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Big News for Individuals Who Need Insurance Coverage for Fertility.

On April 13, 2022, Governor Polis signed into law HB22-1008 on Implementation of Fertility Coverage.

In 2020, Colorado passed HB20-1158 Colorado Building Families Act requiring insurance plans under Colorado law to provide coverage for fertility diagnosis, preservation, and treatment. However, a provision of the law required an affirmative determination that the law would not trigger defrayal (a requirement that the state could be financially responsible for any increase in premiums) under the Affordable Care Act. That determination was not made and the law did not go into effect. However, defrayal is not an issue under the Affordable Care Act for large group market plans, but the Colorado Building Families Act did not distinguish between different insurance markets.

HB22-1008 requires large group plans (applicable to employers with over 100 employees) under Colorado law to provide coverage for fertility diagnosis, preservation for cancer patients and others at risk of medically-induced fertility, and treatment, including up to three rounds of IVF and unlimited transfers, for plans initiated in 2023 or later.

Note that HB22-1008 did not resolve coverage for individual and small group markets under Colorado law. Further, Colorado law does not affect insurance plans under federal law (self insured, Medicare, Medicaid, TRICARE, etc.) or the law of another state, which may or may not require or provide fertility coverage. Be sure to check whether your employer is self-insured or fully-insured and part of the large group insurance market subject to Colorado law.

Dr. Dan Mazur specializes in male infertility and is on the board of Colorado Fertility Advocates (CFA). CFA continues to work with the National Infertility Association to advocate for fertility rights for men and women across the country.

Urology Associates Has Partnered With Urology America

We are excited to announce a new partnership with Urology America, based out of Austin, Texas.  We looking forward to great things ahead for Urology Associates, Anova Cancer Care and our patients with the support of Urology America!

 January 18, 2022 – Urology America (“UA”) is pleased to announce a new partnership with Urology Associates of Denver (“UA of Denver”). Urology Associates of Denver has served patients for more than 30 years and is one of Colorado’s leading urology practices with seven urologists and two radiation oncologists across five locations in the Denver area. The group offers comprehensive urology services, including male and female urology, urologic oncology, robotic and laparoscopic surgery, and male infertility across the greater Denver area.

“We’re extremely excited to be partnering with the phenomenal team at Urology Associates of Denver. The team has a well-earned reputation in the Denver community for their commitment to clinical excellence and patient care, a core set of values we seek in all our partner practices. We are excited to welcome the UA of Denver team into the Urology America family, as one of several new partnerships we expect to announce in the coming months.” said Rich Goode, Urology America CEO.

“It was important for us to find an organization that shares our passion for patient care and would also provide us with the comprehensive support we need to continue growing our practice while spending more time with patients and less time on administrative tasks.  After speaking with many of the potential partners, we felt Urology America was the best partner to meet those needs.” said Dr. Jim Fagelson, President of UA of Denver. “We’re excited to collaborate with the other outstanding urologists of Urology America to continuously improve the lives of our patients.” 

Urology America, based in Austin, Texas, is one of the leading urology-focused management service organizations. Urology America supports more than 55 providers in Texas and Colorado. UA provides comprehensive business support services, which allows partner practices to spend more time caring for patients and less time on the administrative burdens of operating a urology practice. Urology America partners with leading urology practices that seek a partner with the resources and expertise to invest in their practice to ensure they continue to provide best-in-class patient care and continuously expand their practice. If interested in learning more about a partnership with Urology America, please contact Rich Goode (rich.goode@urologyamerica.com)

It Was A Little Miracle For Me!

Tracey is a patient of Dr. Krantz. She found that as she got older she started to feel the effects of childbirth, changing hormones and simply age. Incontinence is a common condition in women, in fact one in three women struggle with stress incontinence as they age. Often starting with small leaks when you cough or sneeze, for Tracey it progressed to happening regularily during exercise and hiking. Eventually, it became a problem that was happening every day, sometimes even with motions like bending over just to tie her shoes.

