel unwell then a surgical procedure might be warranted we're going to talk about that you're going to see the procedure you're actually gonna watch some of the procedures so but what I would generally say is typically you know you most physicians including neurologists like to usually do as little as possible to a person in order to help them meet their goals and generally most of us feel that medications or some of the smaller procedures are a little bit less invasive we usually try to start with those if a patient starts on a medication or has a small procedure and is satisfied we leave them alone we don't usually start with the formal more significant prostate operations we kind of start small and ramp up as we need to so typically medications or small procedures are the first things that we go to right good question so that is not I don't get into that much here so I'll talk about it now but anybody who gets evaluated by a urologist for an enlarged prostate there will necessarily also be a concurrent evaluation for prostate cancer and that's really two things it's the finger exam and it's a PSA blood test but it's that's a whole universe of long discussion but what I'll say is as long as a man who's been seeing being evaluated for an enlarged prostate if his finger exam feels normal and his PSA blood test is normal we we presume that there's no prostate cancer and we don't worry about it if there's any suspicion based on the finger exam or the PSA then we kind of put pause on the enlarged prostate thing and we make sure there's not a cancer concern once we've ruled out the cancer concern then we kind of go back to the enlarged prostate thing if we in there in the in the process if we do develop if we do discover that there is a prostate cancer there then we kind of go down a seperate pathway where we will we do two concurrent kind of things so it's a terrific question it's a long kind of discussion so I sort of I kind of left it out of here but it's a good question so your urologist will be checking you for that at the same time fool prostate cancer in the vast vast majority of men yes if you have a normal digital rectal exam and a normal PSA you are prostate cancer free except for some extremely rare strange circumstances prostate cancer on a digital rectal exam feels very different than an enlarged prostate oh yeah a large prostate has a rubbery consistency to it we use the word in urology fibro elastic has a fibro elastic quality to it a cancerous prostate is a rock-hard thing yeah so they feel very very different yeah okay so so we talked about treatment what does treatment mean well as I said it's not medications or procedures so let's talk about some of the medications so the real the mainstay of treatment medication wise for an enlarged prostate or a class of medications called alpha blockers these are medications that work on the Alpha receptors that are in the smooth muscle in this area of the prostate and the bladder so again this is a diagram of the base of the bladder here's the prostate with the urethra running through it and these green dots are the smooth muscles with the alpha receptors on them what the Alpha receptors do is they inhibit the squeezing of the smooth muscles so they stop all the smooth muscles that are living in here they stop from them from squeezing which is essentially a relaxation they relax the smooth muscles in the bladder neck and the prostate urethra here and what that does is when you urinate it allows the urethral channel to open up more widely and allows more urine to flow through them so it's essentially a urethral relaxer and that's what it does the names of these medications flomax Carderock doxa zosyn and alpha zosyn there's a number of flomax as one of the more the newer ones it's used very commonly doxa zosyn alpha zosyn card or some of the older ones they have slightly different characteristics so sometimes some are better for other you know one or the other may be better for certain men but in general they all basically work the same way they work here to relax the urethra and allow the urethra channel to open up up when you urinate it doesn't tend to cause losing control and leakage if I would say if there's a man with a really advanced case of BPH where the the symptoms have gotten very severe in theory it could cause some difficulty with control I have never had a person who I put on one of these medications who wasn't who hadn't already lost control who then developed loss of control with these medications the other thing about these medications is the effects of them stop once you stop taking them so if there was to be somebody on one of these who was having a problem I would say just stop it and then there and and the effects are totally reversible so my basic answer your question is no they don't cause loss of control some of the side effects of these things are things like some men can develop some dizziness so when they stand up they can feel light-headed some men can develop feelings of fatigue they do cause a strange phenomenon called or they can called retrograde ejaculation which is when you have sexual intercourse and you ejaculate the semen will stop won't come out the end of the penis you basically won't you'll have a dry ejaculation and that's because all of these muscles are now totally relaxed so the muscles that typically would eject that semen out of the end of the penis are now basically totally paralyzed so it's a perfectly safe thing it's not it's not dangerous to have that happen to you but a lot of men don't like it a lot of men are very bothered by that loss of their ejaculation so that's why some men don't want to take these medications so the other major class of medications that's used for an enlarged prostate or something called ar is what 5a our eyes do is they prevent the body from forming that molecule is talking about called dihydrotestosterone we talked about that in the future that's the molecule that basically works on the prostate and over time causes it to enlarge these medications block that the production of that medication so what you're essentially doing is you're starving the prostate of its dihydrotestosterone and what happens when you starve something over time it shrinks down these medications can shrink the prostate gland by about 25% so it's not