WCBS 880AM Interview with Dr. Daniel Kellner on Enlarged Prostates
November 08, 2021November 1, 2021: Dr. Daniel Kellner appeared on WCBS Newsradio 880AM (NY, NY) Health and Well-being with Pat Farnack and talked about enlarged prostates.
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- 00:15my name is Doctor Daniel Kellner.
- 00:17I'm a urologist at Yale Medicine,
- 00:19which is a multi specialty group in
- 00:21the old School of Medicine and I'm a
- 00:23general urologist, but I have a special
- 00:25interest in BPH in men's health.
- 00:27I practice in New Haven,
- 00:29CT, but I also have offices.
- 00:31In Madison, CT and Hamden, CT
- 00:33we're talking this morning with Doctor
- 00:35Daniel Kellner of Yale Medicine,
- 00:37and you are a urologist and you
- 00:39have an emphasis on men's health.
- 00:41Is it a struggle?
- 00:42First of all, to get guys to see
- 00:45a urologist in the first place,
- 00:47I think typically men are are less
- 00:49likely to want to go to the doctor,
- 00:51but unfortunately you
- 00:52can't avoid your bladder.
- 00:53And many times people are certainly
- 00:55at their very aggravated by their
- 00:57situation and so they'll end up making an
- 00:59appointment because if you ignore problem,
- 01:01it doesn't really go away.
- 01:02Or sometimes I have a friend who
- 01:04had a similar situation and kind
- 01:05of clue them in that there is help.
- 01:07So many men who come to me.
- 01:08They've come to me because they are friends,
- 01:10but it's similar experience or coworker
- 01:12would have similar experience and then
- 01:14obviously they're prompted sometimes by
- 01:15their significant other to to come in.
- 01:17No girlfriend, wife,
- 01:18partner because someone else is
- 01:19recognizing that they're having
- 01:21difficulty with what their bladder.
- 01:22Let's go over the symptoms and how severe
- 01:25do the symptoms have to get before you
- 01:28consider some of the procedures that
- 01:30were going to talk about today? When
- 01:33men have BPH, the prostate is
- 01:35typically the size of a walnut,
- 01:38and it can continue to grow,
- 01:40and it could obstruct the urethra.
- 01:41And that's the tube empties the
- 01:43bladder and prostate doesn't have
- 01:44to be big to constrict that too,
- 01:46and symptoms could be increased
- 01:48frequency to urinate,
- 01:49increased urgency to urinate,
- 01:50a slower stream or the stream
- 01:52could be hesitant or intermittent,
- 01:54or there may be more getting
- 01:55up at night to urinate.
- 01:56These things could affect the quality
- 01:58of life, so in in other words,
- 02:00sometimes men will be distracted at work.
- 02:02They'll be thinking about.
- 02:03You know where bathroom is or if
- 02:04they go shopping or they're driving.
- 02:05They're always kind of aware
- 02:07where a bathroom is,
- 02:08or to make sure that they
- 02:09urinate before they go anywhere,
- 02:10and so the symptoms could be quite subtle,
- 02:12but there could be a more
- 02:14serious underlying problem,
- 02:15because men could actually be
- 02:17developing urinary retention,
- 02:18and they're aware of the symptoms are having,
- 02:20but they're not aware that
- 02:21they're retaining urine,
- 02:22and when that urine is
- 02:23retained in the bladder,
- 02:24they could actually start to cause
- 02:26problems with the buyer with the
- 02:27bladder will start to retain urine,
- 02:29and the buyer could get quite large,
- 02:31and that pressure to even
- 02:32back up to the kidneys and.
- 02:33Does kidney damage and it's a
- 02:34bar is not emptying properly.
- 02:36It can lead to other problems
- 02:37such as urinary tract infections,
- 02:39bladder stones,
- 02:40other things could be a problem,
- 02:42so men may be aware of subtle symptoms,
- 02:44but they're not going to necessarily
- 02:45be aware that there is a more
- 02:47ominous problem that may be
- 02:48happening that they're not aware of.
- 02:49So where do you come in and
- 02:51how do you fix these problems
- 02:54when it comes to me and they have urinary
- 02:56problems and the first thing I do is
- 02:58simply do a history and physical and try
- 03:00to assess the degree of their problems.
- 03:01We have a questionnaire we often.
- 03:03Use quality anyway.
- 03:04Symptoms for the American
- 03:06neurologic symptoms score,
- 03:07which is a series of questions and
- 03:09it often kind of gauge how severe
- 03:11a patient or a man symptoms are.