She knew she had to do something, it was affecting her lifestyle and the things she could do. She had tried a few non-invasive options first, but was unhappy with the feel or the function. Tracey was getting ready to book surgery when, she heard about the new Viveve treatment. She jumped at the opportunity to try a non-surgical solution that could potentially help her with her stress incontinence.

Once a resident in the Denver area, she flew to area from a small town, where she currently lives, to undergo the Viveve treatment at Urology Associates with Dr. Krantz.  Not knowing what to expect she was pleasantly surprised by her experience and the ease of the treatment. “It was comfortable, and other than a warm sensation, the 45 minute treatment was virtually pain-free,” she said.

“There really was no recovery time or pain following the procedure either.”  She hopped on a plane that same day, following the Viveve treatment, went home and went to work the next day. “There really was no pain afterwards at all, but it felt like it tightened things up.”


The Viveve procedure works by using a gentle deep heating and surface cooling to stimulate the body’s natural collagen formation process. A treatment tip delivers pulses of monopolar radiofrequency energy, which results in the heating of the connective tissue which results in a tightening of the muscles in the pelvic floor.

Many women who have mild to moderate stress urinary incontinence are excellent candidates for the Viveve Treatment. People who:

  • Experience urine leakage while exercising, running, jumping, sneezing or coughing
  • Have been pregnant or experienced childbirth
  • Have hormonal changes such as, perimenopause or menopause
  • Have had significant weight loss
  • Had a hysterectomy (or any other surgery that affects your pelvic floor)

About a week after the procedure, Tracey began to notice, “I am not leaking when I sit down to tie my shoes, when I go hiking or when I lift my luggage overhead.” Tracey was thrilled! In the month following the procedure, she found it just continued to get even better with time.

“I would do it again –  It was a little miracle for me!”

 

Peeing During Sex is Very Common – Is it Urination or Orgasm?

Peeing during sex is very common.⁣⁣⁣ Approximately 60% of women with urinary incontinence leak during sex⁣⁣⁣. Dr. Tessa Krantz answers common questions that many women are embarrassed to talk about or discuss with their provider.
⁣⁣⁣⁣

What is the Difference Between a Squirting Orgasm, Female Ejaculation and Sexual Incontinence? ⁣


All three involve fluid coming from the bladder during sex. ⁣⁣⁣

  • Squirting is the expulsion of a large quantity of liquid during sexual stimulation. This type of orgasm includes a rapid ejection of urine from the bladder.⁣⁣
  • Female ejaculation is a release of both urine and a substance from the skene’s glands; the secretion is of thick, milky fluid
  • Sexual Incontenence aka Coital Incontinence is when someone loses control of their bladder during sex.⁣⁣⁣
  • Ejaculation in people with vaginas may include a small release of a milky white liquid that does not gush out. Squirting, on the other hand, is usually a higher volume. It is possible to squirt and ejaculate at the same time. ⁣⁣⁣
  • What Other Research is Available?


    The results of a few studies have indicated that Squirting, FE, and CI are different phenomena.
    ⁣⁣

What Treatments Are Available?


There are several treatments available for coital incontinence. The most commonly suggested treatments include: Strengthening the pelvic floor with pelvic floor exercises that can be done on your own or with the assistance of pelvic floor physical therapists , bladder retraining and lifestyle changes. Some of the changes we recommend are: ⁣⁣⁣

  • Understand your triggers, and learn patterns to avoid before sex, including avoiding caffeine and alcoholic ⁣⁣⁣
  • Try different sex positions that place less pressure on the bladder ⁣⁣⁣
  • Empty your bladder before sex⁣⁣⁣
  • Weight loss if overweight may help⁣⁣⁣
  • Decrease fluids before sex⁣⁣⁣
  • Lubrication- this will place less pressure on the bladder⁣⁣⁣

If these treatments do not help, seek help from your provider, there are more options available! Dr. Tessa Krantz is a UroGynecologist at Urology Associates. For more information on women’s health topics, visit her Instagram @pelvichelp

Dr. Fagelson Named As A Center of Excellence for GreenLight Laser Therapy by Boston Scientific