a massive amount of shrinkage but it's about 25% I'll have some men who we've started them on this and they'll come in like you know two weeks later and they'll say Doug that my prostate gland go away is it still there and I say well it's only gonna shrink at 25% and the other thing is just like if you were to starve a person you know if you stop feeding me today I'm not going to be super skinny tomorrow or the next day or the next day it takes a while so this thing takes about three to six months to actually achieve that 25% reduction in prostate size it works best we think in larger sized prostates the ones that are that are much bigger because there's more to shrink the these are two of the names finasteride and do tasker I there's two two of these medications so this is another tool in our armamentarium for for dealing with a large prostate for men who are open to medications and are interested in taking medications so but yes so both of these medications they are their lifelong things so that's one of the downsides to medications they're not it's not like an antibiotic where you take it for five days and then you're done it's more like a blood pressure medication you have to kind of continuously be on it all the time and that's one of the downsides that's one of the reasons why some men opt to do a procedure because they just don't want to continue taking medications so they're different they're different so side effects of these some men will complain that because these medications kind of mess with the testosterone biology some men will say that they feel that their libido is kind of being affected by these medications some men will there are rare cases of men describing that they develop difficulties with erections after being on these medications it's it's relatively rare for that to happens very rare for that to happen but it is described the master IDE interestingly has been studied as a way of preventing prostate cancer formation and it has actually been found to reduce the risk of being diagnosed with prostate cancer it's not widely used for that purpose but the studies do show it reduces your likelihood of being diagnosed with prostate cancer it's controversial why that happens so one of the reasons is that when you start these your PSA blood test will decrease by about half now it's an artificial result so if I see a man whose PSA is two but I know he's on finasteride I will treat him as though his PSA is four I'll do the math I'll say oh it's two but he's on finasteride so it's really four but some people believe that this reduces the risk of being diagnosed because some people forget to do the calculation they see a guy's PSA looks low oh he's okay he's fine well it's actually twice what it is the other thing is people think that this reduces the risk of being diagnosed with prostate cancer because it potentially reduces some of the very non aggressive small prostate cancers that nowadays we actually don't even treat anyway so most people feel well it might reduce your risk of a small non aggressive prostate cancer but we don't even treat those now anyway we just we tell men to just go on surveillance if they have one of those so but is an interesting thing this is also sold so when you take this for an enlarged prostate finasteride it's a five milligram pill and the brand name for it is proscar but they also sell it as a 1 milligram pill for hair loss and that's called propecia so if you've heard of propecia that's propecia finasteride so if you take it for a prostate you may notice that your hair actually will you get some hair growth back I've had a couple guys who sit down my hair is like what's going on so are they're both prescription yes they're both prescription a lot of men and you can take you can take them together and there is actually a combination pill that is finasteride with flomax together in a single pill that's how common it is for men to be on both of these medications so you can take them both they work completely separately there's no drug interactions and and there's a lot of men on both there's a lot of men on both so many men that they made this pill that's a combo pill so this is just kind of a diagram sort of how these are supposed to these two medications are supposed to work so here's the enlarged prostate so these ones we talked about first that relax the urethra these one's kind of open the channel make the channel wider when you're peeing so it opens the channel up and then there's the other ones we talked about that shrink the prostate down and just make it smaller and as I wrote down here some men are prescribed both types of medications because maybe they started on one and their symptoms were still kind of bothersome and they were still kind of annoyed so then the physician gave them a second one so you can definitely take both of them okay so what if the medications don't work what if the medications don't work I've been on both of these medications for a couple years I'm still having problems I just you know I'm up all night it's very slow I can't you know can't get the urine out or what if I just don't really want to take medications forever I'm just not interested in being on medications the rest of my life well then move on to some of these other options and they're all basically some kind of a procedure and I'm going to talk about two that are kind of minor surgical procedures that are relatively new and then I'm going to talk about a few that are kind of the more formal traditional procedures they work the alpha blockers work usually within three or four days that's the good thing about those alpha blockers you can give it to a guy and say try it for a week or two if you don't notice the difference pitch them because they're not going to work if they're gonna work they're gonna work pretty quick the shrinker as I said you got only three to six months so so the first kind of small prostate procedure I'm going to talk about is something called gyro lift it's only been around for a few years so it's a relatively new procedure it's a quick procedure it only takes about 15 minutes it generally works best for small prostates and the long-term durability of the procedure meaning how many years does it work for a guy is still kind of unknown because it's a new procedure and this is a diagram