Micro Blog Articles by Henry Rosevear, MD

“On April 16, 2019 the FDA ordered all manufacturers of surgical mesh intended for transvaginal repair of anterior compartment prolapse (cystocele) to stop selling and distributing their products immediately.” The full FDA report can be found here.

This is the just the next step in a long and ongoing process as the FDA evaluate the use of surgical mesh. Mesh in urological surgery is commonly used for three conditions:

-transvaginal mesh for pelvic organ prolapse

-transabdominal mesh for pelvic organ prolapse

-mesh sling to treat stress urinary incontinence

It is important to note that the recent FDA order only applies to the use of transvaginal mesh for pelvic organ prolapse and does not in any way change our practice of using mesh in other FDA situations. Further it should be noted that the FDA states that “Women who have received transvaginal mesh for the surgical repair of pelvic organ prolapse should continue with their annual and other routine check-ups and follow up care.  There is no need to take additional action.”

I realize that not only are the treatment options available for the treatment of pelvic organ prolapse confusing but the recent FDA announcement further muddies the situation. While I do not treat pelvic organ prolapse in my surgical practice, I have numerous partners who are skilled in all of the treatment options available and if any patient has questions regarding their options, please contact my office for a consultation.

There is an opioid crisis in America; of that no one disagrees.  The reasons for the crisis on the other hand are hotly debated.

I was speaking at the Rocky Mountain Urological Society’s annual meeting recently and the lecturer who followed me was Dr. Nicole Miller of Vanderbilt University.  Dr. Miller is an incredible lecturer and one of America’s foremost kidney stone experts.  She gave a talk about post ureteroscopy pain control that changed my practice.

Surgery hurts; and surgeons are not sadists. As a result, I was trained to prescribe narcotics in the immediate post-operative period. Dr. Miller presented unequivocal data that narcotics do not help control post-ureteroscopy pain.

Think about that for a moment.  What a generation of doctors has been doing in an honest effort to help their patients has been wrong.

It turns out that in the post-ureteroscopy setting, a combination of Tylenol, ibuprofen, Tamsulosin and oxybutynin is all that it takes. 

Further it turns out that 1/10 patients who are given narcotics for post-operative pain become addicted to the medications. As a result, I intend to immediately change my practice to dramatically limit the narcotics that I prescribe in the post-ureteroscopy setting and will highly encourage all of my colleagues to do the same.

Harnessing a patient’s own immune system to fight off cancer is one of the newest trends in the treatment of cancer in general.  It turns out urologists have been doing this for decades!

In the early 1970’s, it was discovered that by treating patients with certain type of bladder cancer with the BCG virus (a virus related to the virus that causes tuberculosis), the body’s own immune system is able to significantly decrease a patient’s chance of having a recurrence of their bladder cancer!

More recently, further advances have been made in the fight against bladder cancer using immune therapy. It turns that an important part of the immune system is a series of “checkpoints” that prevent the body from attacking itself. Interestingly, many types of cancer including bladder cancer often have mutations in these checkpoints.  Two new drugs Atezolizumab and Nivolumab which target two of these specific check point drugs (PD-L1 and PD-1 respectfully) have shown great promise in treating patients with advanced bladder cancer who have already failed traditional chemotherapy.

If you or a loved one have bladder cancer and are curious about the treatment options available, please call my office at 719 531-7007 and I’ll be glad to sit down and talk about all of your options based on what your goals of treatment are.

So, you’ve got a stone. Not the best news you’ve heard this week but, well, it could be worse.

Now you need to decide what to do about it.  The good news is that whatever modality you chose to treat your stone, you will most likely be rendered stone free with nothing more than a simple outpatient procedure.

For most patients, the decision of how to treat a stone comes down to undergoing shockwave lithotripsy vs ureteroscopy and laser lithotripsy.  Yes, there are other options including percutaneous (through the skin) approaches for very large stones but for most stones, a minimally invasive procedure will work very well.

With that in mind, I thought I would walk everyone through the pros and cons of shockwave lithotripsy vs ureteroscopy and laser lithotripsy.

Shockwave lithotripsy involves a patient going to sleep (general anesthesia) and the surgeon then applying concentrated sound waves to the stone to break it up.  To be a candidate for this procedure, the stone should be in the kidney, it needs to be visible on fluoroscopy and the distance between the stone and your skin cannot be excessive.  The advantages of this procedure include its noninvasive technique and its high success rate.

An alternative is to use ureteroscopy and laser lithotripsy.  All stones and all patients are candidates for this procedure though it tends to work best on smaller stones in the ureter.  The advantages of this procedure include its higher stone free rate as compared to shockwave lithotripsy but it does have the disadvantage of being more invasive.

Here at Pikes Peak Urology, we offer all treatment options for stones and we understand that passing a stone is an incredibly painful experience and we strive to treat all of our patients in a safe and expeditious fashion. If you have any questions, please call my office at 531-7007 to make an appointment.

Continuing my effort to provide access to the latest and greatest in cutting edge research, a group from Iowa (my alma mater for what that is worth) just published research showing that eating fried food increases your risk of heart disease.

A truly amazing conclusion worthy of an Ig Nobel.

For those who have any question on what a heart healthy diet is composed of, I recommend reading this website from the Mayo Clinic. Staying healthy isn’t hard, diet, exercise and have fun!