Micro Blog Articles by Henry Rosevear, MD

Let’s be honest, we’re in unknown territory.  This virus is too new for us to truly understand how deadly it is and how easily it spreads.  The little we do know is that this is a serious disease that must be treated with respect.

We know it is contagious. It seems to spread both by respiratory droplets (coughing) as well as direct contact. We don’t know if it spread via urine.

We know it causes fever, coughing, fatigue and breathing problems.

We know it is deadly.  Death rates vary depending on how much testing a country did but seem to range between 1 and 3.4%. Optimistically the death rate is much lower but that assumes a much larger number of people are currently infected and simply don’t know it.

It seems to affect older and sicker patients worse than younger healthier patients. We don’t know why.

We also know that besides “supportive care”, there is no proven vaccine or treatment for the disease. Unfortunately vaccines typically take years to develop.

With that in mind, Pikes Peak Urology is working to ensure that both our staff and our patients are kept safe throughout this ordeal.  We ask that anyone who has a cough or a fever cancel their appointment. We strongly encourage good hand washing.  We are attempting to transition to telemedicine where appropriate.  Our office will continue to be open though as we understand that there are certain urological issues that cannot be addressed over the phone and we would much prefer our patients to be able to be treated in our office instead of having to go to the emergency room.

We appreciate everyone’s understanding during these difficult times and I encourage everyone to reach out to us if you have any questions.

I try to stay away from politics; Democrats, Republicans and everyone in the middle gets sick. On the other hand, I am frequently asked by my patients about health care policy and I do live in Colorado. In Colorado, Gov. Polis has recently proposed changes to how Coloradans receive health care so I thought I would try to explain his proposed changes.

A note, the details of his plan are not finalized so some of this may change.

First, let’s start by stating what he is not proposing. He is not setting up a Medicare for all system, he is not taking away anyone’s private health insurance and he is not forcing anyone to join his program.

He is creating a state-sponsored health insurance plan that will be administered and run by private insurance companies. This plan will compete on the open market against other private health insurance options and the sign up will be voluntary. The controversial part is that he is proposing (and here is where many of the details still need to be worked out) using the power of the state to force health providers (hospitals, doctors, pharmacies and such) to accept rates that are potentially less than what they currently receive.

In its current form, his plan will require every health insurance company of a certain size that sells health insurance in the state of Colorado to offer the “state option” as one of its plans.  These companies would be required to spend 85 percent of the premium on direct health care costs leaving them only 15 percent for administrative costs and profit.  The state would set benchmark rates for what health care providers can charge the insurance companies under the state option.

That last part is the most important section and the part that is creating the most headaches for providers. Under the current system, the federal government sets a rate for a procedure that Medicare will pay for it.  That rate varies by physical location (hospital vs surgery center vs office) and geographic location (New York City vs Denver).  All other rates are quoted as a percentage of that Medicare rate.  In most large cities, Denver for example, it is not uncommon for private health insurance companies to reimburse over 300% of Medicare rates for a procedure. On the other hand, Medicaid usually pays a fraction of Medicare rates.  That lays bare a not well-known fact, if all hospitals received only the Medicare rate for a procedure, many hospitals would not be financially viable as they rely on their privately insured patients to make up for their Medicare or un-insured patients.

And that is exactly how Gov. Polis plans to save money with his state option plan, he would limit what health care providers could charge insurers to somewhere closer to 200% Medicare rates.  That will allow the state option plan to be significantly cheaper to consumers than private plans but will take a lot of revenue away from hospitals and providers.

The question many providers are grappling with today is the existential question of are they a viable business entity at those rates.  And that remains to be seen.  Please check back here for updates on the state of health care in Colorado and remember, at the end of the day, everyone gets sick and everyone needs to be taken care of; it’s just the right thing to do.

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.