Micro Blog Articles by Henry Rosevear, MD

Blood in the urine (hematuria) is one of the most common reasons a patient is sent to see a urologist and, for anyone who has ever had the experience of seeing blood in their urine, one of the most traumatic.  Reassuringly, blood is a very strong pigment and it doesn’t take much blood to turn urine very red.  With that in mind, I thought it would be helpful to talk a bit about why this is a potentially serious symptom and what I, as a urologist, do to evaluate it.

Blood in the urine is classified into two types based on whether it is visible to the naked eye (called gross hematuria) or only visible on microscopic evaluation (called microscopic hematuria). The questions I ask and the investigation that I do is aimed at learning where the blood is coming from so that it can be treated.  It may be surprising that in many cases, no cause is ever found! And that is ok as the investigation that I do in this situation is designed to rule out anything serious.

Some of the causes of blood in the urine include: kidney stones (these can be otherwise completely asymptomatic), urinary tract infections, trauma, an enlarged prostate, or various urological cancers including cancers of the kidney, bladder, ureter or prostate.

The American Urological Association recommends that all patients with blood in the urine undergo two diagnostics tests.  The first is a contrasted CT scan.  The reason this is done is that the kidney and ureters (the pipe between the kidney and the bladder) is basically impossible to examine on physical exam. The second test is a brief visualization of the bladder itself. The reason this minimally invasive procedure is recommended is that because the bladder is a hollow organ, it is not well visualized on CT scan and small tumors are easily missed by CT scan.

Overall, while most people with blood in their urine are not found to have any significant urological problem, blood in the urine is the most common presenting symptom of most urological cancers so should be considered a serious medical issue and needs full and prompt investigation.

If you have any questions, please call my office at (719) 531-7007 to make an appointment!

Kidney stones are incredibly painful and incredibly common. There are also numerous myths and half-truths floating around the internet regarding stones.  With that in mind, I thought I would set the record straight on some of these:

1. Dissolving stones:  There are dozens of types of stones and only one of them, uric acid stones, can be dissolved by taking oral medications.  Unfortunately, only 5-10% of all stones are uric acid stones.  All other stones cannot be dissolved with oral medication so don’t fall for the latest greatest stone busting drug you read about on the internet; they rarely work!
2. Medicines like tamsulosin help pass stones. This is a controversial statement as there are well designed randomized studies addressing this topic which have shown divergent results.  Translation, I don’t know if the medicines work.  I prescribe these to help pass stones (even though it’s not a FDA approved indication) as they have few side effects and if they help, great, but truth be told, the data is not perfect.
3. Beer helps pass stones. I wish that were true.  Staying well hydrated has been shown to both help reduce your risk of forming stones and helping patients pass stones but I can’t quote a study that shows that beer is a good thing.  Having said that, there are lots of great breweries in Colorado to explore.
4. Most stones are calcium based so decreasing your calcium intake will help prevent stones.Not exactly.  While calcium oxalate stones are the most common type, if you decrease your calcium intake too much you are at risk of over-absorbing oxalate which can lead to more stones! How much calcium you need in your diet is a complicated discussion which is best had on an individualized patient to physician basis.
5. Eliminating oxalate will decrease your risk of stone formation. Again, while it is true that calcium oxalate stones are the most common type of stones, most high oxalate foods are also high in magnesium, fiber or potassium which are all anti-stone formers so the truth depends greatly on your diet taken as a whole.

So what diet do I recommend? Unless a person is a recurrent stone former in which case I recommend a 24hr urinalysis so I can make specific patient specific dietary recommendations, the diet I recommend for first time stone formers is an American Heart Association heart healthy diet.  Why?  Most people die of heart disease and if I can reduce someone’s risk of heart disease, I’ve done them a favor.

The treatment of Erectile Dysfunction is one of the most common diseases that I see in my clinic.  Given the confusion over the various oral treatment options, I thought it would be useful to go over some of the most commonly asked questions.

1.  Is Viagra available in a generic?  Yes, Viagra has gone generic but, no, the prices have not come down yet.  It turns out that there is only one company allowed to sell generic Viagra (sildenafil) until April 2020 and as such while generic versions of Viagra are now available, the prices are still ridiculously high.
2. Which of the medications work fastest?  While there is a significant variation in time to effect based on individual patients, Stendra usually has the fastest onset working in as little as 15 minutes!
3. Which of the medications lasts the longest?  Again, while variation exists patient to patient, Cialis has the longest half life and can last up to 36 hours in some situations.
4. What are the common side effects?  All of the medications are commonly associated with headaches, flushing and an upset stomach.
5. What should I do if I have an erection that lasts for more than 4 hours?  Go to the ER immediately. This condition is called priapism and is a medical emergency!

I hope this answers some of the more commonly asked questions about the oral erectile dysfunction medications.  If you have more questions or are interested in a prescription, please call my office and I’ll be happy to see you in clinic.

Pikes Peak Urology is a great place to practice medicine.  Not only do my partners and I provide state of the art medicine but we do it in a timely and efficient fashion.

And it is that efficiency that I want to talk about today. Running a medical office is tough but the staff at Pikes Peak Urology is an amazing team.  From the check-in staff to the nurses and medical assistants to the schedulers, our goal is to get you in and out of the office on-time.  We’re not perfect, and emergencies happen and sometimes I do run behind, but in the vast majority of situations, we accomplish our goal.

Our goal is helped if patients arrive on time for their appointments and have their paperwork (don’t blame me, I hate filling out paperwork too!) completeted.  Required paperwork can be found here.

My promise is to do my best to be on time for appointments while always giving patients all the time they feel is necessary to discuss their unique medical situation. I know I speak quickly and I get excited when I talk about Urology so if I ever say something someone doesn’t understand, please ask me to repeat myself!

Thank you to my staff and my patients for all of their help in acheiving our goals.

The answer to one of the most commonly asked questions in urology…are boxers or briefs better for male fertility?  According to a new study published in Human Reproduction, boxers may be better for sperm production. Read the details here.  Bye bye whitey-tighties…