of basically how it works so here's this enlarged prostate and you can see the urethra channel is really being kind of compressed here and what the doctor will do the urologist is to put a camera into the urethra they go up to where the prostate is and then they'll insert these stitches and these stitches go in and they actually stretch open the urethra and they hold it open and then re-establish the urinary Channel here it's it's it's a pot it's a procedure that's gaining in popularity it could it could be effective I mean the urologist will make a determination about so you don't necessarily have to put four of these stitches in sometimes you'll put two sometimes you'll put fewer or more and you can put several on each side so let's say it was one side that was larger than the other the person could deploy more stitches on one side than on the other so it would be tailored it would be tailored so so for this so the prostate is typically enlarged most commonly on left and right and then in some men on the back there's very few cases of an anterior enlargement it's almost always left right and maybe the back this procedure is not great for people who have a problem in the back it's most meant for men with a left and right problem and so before you have this procedure your urologist will probably have to do a cystoscopy or a camera look into your urethra in the office and we didn't really talk about that as part of the evaluation but that's often part of the evaluation we'll do a camera look into the in the office to see what's the shape of your prostate excuse me and which one of these procedures would work and if you have a back sided enlargement your urologist will probably tell you this is not the best procedure for you they tailor it they tailor it I don't do these procedures but I've watched plenty of videos and spoken to people who do it they usually try to open it as much as they can I mean the idea is to get a maximum Channel here the idea is the the more open the better the more open the better in general so this is the another small procedure I'm going to talk about called resume and this is another relatively new procedure for enlarged prostates the way it works so and it's when I say it's a small procedure it's done in the office we do these in our office it's a quick procedure it takes about five minutes something like that there's a bit of a prep time and everything but the actual procedure itself takes about five minutes and the way it works is again just like that other procedure a camera is inserted into the urethra up towards the prostate we're gonna actually watch a video of this and then steam is actually injected into the prostate in several locations so a little catheter comes out of the camera goes into the prostate and steam is injected and each injection takes about nine seconds we'll see it on the video and what happens is the prostate doesn't like that steaming and over time it kind of shrinks down and as it shrinks down that channel the urethra opens up this let me show you a diagram so imagine so the steam gets injected here and here and when this tissue shrinks up it kind of retracts and makes the channel open up does that make sense let me show you another diagram the steam is killing the prostate exactly the steam kills the prostate but it takes a little while is that a better answer to your question yeah the steam kind of like kills the prostate gland the problem with this one is it doesn't happen immediately just like that shrinker it takes a few months this thing takes a few weeks for the prostate to kind of die and shrink up and kind of wither away because it doesn't happen immediately the first thing that happens is the press that gets real swollen because it just had steam injected into it so after this procedure you do have to have a catheter for a few days because you won't be able to pee right away because your prostates just mean it's very kind of inflamed and steamed but then after about a week we take the catheter out five to seven days and and over time the symptoms get better and better usually about two weeks you men start to see improvement and then after a few months it gets better they publish their data for this in well it's been about a year since they published their data and I think in January they'll probably have five-year follow-up data but in January 2019 they published their full-year follow-up data and it looked like the durability of the effect lasted at least four years so again because it's a new procedure we don't know how long it's gonna last for men how long the benefits are gonna last but it does look like the benefits last at least about four years yeah I mean it causes as far as on the cellular level how I would describe it but yeah I mean it basically causes the you know the prostate tissue to kind of get injured and atrophy and kind of shrink up just on the inside not the whole prostate exactly exactly right exactly right so I should mention both of these procedures the gyro lift and the resume one of the other selling points to them is that they are not they do not have an effect on your ejaculation so you will still be able to ejaculate normally after that that's what their data shows that's what their data shows now listen there's no hunt there's no guarantees in life but when I do these resumes I haven't had a person who had a change in their ejaculation so that's good but I do tell guys listen so far so good I'm not making any guarantees anytime you go in and start messing around with you know the the body and the anatomy things can change but in general no so that's one of the popular things about both the gyro lift and the resume is that it will not affect a man's ejaculation so here's a video actually of the resume so what you're looking at is we're in the urethra and this is the prostate tissue here so if we were to keep going up to the right we'd go into the bladder this white tube just went in into the prostate tissue and what they're doing is they're injecting steam and they're injecting steam into the prostate tissue it'll last about nine seconds and you'll see the tube come out okay and now the urologist is going to go up this black area up here is up in the bladder so that's up in the bladder now he's going to go find another spot here's another spot on the other