WCBS 880AM Interview with Dr. Daniel Kellner on Enlarged Prostates

November 08, 2021

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November 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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