- 03:13And often we could categorize them as
- 03:15kind of mild, moderate or severe symptoms.
- 03:16We also have ways of measuring
- 03:18the bladder to see if it empties.
- 03:20We call that a post void residual,
- 03:22and then we also assess things that
- 03:24may be contributing to the area.
- 03:25Symptoms such as excessive caffeine intake,
- 03:28alcohol intake,
- 03:29certain medications that are
- 03:30prescribed such as diuretics which
- 03:32could cause urinary symptoms so.
- 03:33That's how we initially evaluate a man
- 03:35what has to happen for you to decide
- 03:38to go to the euro lift? Let's say
- 03:41when a man has difficulty with urinating
- 03:43and first thing we do is lifestyle.
- 03:44Modifications typically will try men
- 03:46on medications and there are different
- 03:48medications that relax the prostate,
- 03:50make it easier to pass the urine.
- 03:53If a man is not having a
- 03:54good response to medications,
- 03:56side effects from medications,
- 03:57or simply does not want to take medicine,
- 04:00we could think of alternative
- 04:01options such as the euro lift.
- 04:03Now the euro lift.
- 04:04Is a procedure that is done
- 04:05where you put an implant into the
- 04:07prostate and it holds the prostate
- 04:09tissue in an unobstructed way.
- 04:11Basically opening the channel
- 04:12and making it easier to urinate.
- 04:14Now one of the appeals of the euro
- 04:16lift is it also could be done right in
- 04:18the office with a local anesthetic,
- 04:20and there is a relatively quick
- 04:22recovery and significant improvement
- 04:24in urinary symptoms,
- 04:26but it doesn't fix the enlarged prostate.
- 04:29Is the prostate still enlarged
- 04:31so when you do that, you roll it?
- 04:33You're not removing any tissue.
- 04:34You're not burning any tissue.
- 04:35Nothing is being removed.
- 04:36You're simply taking that issue
- 04:38that's obstructing and by putting
- 04:39these implants and you move the
- 04:41tissue into unobstructed way.
- 04:42I mean, you could think of something like a,
- 04:44you know, like a hose.
- 04:45If you if you basically have
- 04:46your thumb partly over host,
- 04:48it really changes the flow of the liquid,
- 04:50right? I'm removing moving
- 04:51your thumb out of the way.
- 04:53The flow is going to change a lot,
- 04:54and so with the Europe is similar.
- 04:55If you basically move that tissue
- 04:57out of the way and you don't
- 04:58necessarily move is very far.
- 04:59The air flow is going to be much better,
- 05:01and when that happens,
- 05:02then typically the other symptoms.
- 05:04Starts to get better too,
- 05:05such as the frequency of urinating
- 05:07urgency to urinate so that one of the
- 05:09appeals of the euro lift for many men
- 05:11as well is there are no documented
- 05:13sexual side effects because many of
- 05:15the other surgeries that we do or
- 05:17some of the medications that we give
- 05:19sometimes interfere with the ability
- 05:20to ejaculate or could sometimes
- 05:22even cause problems with erections.
- 05:24So the euro it has really no
- 05:26documented sexual side effects,
- 05:27so that is very appealing to many men.
- 05:29Does it return a guide to normal?
- 05:31Not maybe to his 20s? But does it?
- 05:34Return him to a normal urinary flow, then
- 05:37at times there is a very very remarkable
- 05:40improvement with the euro lift.
- 05:42I mean, I think it is very important
- 05:43that a managed properly selected
- 05:44there are certain anatomy's that are
- 05:46very good for your lip procedure.
- 05:48I think there are other anatomy
- 05:49is where a person really is,
- 05:50not a good candidate for the airlift.
- 05:52And if they're not a good
- 05:53candidate for their lists,
- 05:53the fortunate thing is we actually have
- 05:55many other procedures that could be done
- 05:56which could help them out by anatomy.
- 05:58What do you mean?
- 05:59I mean, the prostate anatomy,
- 06:00the size of the prostate,
- 06:02and the shape of the prostate has to be.
- 06:04Determined there are certain
- 06:05shapes of the prostate,
- 06:07just basically the where the tissue
- 06:08is located in how it's constricting,
- 06:10which could determine if the
- 06:11airlift is a good procedure or not.
- 06:13So I think it's really up to the
- 06:15experience of the urologist to
- 06:16kind of distinguish who is a good
- 06:18candidate for euro lift and who isn't.