side of the prostate there goes the tube the steam is being injected now and typically you'll do anywhere from it depends on the size of the prostate but you can do an essentially an unlimited number of these steaming injections so in you know typical you'll do let's see if we can make it go again so typically he'll do somewhere between four and eight of these steam injections when you do these treatments we are seeing the urethra that is within the prostate here this is the prostatic urethra there's some other movies we'll we'll see a little bit better look at the anatomy yeah it's coming you're going in you were the urethra is a tube we're in the tube right this is the role of the urethra but it sits in the prostate part and this is the needle going right in through the wall the urethra and injecting the steam in yeah so that's this resume water vapor therapy it's a popular option for men who are really concerned about the the effect that on their ejaculation men who are really concerned about their ejaculation this is a popular thing for being able to help them with BPH but not affecting their ejaculation my main concerns about this particular procedure or we don't know how long it's gonna last seems like it lasts about at least four years and the other things not popular is again because the steam is going in and the prostate at least initially gets very inflamed you have to have a catheter in for at least five to seven days the men don't love that so that's kind of the downside so now what we'll do is talk more about the sort of traditional formal prostate operations and the first one we'll talk about is called the trans urethral resection of the prostate or Terp Terp is the gold standard prostate surgery for an enlarged prostate it has been around for many many many years there have been some small modifications to it over the years but it is the oldest and it's the most bread-and-butter enlarged prostate surgery unlike the other procedures this is performed under general anesthesia so you have to go to sleep for this or at least you have to go into the hospital for this they can do it under a spinal anesthesia but but you do have to be in the operating room it's done with camera that's placed through the penis just like the other two that we talked about and the overgrown prostate tissue is essentially whittled or carved out from the inside typically men will spend one night in the hospital although some men will go home some men will go home the same day and you will have a catheter in for anywhere between one and five days after this so it's interesting sometimes when I'm talking to men about the resume the steam or the Terp often times I'll tell them the trip is a bigger surgery but your prostates actually going to come your catheter is going to come out probably sooner than it would if you had a resume so and the reason is that during the Turk we actually shave out the tissue write that in there and opens up the channel immediately so you immediately get some increase in the channel yes yeah you arm the arm you urethra which is overlying the prostate so they're all one in the same thing so what you'll see in the movie here so here's what you do this is a diagram of it you go up just like the other one here's the urethra overlying the prostate but you just cut into the urethra and start cutting out prostate and here that here has been partially whittled away here's the end so instead of all this overgrown stuff you now have a nice big urine channel but only this here the urethra has been totally whittled away here okay but it's just the cells come in and over you know regrow over here and the whole thing heals it's a initially it's a big scab in here but it just you know it's like a scab on your skin eventually it just resurfaces itself you're definitely peeing bread for a little while after this the resume not as much you can you certainly can I've had a couple guys who have resume we took their catheter out and they were having some bleeding most of these almost any of these prostate procedures you can have blood in your urine afterwards the prostate is a very vascular organ it has blood a lot of blood vessels in it the minute you start doing anything to it you can have blood in your urine and especially when it gets overgrown and enlarged it gets very very bloody yeah it gets very blade so no matter what you're gonna have some blood in your urine but it's transient it stops it goes away yeah I know Michael he's a friend of mine yeah that's probably this I'll show you the shaving this is it this is it this is it so here is a movie of a Terp and actually this is probably the best movie that shows the anatomy so right now we'll start the movie the second but we're in the urethra of the prostate okay all of this is prostate gland but the surface the inner the channel is the urethra is the lining so we're going to go up if you just if we drive up in here we're gonna go up into the bladder and you'll see that in a second so endoscopic view so this is all prostate left and right and up here is bladder if you continue up you go into the bladder and these are the overgrown pieces of prostate you can see the channel is very skinny now he's in the bladder looking around the inside of the bladder and here's how he begins the riddling here's the whittling so this is the turf procedure he has an instrument here you'll see it's a loop and just starts carving and it just starts it's a roto-rooter that's it so you just start carving out prostate and as you can see so it goes up into the bladder initially and then at the end of the operation you vacuum it all out and it all comes out yep and then measure the weight of it so actually you get a report at the end how much how many grams so a lot of a serologist will look and say how did I do how many grams did I get they will also when you chip when you shave this out they'll check it for cancer but as I say anybody undergoing this procedure should have already been cleared from a cancer perspective no this is just more shaving there's some stones there if you saw those little stones the prostate because it has ducts in it little forms little stones can form so this is more the procedure just and it's a very easy procedure to do and you just go in there and you keep shaving out and whittling out and