Dr. James Fagelson designated as a Center of Excellence for GreenLight™ Laser Therapy, a Treatment for Benign Prostatic Hyperplasia (BPH), or Enlarged Prostate

 

Center of Excellence Recognizes High Degree of Experience with New Technology


Dr. Fagelson has been designated as a Center of Excellence for GreenLight™ Laser Therapy treatment – a minimally invasive outpatient procedure for men looking to treat their benign prostatic hyperplasia (BPH), not just the symptoms. GreenLight Therapy can help provide immediate relief from enlarged prostate symptoms such as frequent urination—especially at night, weak urine flow, urgency and incomplete bladder emptying. In addition, GreenLight Laser Therapy requires no incisions and typically has no overall impact on sexual function. The Center of Excellence designation recognizes Dr. Fagelson’s high degree of experience with GreenLight Laser Therapy and commitment to delivering effective, long-lasting therapy to men suffering from benign prostatic hyperplasia (BPH).

BPH is a condition in which a man’s prostate enlarges and squeezes the urethra, causing frustrating symptoms such as frequent or urgent urination, a weak or interrupted urine stream, and the need to get up several times a night to urinate. It affects about 50% of men by age 60, and up to 90% of men by age 85.

“Being designated as a GreenLight Center of Excellence is a meaningful recognition for us, as we strive to provide the best possible treatment of urological conditions for patients in the Denver area,” said Dr. Fagelson.  “For years, the primary options for treating BPH were through behavior modifications, medications or invasive surgery. However, medications may not work for everyone. With GreenLight Therapy, we’re able to provide relief of BPH for men who do not want to take medication or want to avoid more invasive surgery.”

GreenLight Laser Therapy uses laser energy to vaporize the enlarged tissue, creating an open channel for urine to pass through the urethra. In addition to typically experiencing immediate improvements in urine flow, many patients are pleased to know that GreenLight typically has no overall impact on sexual function. GreenLight Laser therapy is a long-term solution without the need for BPH medication.

GreenLight Therapy is currently being used in many leading urology practices throughout the United States. To date, more than 1 million patients around the world have been successfully treated with GreenLight Therapy.

Fact or Farce – Do Cranberries Cure Urinary Tract Infections?

 

When does the population consume more cranberries and drink more cranberry juice than during the holidays? For some who suffer from urinary tract infections (UTI’s) they have a little cranberry juice or even a cranberry pill every day.

Urinary tract infections are common, in fact, they are the second most common infection that people seek treatment for.  Over a lifetime, a woman has a fifty percent chance of having a bladder infection. But it’s not just women at risk for these pesky infections, men get UTI’s too.  It just happens to be more common in women because they have a shorter urethra, in comparison to men, and that makes it easier for bacteria to get into the bladder.

The most common cause of a UTI is bacteria, but viruses and even yeast can also travel through the urethra and into the bladder causing an infection. There are also several medical conditions that can put one at higher risk for a UTI.  Individuals with diabetes are at a higher risk, as we age the risk goes up, and women in menopause can have a higher incidence. Sexual intercourse can increase the risk and bowel conditions such as constipation or loose stools can also increase the risk of a UTI. It’s important to be aware of the signs and symptoms of an impending bladder infection, because if you catch it early, you may not need medical intervention.

Early symptoms of a UTI include:

  • Urgency to urinate
  • Discomfort – painful or burning sensation during urination
  • Frequency – visiting the bathroom frequently even if there is little urine

Advanced symptoms include:

  • More severe urgency and frequency
  • Cloudy, dark, foul-smelling or bloody urine
  • Difficulty urinating and emptying the bladder fully
  • Fever
  • Nausea or back pain

The first line of treatment for a suspected UTI can start at home – start by increasing your consumption of fluids. Make sure you are emptying your bladder often and fully. And finally, add a little cranberry to your diet. It is a farce that cranberry will cure a UTI; it will not kill the bacteria.  It is a fact, however, that cranberry juice can be a part of the cure because cranberry actually prevents the adhesion of bacteria to the bladder wall allowing the body to win the battle against the infection. Some studies show that it provides up to an 80% reduction of bacterial adhesion. So, while cranberry doesn’t kill the bacteria, it does make it unable to grab onto the bladder wall and bacteria can then pass through and out of the bladder easier. Therefore, cranberries have been shown to reduce the risk of a symptomatic urinary tract infection by about 40%.