- 06:19It's not a good procedure across
- 06:21the board for every man,
- 06:22so I think every man has to be
- 06:23evaluated often times that we have
- 06:25to do what's called a cystoscopy,
- 06:26where we look directly inside
- 06:27the prostate at that issue.
- 06:29And then we could figure out if the person
- 06:31is a good candidate for the euro lift.
- 06:32Do you usually need to do a euro lift?
- 06:35Again, down the road,
- 06:36or is it once and done? Usually
- 06:39the euro lift has very very good durability.
- 06:42When it was approved by the FDA,
- 06:44there was a trial club,
- 06:44a lift trial which looked at five year
- 06:47follow up in the retreatment rate.
- 06:48The surgical retreatment rate
- 06:50for euro lift is about 13 to 14%.
- 06:53So most men at five years are going to be
- 06:56OK with that or after having the airlift.
- 06:58But there will be a certain percentage
- 07:00of men who may need to go on to
- 07:01have either another euro lift or a
- 07:03different procedure to help them.
- 07:04What is? Recovery like for euro lift.
- 07:07Most men after euro lift of
- 07:09experienced some irritative urinary
- 07:11symptoms so they may have some
- 07:12urgency or frequency to urinate.
- 07:14Some burning with urination,
- 07:15some blood in the urine and this usually
- 07:18goes on for a few days and then he thinks
- 07:20they kind of get better over a few weeks.
- 07:22Or maybe maybe mild symptoms and
- 07:24over the course of several weeks.
- 07:26Then you start to see the
- 07:28improvement in the urination.
- 07:29There are other procedures though
- 07:31that address BPH and you want to talk
- 07:34about one of them today. That you do
- 07:36right? So I'd like to talk about
- 07:38a procedure called the whole LIP,
- 07:40which is holmium laser enucleation
- 07:42or prostate, and this is a very
- 07:44unique procedure at Yale Medicine.
- 07:46We are the only group in Connecticut
- 07:48that actually performs this procedure.
- 07:50Surgical technique which is minimally
- 07:52invasive where you go inside the
- 07:53prostate with a scope and you're
- 07:55able to basically peel out the
- 07:57inside of the prostate like you're
- 07:58peeling out the inside of an orange.
- 08:00And the nice thing about this
- 08:02procedure is it's really complete.
- 08:04Removal of the inside of the prostate.
- 08:06And there's very little bleeding,
- 08:07similar to if you're in the right.
- 08:09If you're peeling an orange
- 08:09in here in the right plane,
- 08:10there's very little juice.
- 08:12Well, just think of that juice as blood,
- 08:13so when you get into the right plane,
- 08:15you could basically peel out the inside
- 08:17of the prostate so it's really complete.
- 08:19Removal of the inside of the prostate,
- 08:20and then we use an instrument
- 08:22called the morsel later,
- 08:22which removes the tissue.
- 08:23So there's no in stations,
- 08:24and with this procedure you
- 08:26can treat any size prostate,
- 08:28so for very very very large prostates
- 08:31manner have very few options.
- 08:32Be able to treat them,
- 08:34and they often have to consider
- 08:35an open surgical.
- 08:36Approach,
- 08:36which is very morbid and it requires
- 08:39several days in the hospital.
- 08:41Potentially a lot of bleeding with
- 08:42the procedure called the whole app.
- 08:44We can do these surgeries without
- 08:46any incisions,
- 08:46and most of our patients go home
- 08:48the same day and actually is.
- 08:49And also we have very little pain.
- 08:51Actually I don't even prescribe pain
- 08:53medication with this procedure,
- 08:54'cause men really don't complain
- 08:55of pain with the procedure.
- 08:56Now the way you describe it,
- 08:57I would think that it would rely
- 08:59really on the skill of the surgeon
- 09:02and the artistry of the surgeon.
- 09:04It's a difficult surgery
- 09:05to learn if there is.
- 09:06Certainly a learning curve,
- 09:07and I think you need to be a
- 09:10dedicated surgeon who really
- 09:11wants to focus on this procedure.
- 09:12This is not a procedure that's
- 09:15done casually by any urologist,
- 09:17so for someone who's doing a whole,
- 09:18if you really kind of have to be
- 09:20dedicated to the art of doing
- 09:21this procedure so we have a
- 09:23very successful program at Yale,
- 09:24we've been doing them since 2019 and
- 09:26actually we have patients were coming
- 09:28from all over Connecticut and even
- 09:30outside states such as Massachusetts,
- 09:32Rhode Island, New York,
- 09:33because they hear about this procedure
- 09:35and and once they find out about it,
- 09:36they have a lot of interest.