whittling out and whittling out there's bleeding you can cauterize the bleeding like that [Music] it's going up into the bladder the pieces go up into the bladder and at the end of the case you just vacuumed them out yeah depends on the size of the prostate let's watch it again I'm a urologist they like watching videos of these Terps it depends on the size of the prostate so if you're doing somebody with maybe like a 50 gram prostate it might take you 45 minutes if you're doing somebody with a 90 gram prostate it might take you an hour or two yeah the patient is asleep yep the patient is asleep yeah the patient's asleep yeah but as you can see you just slowly work your way through up there well not I should have probably put in a nice video of a cystoscopy so you guys could see it's cystoscopy but just with no procedure with just showing you the layout but say do you see this metal band here that metal band that's coming in is electrified it's a hot electric knife and it just slices it's like a meat slicer if you go get your shwarma or something and you just meat slicing I mean literally that's what it is yeah each one of these pieces is probably this long and yeah maybe three or four millimeters thick and you do and you do hundreds of these I mean I mean every it's like whittling you you Whittle way hundreds of times during a case you end up with a pile of these tiny little slivers you know of hundreds of these tiny little slivers this is the urethra so he's cut it you basically cut out the urethra you cut out there is a-- so what I'm trying to explain is within the prostate the urethra is not a separate structure if then what happens is the lining of the bladder comes down and when it continues off you know through the prostate beyond the prostate the urethra itself becomes more of a distinct different structure but I mean the urethra is I'll show you whether your interest this is the urethra and this is it it's it's it's privates it's this is all the lining it's not really separate in the prostate it's one lining and what you end up with you shave out the lining you remove the lining on the lining just regrows itself that loop is probably about eight memories about this wide yeah yeah so this is another prostate procedure that is relatively similar to the Terp but we'll talk about it because it's become popular it basically does the exact same thing as a Terp except for instead of that loop doing a whittling it uses a special laser that just vaporizes the prostate tissue it's kind of magical it's just literally and we'll see a video of it it just kind of melts the prostate tissue in the prostate tissue just disappears the laser has very unique qualities in that it causes very very little bleeding when it vaporizes the tissue it takes longer to remove that prostate tissue though when you compare it with the Terp the tip you see that I'll loop you can quickly take big big slices this thing you'll see it works kind of slowly so in my opinion it removes less prostate tissue than a Terp now if you sat there with a laser and you were incredibly patient you could probably eventually get about the same amount of of widening of the channel but but it's very difficult to do that because for technical reasons but in my opinion because it removes less tissue there's a higher likelihood of maybe needing another procedure later in life so that's another thing to keep in mind like those procedures we talked about that that pinching the euro lift one and the steam one we don't know how long it lasts the green light probably does not last as long as a Terp the turk probably lasts the longest and that and the sort of the party line on the duration of a Turk is that if you have a Terp you shouldn't have any need for another procedure for at least fifteen years so for most people a Terp should probably be their last single and only prostate procedure sometimes when they do agree if you do a green light and a young man let's say you're doing a green light and a 55 year old man I would advise that man you may need another procedure when you're 75 if you do a Terp at age if you do a green light at age 55 it's a good question you know I would probably tell them that it may within 10 years they may need something right exactly so if I have a guy who's like in his 90s I'd say you know what we can do green light and his prostate was a reasonable size and shape for it I would say a green light will get you everything you need I think but as I say a 55 year old guide so we can do the green light but I tell you I may be talking about something else when you're 75 because the prostate does continue to grow does continue to grow over time [Music] yeah just kind of read covers itself yeah yeah oh we suck it out of the body and we send it where we take it out at the end of the case we take it out yeah [Music] geez you know I don't know if I'd want to do that without looking this up and giving you an official an official statement on that but I would say that probably the smart listen smaller procedures because they sort of do less probably inherently have fewer complications because you're just doing less I would say the Terp probably has the highest rate of complications but that's also because it gets rid of the most prostate yeah the other thing about this green light which I'll show you a video of in a second is because this laser is so good at making it such that there's no bleeding the most people go home the same day as a green light procedure so it's done again in the operating room like a Terp but most patients go home the same day as their green light whereas most Terp patients spend the night the other thing that's good about the green light is if you have a person who has to be on blood thinners for some reason a heart stent or some other problem it you know issues you can do this green light laser while they are on those blood thinners whereas a Terp procedure it can be done on blood thinners but I think most urologist will be a little bit nervous to do that this green light is is good you can do it with anybody on blood thinners so that's another nice benefit of so we'll show you another video so here's a diagram here's the again camera up into the urethra up to where the prostate is and then this is the laser and it's causing a it's sort of vaporizing out this prostate