Wayne Kuang, M.D.: Taking Charge of Prostate Health

Wayne Kuang, M.D.

Credit: LinkedIn

Wayne Kuang, M.D., a urologist and founder of the ManVsProstate Crusade, is passionate about raising awareness of benign prostatic hyperplasia (BPH) and its impact on men’s bladder and overall health.

In an interview with The Educated Patient, he explained how BPH progresses in five stages and emphasized the importance of recognizing early symptoms, such as frequent nighttime urination and weak flow. Kuang also addressed the stigma surrounding BPH, advocating for open conversations and highlighting minimally invasive treatments that preserve sexual function and vitality. With advancements in diagnostics and treatment, he believes men can achieve better outcomes and avoid the late, debilitating stages of the condition.

What is BPH, and how does it affect the prostate and urinary function?

Wayne Kuang, M.D.: Let me back us up a little bit. BPH is really about bladder health. There are two major organs you can’t transplant — your bladder and your brain — so we need to take care of them. Just like the heart pumps blood, the bladder is a muscle that pumps urine through the prostate, which starts about the size of a golf ball and is shaped like a mini donut.

As men age, the prostate grows, and the “donut hole” tightens. This affects bladder function in five stages. In stage one, as the prostate enlarges, urine flow slows down. Over time — five, 10, 15, 20 years — the bladder muscle struggles, quivers and becomes overactive, causing urgency and frequency, especially at night (stage two).

If untreated, the bladder becomes "rebellious" and squeezes without permission, leading to urine leakage (urge incontinence, or stage three). In stage four, the bladder can stop working altogether, leading to emergencies requiring catheters to drain urine. Finally, in stage five, the bladder essentially “dies,” requiring lifelong catheterization. Unlike the heart, which can be transplanted, there’s no replacement for the bladder.

So there’s time to catch this early on, right? What are the early signs of BPH, and when should someone consider seeing a doctor?

WK: How do we communicate this to men? That’s the big challenge. I’m the founder of the Man Versus Prostate Crusade, and we call ourselves the “Defenders of the Detrusor.” (The detrusor is the bladder muscle.)

Modern men at 60 are middle-aged — 60 is the new 40. Men don’t just want to live longer; they want to live better. Thankfully, we’re in a golden era of BPH treatment with advanced diagnostic technologies and minimally invasive procedures.

The early signs of BPH correspond to the five stages I mentioned. In stage one, as the prostate grows, urine flow slows and flow becomes weak — they may dribble, stop and start or take a long time to get started.

Stage two is when the bladder struggles, leading to urgency, frequency and waking multiple times a night. These men are exhausted because they’re not getting good sleep. They start planning their day around bathrooms — peeing before leaving the house, knowing where the restroom is at the supermarket or rushing to the bathroom before boarding a flight.

In stage three, the leakage begins. Men may start wearing pads or protective underwear, which can be very embarrassing and emasculating. I’ve spoken with men who avoid dating or intimacy because of it. It affects their confidence and quality of life.

Stage four is when they can’t urinate at all. This causes a painful buildup of pressure, leading to emergencies and catheterization. Finally, stage five is bladder failure — requiring lifelong catheter use.

All these stages are signs that something is wrong. To assess this, we use the International Prostate Symptom Score (IPSS) — a questionnaire that helps identify the severity of symptoms. If your score is 8 or above, it’s time to talk to your primary care doctor or a urologist. This scoring system should really be called the “International Prostate and Bladder Symptom Score” because it reflects both prostate and bladder health.

Why do you think men are so hesitant to talk openly about this condition, and how can we reduce that stigma?

WK: That’s a fantastic question. To reduce the stigma, we need to start talking about it. Men need to understand this isn’t just “part of getting older.” It’s a real, definable problem.

Think about it: if you had a blocked kidney, you’d recognize it as a mechanical issue that requires a mechanical solution. The same goes for the prostate. A tight "donut hole" is a mechanical problem that sometimes requires intervention.

One major barrier is the idea that taking medication is the only option. Medications can help manage symptoms temporarily, but they don’t solve the underlying problem. Worse, many medications have side effects, including negative impacts on libido, erections and ejaculation. Men need to understand this and know there are surgical options today that are much less invasive and preserve sexual function.

Another stigma is the fear that seeking treatment will ruin their sex life. In reality, the least and minimally invasive surgical therapies — like iTind — can address the problem while preserving vitality, sexuality and quality of life. It’s all about having the right data, the right dialogue and the right solutions.

You mentioned that medications may not be the best solution for everyone. How effective are surgeries?

WK: They can be very effective for the right patient at the right time. This is where shared decision-making comes in. Historically, decision-making was between the urologist and the patient (shared decision-making 1.0). Then health care systems began influencing treatment options (2.0). Now, we’re in what I call shared decision-making 3.0, where the bladder gets a “seat at the table.”

What I mean is this: Men aren’t always reliable judges of their bladder health. Many overestimate how well they’re doing because of what I call “I’m Fine Syndrome.” So we need objective data — prostate size, prostate shape and bladder function — to make informed decisions.

With the right data, we can match the right technology to the patient. By intervening early enough, we can preserve bladder function and avoid the late stages of disease.

Is there anything else you’d like our audience to know?

WK: Yes! When you go to the urologist, ask, “What about my bladder?” This will naturally lead to discussions about getting the right data so you can make informed decisions.

In the meantime, medications can help with temporary symptom relief, but the goal should be to address the mechanical problem when necessary. This allows you to live chemical-free and catheter-free.

This transcript was edited for clarity.