Micro Blog Articles by Henry Rosevear, MD

Urinary leakage is a debilitating condition. It is embarrassing. It makes you a prisoner in your own house. It can also be treated.

Urinary leakage has different causes and each different cause requires a different treatment.  One type of urinary leakage is called “stress urinary incontinence” or SUI.  SUI is not associated with having a bad day at work or from your kids misbehaving; rather, SUI is a type of urinary leakage associated with activity. Some common examples are coughing, laughing, or sneezing.  This is also not the type of leakage associated with urgency or that “gotta-go” sensation.

SUI is caused by laxity or weakness of the pelvic floor and as such is a disease that cannot be treated with medicines.  The easiest way to treat SUI is with pelvic floor therapy specifically Kegel exercises.

A Kegel exercise done correctly is a subtle tightening of the pelvic floor.  An easy way to learn which muscle you should tighten is to practice turning off your urine stream mid-flow. Unfortunately, Kegel exercises do not work for everyone and that is where surgery has a role.

There are currently two types of surgeries for SUI.  The first involves injecting some sort of inert (nonreactive) substance in the tissue near the urethra to bulk it up and increase passive resistance.  Collagen and Durasphere are common examples of this technique.  This is a good first step but most published studies have success rates less than 50% with few if any serious complications.

On the other hand, for more serious cases of SUI, surgery is often the answer.  Until recently, the best option for most patients was a simple 15-minute outpatient procedure where a chewing gum sized piece of mesh was placed under the mid-urethra to limit mobility of the pelvic floor.  This procedure worked in over 90% of patient but the mesh itself was associated with rare though terrible complications and recent changes by the FDA have made mesh surgery rare.  As a result, woman with SUI now must rely in older, less effective and potentially more invasive procedures. 

The two options for SUI in the post mesh world are either cadaveric tissue or autologous tissue.  Cadaveric tissue is just what it sounds like; the surgeon implants a small piece of sterilized cadaveric tissue under the urethra in a manner similar to the mesh surgery.  This technique does not have the same long-term efficacy as mesh but also avoids most of the complications associated with mesh surgery.  Autologous tissue is tissue that the surgeon removes from the patient herself usually either from the leg or the lower abdominal area and then implants under the urethra. This has higher success rates than cadaveric tissue but lower than mesh and avoids the use of cadaveric tissue.  The problem with autologous tissue is that it must be removed from the patient which adds time to both the surgery and the recovery.

While none of the options for SUI work 100% of the time, for patients who avoid activity for fear of urinary leakage, good options do exist. If anyone has more specific questions, please call my office and I’ll be glad to sit down and talk through all the finer points of this complicated problem.

Everyone knows that sensation, that feeling of dread when you need to use the restroom and know that you won’t be able to find one in time.  It’s that fear that keeps some people trapped as prisoners in their own home.

First line treatment of this condition is oral medications and for many patients, these medicines are life changing treatment.  For those patients where medications don’t work, second line treatment involves implantation of a neuromodulating device called Interstim.  And don’t get me wrong, the Interstim is an incredible device.  Small, easy to use and with a success rate over 80%.  Unfortunately, the original Interstim device is not compatible with MRI’s which limits its use in some patients.

Until now.  The second-generation MRI safe Interstim has been announced and we are eagerly waiting its arrival.  This newer device promises the same incredible urinary control with easy to use controls and also is safe for MRI’s.

Any patient who has been hesitant to consider an Interstim because of their potential need for an MRI, should contact us and learn more about this new device.  Don’t be a prisoner in your own house!  Call and schedule a consult today to learn about this new life changing technology.

When I applied for residency, Urology was one of the more competitive residencies.  There were almost two applicants for every residency spot available.

Unfortunately, that is no longer the case.

Though the reasons for that decline are still debated and it is becoming more common to see papers in the literature such as this one which try to explain the decline, the implications of this decline for patients remain concerning.

As the number of applicants decline, the field’s ability to ensure that only the very best medical students are selected decline.  We all know the old joke that goes, what do you call the guy who graduates last in medical school?  Answer: Doctor.  While we wish it weren’t so, there is variation in ability of medical students and as the field of Urology becomes less competitive, we risk our patient’s health. 

My request:

To the American Board of Urology and to those in the field of resident teaching, please, for the sake of our patients, do not let the standards of teaching decline. 

To my current urologists in the trenches of urology, for the sake of our patients, please, only hire well trained urologists.

To hospital administrators, for the sake of our patients, please accept that quality matters and hiring some new graduate is not the same as working with an experienced and well trained urological surgeon.

To my patients, before accepting whatever urologist you are assigned to, do your own research, not all of us are created equal. 

Don’t kid yourself; urinary retention hurts.  When the bladder can’t empty and the volume of urine in the bladder increases, the result is very painful.  Having said that, I’m not sure if manually siphoning urine out of someone’s bladder is something that I would do on a daily basis.

Having said that, here is an example where a Chinese surgeon did exactly that.

The best way to avoid this situation is to address the most common cause of urinary retention before it causes problems. What is the most common cause of urinary retention? An enlarged prostate.  Luckily there are numerous medications that work very well for this condition.  And even better—these medicines are cheap and generic with very few side effects.

If your stream has slowed, or if you feel that you are not emptying your bladder well, please call my office and I’ll be glad to discuss all of the available options so that you never end up on a plane unable to empty your bladder!

Nobody likes to talk about erectile dysfunction.  Thirty years ago, the medical community had nothing to offer men with this disease and blamed erectile dysfunction on the man himself often sending him for psychiatric evaluation.  How the times have changed for the better.

Once Viagra hit the market a new era in the treatment of erectile dysfunction began to the benefit of millions of men and their partners. What we’ve learned since then though is that while Viagra (which is now generic and cheap!) works well, the medicine eventually fails in all men as the underlying disease (usually poor arterial blood flow) worsens. 

Currently, the best treatment option for men who no longer respond to Viagra is injection therapy. I realize it sounds crazy but there exists a combination of drugs called Tri-mix which can be safely administered at home by a patient and which creates an erection in most men. There are certainly risks including infection and priapism (an erection that lasts for more the four hours) but usually it works very well.

A new treatment option though is emerging and is receiving lots of press coverage so I thought I would discuss it.

GAINSWave is a non-invasive soundwave-based therapy that in initial studies shows promise.  It involves using high frequency low intensity soundwaves applied directly to the penis to increase blood flow.  The procedure is not painful (I’m being honest here) and involves between 6 and 12 treatments done in an approved provider’s clinic. It is FDA approved but it is NOT covered by insurance and can cost well over 3000 dollars.

GAINSWave is not without its detractors.  The studies to date are limited in their scope, numbers and design.  Reported side effects are minimal but long-term data on treatment results and potential complications is limited.  Further the business model that the company is choosing to employ where they do not seek coverage by insurance companies and keep it as a cash only business bothers some providers as it appears to limit the treatment to well-off patients only.

There are currently no urologists in Colorado Springs providing this treatment though there are providers in Denver. If anyone has questions about this treatment or treatment for erectile dysfunction in general, please call my clinic at (719) 531-7007 and ask for an appointment as I’m happy to sit down and discuss all options in a private setting.