tissue and we'll see the video of it here so the laser is coming out the side of this wand and you'll see it's hitting this prostate tissue here and you can see this prostate tissue is just melting away it's very straight I did one of these yesterday it's it's kind of amazing the way this thing works but it's slow it's very slow you have to work very slowly the Terp is a little bit more I feel as though there's a little bit more control with the Terp you can see things a little bit easily it works more quickly it's sometimes with these green lights it's hard to see your progress but you'll see how there's this open channel now the urethra is nice and open this is all they've created this big cavity here and that's the urethra or that I should say that the prostate it's you know it's the channel the prostate channel so this is this laser and he's just coming you can see sort of meandering around finding this this right prostate tissue and he's just vaporizing and it has this kind of furry appearance because that's what's left behind after you laser it kind of gets furry and it kind of sits there there's no possible there always is yeah I mean if you go too wide you know you could end up poking a hole in the prostate for sure and getting out into here there's there's nothing really critical in this area but you could go too far deep behind and get into the rectum you have to be careful yeah you have to be careful so here's this big channel that they've created and again he's using this laser to kind of vaporize out this white fluffy tissue and now he's looking up into the bladder a little bit and doing a little bit more work here so this is it's similar to a turk but instead of using that electrified loop you use this laser and again you can see there's very little bleeding here it's just you know remember with that Turkey did those shaves and then you could see the blood this thing just cauterizes very very well so oh geez there's the rest of this so the what [Music] while we talked about the reasons the reasons are it contributes to the to the ejaculatory a seaman but most men in their 70s or whatever are not worried about yeah it's generally irrelevant and and its role in keeping the urine in when it's gotten so big that it's keeping the urn in too much then it's you know it's it's not it's it's it's gone from being functional to dysfunctional and this helps to kind of reestablish a balance you know so I don't have videos of the next couple procedures but I'll just mention them because they are you may see the mention but there's something called a whole name laser and nucleation of the prostate it's again it's a somewhat of a new procedure it's like the other ones it's performed through a camera that goes up into the urethra that they actually cut rather than riddle the prostate out in small pieces or or laser it and just vaporize it they actually carve it out they carve out the overgrown pieces of the prostate in a single unit and it's pretty wild to watch they actually get on a plane and they actually just sort of carve the whole thing out in a giant unit they push the giant unit into the bladder and then they insert something that actually within the bladder that sucks it up and and and sort of vaporizes it and sucks it out of the urethra it's designed for very very large prostates prostates where the the laser would take like 10 hours to get all of all of it out or even the Terp would take away too long it's a very challenging procedure to learn most urologists don't know how to do this procedure i do not know how to do this procedure it's it's there's a few people who specialize in this it's very and it's very hard to learn you have to do many of them to get good at it but it's a good option for men with very very large prostates there's also something called a suprapubic prostatectomy this is an old-fashioned type of procedure that has been updated and is now done with the surgical robot and i do this procedure it's again for very large prostates this one works differently than all the one we talked about in that it is not performed through the urethra it's actually performed through the abdomen so this one we use the da Vinci robot we go through the abdomen but instead of going in I'll just use this other picture as an example let me come here instead of coming in through the urethra we actually come in from the top we slice open the bladder we get into the bladder and then we come in here and basically from this side just call all of this out and we use the da Vinci robot to do that again it is a good option for very very large prostates you'd never do it you would never do it for somebody with a medium sized prostate it's for prostates that are very large that would be considered greater than a hundred grams so a normal sized prostate to give you an idea of a young man would be like 25 grams a man in his 60s might have a 50 gram prostate this is for people with prostate that are like a hundred and fifty grams so very very very big and it allows you again to take out you you car that the whole overgrown portion of the prostate in one single kind of unit and you go in from the top so let's go to the conclusions of the talks so most men will develop an enlarged prostate to some degree as they get older prostate enlargement itself is not in and of itself a medical problem so just having an enlarged prostate is not the problem the reason is not all men with an enlarged prostate have symptoms or have problems however many will when symptoms occur they can affect quality of life the slow stream that difficulty going the problem is going and treatment is warranted if the symptoms are bothersome to the patient and they want to do something about it or if some of the other more severe problems arise like infections bleeding inability to go entirely there are effective medications and effective surgical treatments treatments should be individualized to the patient the best patient excuse me the best treatment for a given patient defense depends on a number of different things including the patient's symptoms a patient's comorbidities anatomy and very importantly a patient's priorities what that patient what's important to that patient just because you have a large prostate doesn't mean that you have a problem but if you are having problems you