There are a couple ways to add cranberry to your diet. You can drink one 8 oz glass of cranberry juice each day, or for those who don’t like cranberry juice or are watching their sugar intake, they can take cranberry tablets, one pill should be equilivent to one eight-ounce glass. Both contain the active ingredient proanthocyanidins. This is what helps to prevent infection.  Bladder infections can go away on their own – especially if you catch them early enoughand if you can take enough cranberry to help fight it off. If following these steps, you are still unable to get relief from your symptoms, see your health care provider to have a urinalysis and possibly a culture.  If you have more than three infections in a year you should consider an evaluation with a urologist.

 

The Warning Signs of Prostate Cancer

Each year there are more than 30,000 prostate cancer deaths that could be prevented through prostate cancer screening, which helps to find prostate cancer early, before there are any symptoms. In fact, most prostate cancer does not have any symptoms at all. However, when prostate cancer is not caught early, often urinary changes are the first thing that men notice. While urinary problems can be a result of the normal aging process, it can also be a sign that something is wrong. For individuals with symptomatic prostate cancer, they may experience:

  • A painful or burning sensation during urination or ejaculation.
  • Frequent urination, especially getting up at night to go to the bathroom
  • Difficulty stopping or starting urination.
  • Slower flow of urine
  • Blood in urine or semen

As cancer advances people may also have:

  • Unexplained pain in the back or spine
  • Unexplained weight loss

Your role in prostate cancer screening

 The time to diagnose, treat and cure prostate cancer is through good screening versus waiting until symptoms arrive. Sometimes patients wait for their primary care doctor to guide them, however, due to some confusion in the frequency PSA testing guidelines, many primary care doctors are not familiar with the current recommendations, so you should be your own advocate and let your urologist be your guide.

A PSA test is a simple and inexpensive blood test that is used to detect prostate cancer. PSA testing works. Prior to regular PSA screening, in the mid 90’s, 75% of men who were found to have prostate cancer had metastatic disease. Meaning the cancer had spread outside of the prostate. Today, with regular PSA testing, urologists can find prostate cancer while it is localized to the prostate and when that happens, the cure rate is in the mid 90% range.

Urologists recommend a PSA screening at least every other year and for some at higher risk – every year. Men should think about starting PSA testing at age 55 and continue at least until they are 70, and even after 70, if healthy. Some higher risk individuals may need to start screening earlier.  For those individuals who have a primary relative who has been diagnosed with prostate cancer and those who are African American it is recommended that they begin screening in their 40’s.

Early diagnosis is important as finds cancer before it has spread, and that leaves more options for treatment. Men should know that like mammograms for women, prostate cancer screening is not something to fear and preventive care should be a top priority. If the cancer is caught early, many of the treatments available today are less invasive and have very few side-effects while still having high rates of curing cancer. Now, we even have non-invasive treatments like Cyberknife, which can treat and cure cancer in a matter of weeks, more advanced surgical techniques and many opportunities to mitigate unwanted side effects and still cure the cancer.  So don’t wait until you have symptoms – find a urologist and get on a schedule to be proactive and keep yourself in good health.

 

 

 

 

 

What Happens If Prostate Cancer Comes Back?

If prostate-specific antigen (PSA) levels remain high or become elevated after prostate cancer treatment, these are indications of a prostate recurrence. The approach for treating a prostate cancer recurrence varies based on a number of factors including the following.

  • The type(s) of previous cancer treatment(s) received by the patient.
  • The extent and location of the cancer recurrence.
  • The age of the patient and other existing medical conditions.

Patients treated with traditional surgical, radiation and chemotherapy treatments often require follow-up treatment. CyberKnife can be used in conjunction with traditional cancer therapies, as well as immunotherapy and proton therapy, to manage and reduce prostate cancer recurrences.

