Micro Blog Articles by Henry Rosevear, MD

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.

Genetic testing is all the rage nowadays. Companies sell kits that will use your genes to both tell you where you ancestors come from as well as tell you what diseases hide in your genes.  I was recently asked about the role of genetic testing in urology and thought that it was a great question.

First, a warning, I’m not going to mention any specific genetic test as I don’t want to provide advertising to any company so if someone has a specific question, just ask me at your next visit.

Let’s start with screening for urological diseases.  It turns out that in the kidney cancer world, there are a few genetic diseases that put patients at high risk of kidney cancer including von Hippel-Lindau disease, hereditary leiomyomatosis, hereditary papillary renal carcinoma and Hirt-Hogg-Dube syndrome but unfortunately for the most common type of kidney cancer, sporadic clear cell renal cell carcinoma, there is no commercially available genetic test.  In fact, the most common way kidney cancer is diagnosed nowadays is as an incidental finding on abdominal imaging!

Prostate cancer is a bit different but not much.  About 95% of all prostate cancer is sporadic meaning that it does not have a genetic component but there is a small group, about 5% of all patients, who harbor a genetic predisposition to prostate cancer.  Mutations in the BRCA2 gene, the same gene that can cause breast cancer in women, has been linked to prostate cancer so men with two or more first degree relatives with prostate cancer should be screened.

On the other hand, using genetic testing after the diagnosis of prostate cancer is an exciting field that has much potential.  The trick with treating prostate cancer is that most prostate cancer does not require any active treatment.  It can be safely monitored because it tends to grow very slowly.  On the other hand, not all prostate cancer grows slowly and so there are numerous genetic tests available that can help guide physicians and patients in selecting appropriate patients for monitoring.  If you have prostate cancer and have questions about using genetic tests for monitoring, please contact me.

Another common question is the use of genetic screening for kidney stones and unfortunately the answer is a bit complicated.  It is a true statement that kidney stones run in families; if a parent had stones, a patient is much more likely to get stones themselves. That does not mean though that your genetics is to blame.  Why? Because most families eat the same types of food and dietary considerations are much more likely to blame.  There are certain stones though, cysteine stones for example, that are genetic but those are incredibly uncommon.

Like most physicians I believe that as our understanding of genetics increases, my ability to treat patients will improve but unfortunately genetic testing remains at its infancy and in most cases is not ready for clinical use.

If you have questions, please call my office for an appointment and I’ll be glad to explain everything in person!

As I’ve talked about in the past, in April of this year, the FDA released a new statement on mesh and vaginal surgery and not surprisingly it is generating an incredible amount of questions. With that in mind, I thought I would highlight a few of the most relevant articles on the subject.

Let’s start with the actual FDA warning here. It ordered manufacturers of surgical mesh intended for transvaginal repair of anterior compartment prolapse (cystocele) to stop selling and distributing their products. Note that this order only applies to mesh for transvaginal cystocele repairs.

And that is important because surgical mesh for stress urinary incontinence is still legal.  Here is the American Urological Association’s position paper on that subject.

If you’re curious how the lay press is covering the FDA’s statement, here is an article from CNN on the FDA’s statement.  

And here is a great article from the NY Times about how certain unethical doctors are responding to the FDA’s order.

But if you really want to understand the FDA’s order and its implications for urology, this is by far the best article I’ve read. 

I realize this is a confusing topic and so if anyone has questions which these articles don’t answer, please call my office for an appointment and I’ll be glad to explain the status of mesh. As a warning, though, I have not used mesh in my practice for over 5 years and do not remove mesh but I can certainly put you in contact with other highly experiences surgeons in town who do.

It’s no secret that exposure to opioids is the largest risk factor to developing an addiction.  And guess what patient population of mine is most frequently exposed to narcotics? Recurrent stone formers.

A recent study by Dr. Shoag shows that almost 10% of all chronic narcotic users have a history of kidney stones. The study in no way concludes that forming stones itself increases a patient’s risk of chronic narcotic use; rather, it appears that repeated exposure to opioids dramatically increases a patient’s risk of becoming chronically addicted.

As Dr. Resnick (one of America’s foremost urologists) succinctly states, “These data underscore the critical importance of developing, implementing, and evaluating multimodal approaches to pain management in populations at particular risk for opioid use and opioid abuse.”

If you have any questions about stone treatment or prevention, please call me office for a visit. 

One of the most challenging decisions a man must make after being diagnosed with prostate cancer is what to do.  The sheer number of treatment options from invasive surgery to radiation to observation can be daunting to understand.  Luckily there is some randomized data to help guide that decision.

The best randomized study is the ProtecT Trial.  This study randomized 1643 men with clinically localized prostate cancer to receive active surveillance, radical prostatectomy or radiation therapy.  The vast majority of these patients had Gleason 6 disease and were stage T1c.

Those two facts are important as the data is best applied only to men with that pathology and for men with higher risk disease (Gleason 7 or higher or T2 disease, these data may not be applicable).

The good news is that with ten year follow up cancer-specific survival was low among all groups with no significant difference between the three groups.  Translation: it doesn’t matter which treatment option you choose!  There was a slightly higher incidence of disease progression in the active surveillance group as compared to the other two groups which were similar.  On the other hand, the risk of complications from intervention was higher in the surgery group than the other two groups.

Making treatment decisions with a new diagnosis of prostate cancer is challenging; but data like this can help guide patients and their family to reaching a decision.

If you have questions about this study or any other study, please call my office for a visit.