definitely need to talk to your urologist and figure out what your options are and that's it not well I can show you the slide we had depending on the age but if you get to be about 90 years old there's about an 80 or 90% chance you're gonna have problems so not I don't think it's fair to say that every man but nine out of ten so pretty close to that [Music] [Music] I don't know of any data that suggests that that's true I don't know of any data that suggests that that true but I do I do now to several patients who ride bicycles and who have had other kinds of issues as a result of a lot of bike riding so I don't know if it causes an enlarged prostate I don't not not that I'm aware of not that I'm aware of but again it's fair to say I mean in the 90s eighty percent of men will have symptoms so I don't think it's fair to say that every man but many many many so PSA is everybody familiar with PSA with PSA is PSA is a blood test that got invented in the 80s that is used as a screening test for prostate cancer and the reason they invented it is that early prostate cancers have absolutely no symptoms so that's the other thing a lot of men will come in with these symptoms of BPH and think that their symptoms of prostate cancer and that is almost never the case or very rarely is that the case so they invented this PSA blood test as a way of trying to identify men early who might have prostate cancer and PSA has been very effective at reducing the number of men who die of prostate cancer since the invention of PSA the number of men in the u.s. who die of prostate cancer in the light so that's been about 30 plus years has gone down by about half and we have no other good explanation for why that would happen except for the PSA so it's been a tremendous advance in cancer care but the problem is even so PSA is not that great because it's high it can be high if you have a prostate cancer but it can be high if you have an enlarged prostate and it can be high if you have infection in your prostate even one that you don't feel even one that you don't have symptoms from some men having high PSAs and we simply have no explanation for it we've investigated cancer in these men they do not have prostate cancer and yet they have high PSAs and we don't know why so this is not perfect but it has been very useful why a man might have a rapidly rising PSA could be could be a prostate cancer it could be all the things we talked about BPH enlarged prostates don't tend to cause a rapidly rising PSA it could be inflammation or infections I've seen PSAs go high because of men who have actually a colon infection and their colon is so inflamed but the prostate is nearby and so the PSA starts PSA goes up if you've had a cystoscopy or procedure on your prostate the PSA will certainly go up if you've had sex within 48 hours of your PSA that can make your PSA go high a little bit PSA spikes for all kinds of different reasons most of them we're not exactly certain why if you start taking testosterone so if you start giving yourself testosterone because your testosterone is low that can make your PSA go up if you were on finasteride and then you stopped the finasteride your PSA will start going up and a lot of guys will stop finasteride and not realize that and then their PSA will start rising and whoever's checking the PSA doesn't realize that they were on finasteride and now they're often asked are the PSA is going up so there's a lot of different reasons one of them being cancer but a variety of other explanations too increased mobility but I've got in my to my feelings no negative symptoms I'm not experienced anything yeah experienced before right right right you're not feeling anything different yeah well it should be evaluated I mean usually the first thing we'll do is trend it for a little bit you know every couple months and see if it's you know sometimes the PSA will spike but then it'll go back down and typically we kind of blow that off and say well it doesn't look overly concerning sometimes we'll do some additional work ups at UCLA we use a lot of MRI of the prostate because we can we think that [Music] yeah good yeah one thing the MRI yeah one thing the MRI can be useful for is it can it can really accurately measure the size of your prostate and so there's a concept that we didn't talk about today called PSA density which is that if you take the PSA and then correct it for the prostate size it actually works a little bit better as far as risk stratifying you so if you have a prostate that's this big small but your PSA is let's say seven that's a much more concerning meaning possible cancer situation that's much more concerning versus if you have a PSA that's if prostate that's this big and your PSA is seven that is not that concerning because the explanation is right here you're pissed a seven cuz you plus it's enormous right exactly so the way I explain it to people in clinic is it's a little bit like weight so it weight versus body mass index so if you don't know anything about a person and you're trying to figure out is this person overweight do we need to worry about weight loss for this person and you don't know anything about them other than their weight and let's say their weight is 200 pounds it's very difficult for you to say whether or not that person is overweight because you don't know how tall they are if that person that person who is 200 pounds it turns out that they're 610 you probably say oh no that person is not overweight that person is actually quite thin versus if that person is five foot one oh yeah well that that's an overweight person so that's what PSA density does a PSA of seven with a giant prostate probably not a big deal PSA of seven in a small prostate that needs to be investigated for sure so that's PSA density so your MRI will tell you you're all just exactly a big your prostate is if you've got a very big prostate than a slight elevation in your PSA is probably not something because yeah and so I wouldn't think your prostate your prostate again as sort of as we touched on it doesn't tend to enlarge rapidly it's not swollen like that girls I it's it's it's a slow process so if your PSA is rising fairly rapidly you know that could be inflammation that could be a different kind of thing so but yeah it needs to be checked out it needs to