- 09:37What is the benefit of the
- 09:40whole up over the euro lift
- 09:42so the euro lift is really good for
- 09:44patients who have prostates are
- 09:46kind of on the smaller side that the
- 09:48original approval of the airlift was
- 09:50for properties from 30 to 80 grams.
- 09:52And now it's just been extended from 30
- 09:55to 100 grams with the whole of procedure.
- 09:57You can do any size prostate you
- 09:59can do prostate better,
- 10:00even several 100 grams and the
- 10:02whole app is really good for any
- 10:04prostate versus the euro lift is
- 10:06going to be good on select prostate.
- 10:08Based on the anatomy
- 10:09and what is the recovery like for Jolla
- 10:12so most patients will go home
- 10:14the same day after the whole app.
- 10:16They live far away.
- 10:17Sometimes will keep them overnight and
- 10:19usually we keep a catheter in for a day
- 10:21or two after the catheter comes out,
- 10:23so they should not do any heavy lifting
- 10:25or straining this activity for about
- 10:26two or three weeks so they can drive.
- 10:28They can walk, they can shower,
- 10:30and after two or three weeks they could
- 10:32start to do normal activity again.
- 10:34I noticed that there are ads
- 10:36online and on television.
- 10:38And on radio for some of these procedures
- 10:41that you never used to see before,
- 10:43I guess it was taboo.
- 10:44Is the taboo around this topic lifting?
- 10:48Do you think?
- 10:49Or why are we talking about it more
- 10:51and seeing more of this in your view?
- 10:53Well, I think that the reason we're
- 10:55seeing a lot more of this on TV and
- 10:57other places this is marketing.
- 10:59There is a business aspect terms of
- 11:01you know products that are being used.
- 11:03But it also comes with good intention.
- 11:05I mean there is a huge huge need for men.
- 11:08We're having difficulty
- 11:10urinating who need care,
- 11:11and so I think it is good that men are
- 11:13being made aware of different options.
- 11:15Making this conversation come to life.
- 11:18Universe is something that
- 11:19you just don't talk about.
- 11:20I mean, I think some men they
- 11:21just accept that part of aging
- 11:23is having difficulty urinating
- 11:25getting up many times at night.
- 11:26You know,
- 11:27not being able to sit through a movie
- 11:28without having to get up a few times and
- 11:30it really doesn't have to be that way there.
- 11:32There are treatments that are available
- 11:33and it's just a matter of kind of
- 11:35looking for those treatments and
- 11:36finding out what's right for you.
- 11:37Must be a lot of satisfaction.
- 11:39Doing what you do,
- 11:40it's very satisfying,
- 11:41so my focus is really meant self.
- 11:43But really my my passion is treating BPH.
- 11:46It's very very black and white.
- 11:47I mean when you have someone who
- 11:48can't urinate and they may have
- 11:50a catheter end and then you can
- 11:51do a procedure and then then the
- 11:52next day they're able to urinate
- 11:54like they're ten years old again.
- 11:55I mean, it's a very, very satisfying,
- 11:57so there's no school of delay gratification.
- 12:00I mean, you get some gratification
- 12:01very quickly when you treat BPH,
- 12:03able to help someone urinate.
- 12:05And I think I think I make a lot of
- 12:07lifelong friends by doing this procedure,
- 12:09so it it's.
- 12:09One of the things that I really enjoy,
- 12:11well, I can tell your passion
- 12:13really comes through anything else
- 12:15that you want to add on either
- 12:16the euro lift or the whole lip. I
- 12:18think there are many
- 12:20different options for men.
- 12:21I think it's important that
- 12:23basically they make an appointment.
- 12:24You have to see the urologist to
- 12:25be able to go over the different
- 12:27options that are available.
- 12:28I think men are pretty savvy these days.
- 12:31What they could learn on the Internet?
- 12:32Many of them come in with some
- 12:34knowledge of what's available and
- 12:35then when they come in I could kind
- 12:37of tailor the right approach to.
- 12:39The person based on what really what
- 12:41their desire is, is their number.
- 12:42One desire to preserve sexual function,
- 12:44but they want to urinate better
- 12:45or is their desire to have one
- 12:47procedure where they're going to
- 12:48have the best urinating or will
- 12:50ever be able to achieve and never
- 12:51need another surgery again.
- 12:53So we can kind of tell her what
- 12:54the the treatment is to the
- 12:56patient and what their desire is.
- 12:58Well you've given us a lot
- 13:00of information and I want to
- 13:01thank you for taking the time.
- 13:03No thank you.
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