be checked for sure well I wouldn't say healthy or unhealthy I mean I would say a sort of a 30 gram prostate which is kind of sort of the normal size for a young man is about the size of a walnut we usually say a large you know kind of an enlarged prostate would be you know something like more like a nectarine you know something like that or a lemon a lemon would be a you know reasonably and then and then you've got people who come in with a prostate that looks like a grapefruit and that's a yeah that would be a severe you know that would be like it probably a 200 gram prostate a very enlarged prostate yeah but again if a 200 gram of a man who came in and had a 200 gram prostate came to my office and his PSA number was not crazy and he was emptying his bladder well and he wasn't having bleeding and he told me and I said how's your stream and he we measured a stream and he have you know a good looking stream and he told me and I told me you having problems pings and no I'd say hit the road I don't care about how big it is I care about if it's a problem now usually usually if you have a 200 gram prostate you're usually having some you're usually but not all I've met a couple guys who I just sort of said alright he's doing fine it's fine [Music] [Music] [Music] tamsulosin is flomax oh yeah it's the same medicine it is the same yeah floor max is the generic tamsulosin is the generic for flow max they're the same same thing yeah yeah [Music] yeah well you know yeah very common very common yeah well it's probably you know you shouldn't you shouldn't you know get with your urologist and figure out figure out what you know if there's something's warranted but again it's a joint decision between you and your urologist this is about your it's about your priorities and how bothered you are and whether or not there's anything else happening you know it's things can get very difficult at night that's a long conversation sure sure I know it's very good all right I know the story then so good okay cool sounds good nighttime is tougher because as people get older their kidneys so then we get into a different situation which is actually it's not so much the bladder and the prostate usually the bladder and the prostate are already having a little bit of trouble and then what happens is particularly men in their 70s 80s and 90s their kidneys start to do this thing where they decide they're gonna make all the urine at night so during the day the kidneys aren't doing too much you know you pee a couple times and then at night the kidneys are like Bing and they start producing 60 70 percent of the urine at night it's very irritating very annoying the way to deal with it is the first part is we try to make sure that sort of enlarged prostate stuff isn't isn't the primary problem then we usually have men do what's called a voiding diary where they keep a record of when how much they're peeing and when and let's say you're sleeping for eight hours then about a third you know eight hours is a third of the day so you should be peeing out about a third of your urine during that period but what happens to men as they get old men and women and this affects women as well they start making instead of 33% of their urine they start making like 66 percent of their urine in the night time so again we rule out these kinds of situations try to make sure it's not a bladder and prostate issue oftentimes it's that's part of it but it's also this urine production tonight and then there are some medications that they that we have that can basically slow your kidneys down at night to tell the kidneys stop just relax for the next eight hours don't make so much urine that medication only lasts usually a few hours by the morning it's worn off your kidneys can kind of wake up again and start producing your urine in the daytime so it's a treat it's a tricky that is a very tricky problem as as folks get older in the nighttime it can be very tricky so there is some medication for that we also tell people basic things like don't drink fluids you know after six o'clock you know try to avoid alcohol because that tends to make it worse but yeah it's a tricky problem so it depends so first of all there are a lot of supplements out there a lot of ads for different supplements what I will say is there's a couple I I can't I really can't even make a comment on any given supplement because one I don't know what's in it to most of them have not been tested and they're not really FDA cleared so I don't know I would advise most people to kind of steer clear those things certain things like there's a there's a compound called saw palmetto that's very popular for prostate health it has been studied extensively it has been shown to be safe whether or not it does anything is a little bit fuzzy it's not clear that it actually helps very much so I tell people if you want to try that it appears to be very safe whether or not it's going to help you sort of unclear some guys try it and say this is really helping me I say great continue it some guys try it and they say you're shaking your head you try to don't do it it them doing it yeah as some people yes some people know it's hard to say it's safe I will say that it's been proven to be safe but a lot of those supplements you don't really know what's in them and so I can't really comment on it didn't really do so much yeah they're not really studied I mean people put stuff in there and say it's good yeah I think there's certainly variability I think for some guys that'll work and that's why I say you can try saw palmetto because at least I owe this I know it's safe I tell them you it's safe whether or not does anything hard to say I think Larry King has one called prestige annex that a lot of people use and most of them have a combination of like saw palmetto plus a couple other things so alright well nice to meet you all thanks [Music] you

Channel: UCLA Health

Views: 930,540

Rating: 4.7954988 out of 5

Keywords: UCLA Health and Prostate Surgery, Mens Health and UCLA, Enlarged Prostate, Benign prostatic hyperplasia, BPH, BPH and UCLA Health, BPH and men's health, Men's health and UCLA, men's health and urinary tract, prostate gland enlargement and UCLA Health, prostate gland enlargement

Id: ntqn69LyFU4

Length: 81min 36sec (4896 seconds)

Published: Thu Apr 16 2020