Prostate cancer recurrence is often emotionally deflating for patients who have already endured treatment and their loved ones. Fortunately, Anova Cancer Care’s CyberKnife radiotherapy treatment may be an appropriate therapy option for recurrent cancers, with fewer side effects and less down time.

Learn What to Expect from CyberKnife Treatment

How oncologists diagnose prostate cancer recurrence

After prostate cancer treatment, the amount of PSA in a patient’s blood typically drops and remains stable. Following treatment, many men receive regular medical checkups that include routine PSA testing. If PSA levels begin to rise, it can be a sign of a prostate cancer recurrence.

Additional testing may be required to determine if rising PSA levels indicate a recurrence or the spread of the cancer to other parts of the body. Doctors may use X-rays, bone scans or perform an Axumin PET scan, which uses calcium-related radioactive substances to locate cancerous cells throughout the body. Unlike standard methods of screening, which require PSA levels in the 10-50 range to detect cancer, Axumin can identify cancerous tissue in patients with PSA levels under 10.

Types of prostate cancer recurrence

The two major types of prostate cancer recurrence that can be treated using CyberKnife are local and distant. Prostate cancer recurrences in the tissue surrounding the prostate, such as in the seminal vesicles, pelvic floor muscles or rectum, are known as local recurrences. Cancer recurrence outside the pelvis is known as a distant recurrence or metastatic cancer recurrence, for example, if a tumor has developed within distant lymph nodes.

In some cases, an individual may experience heightened PSA levels with no other clear indication of a cancer recurrence. For example, there may be no visible instances of cancer in the patient’s imaging tests. Patients with slow growing prostate cancers such as this may opt for active surveillance over treatment.

Likelihood of prostate cancer recurrence

Upon a patient’s initial diagnoses, several factors can point to an increased risk of prostate cancer recurrence. These include the size of the tumor, the stage/grade of cancer and whether the cancer has affected any of the lymph nodes.

Patients who have been diagnosed with more advanced stages of prostate cancer and patients who have higher Gleason scores (or grades of prostate cancer) are more likely to experience a recurrence. Patients who have larger tumors, or whose lymph nodes have been affected by prostate cancer, are also more likely to experience a recurrence.

CyberKnife for prostate cancer recurrences

CyberKnife offers patients precise treatment of recurring cancer tumors, with minimal side effects. CyberKnife stereotactic treatment is noninvasive, requires fewer sessions than traditional radiation, is often more effective than traditional treatments, and is often more comfortable for the patient than treatment alternatives. Unlike common treatments for prostate cancer recurrence such as radical prostatectomy and cryotherapy, CyberKnife carries little risk of causing incontinence, erectile dysfunction or lower sex drive.

Recurrent prostate cancer patients with hard to reach or inoperable distant tumors, and patients looking to avoid the harsh side effects and complications of other treatment options, should discuss CyberKnife with their physician. It’s important that these patients discuss their full medical history and previous cancer treatment protocols with their care team to determine an appropriate treatment plan.

CyberKnife after radiation therapy

CyberKnife can be a safe and effective alternative for patients who have previously undergone traditional radiation therapies, as these patients are often not eligible to undergo radiation therapy again due to an increased risk of severe side effects.

Make an appointment with our office, or contact us with your questions.

 

 

How Does Marijuana Affect Male Fertility?

The use of cannabis is on the rise, as it has become legal for both medical and recreational use in several states across the country.This comes with its own unique challenges. One of those challenges is the negative effect that marijuana can have on male fertility.

 

There is a body of evidence today that supports this finding and studies now suggest that the impact is multi-factorial. The use of marijuana can lead to:

  • Reduced sperm count
  • Reduced sperm concentration
  • Changes in sperm motility and morphology
  • Hormone changes
  • Reduction in libido and sexual performance
  • Reduced sperm viability

Unfortunately, many of these effects can linger for weeks and even months after discontinuing the use of marijuana. Dr. Daniel Mazur at Urology Associates has been involved in researching and reporting the effects of marijuana use on male fertility. Let’s take a closer look at some of the things he and the team discovered.

For many years, studies have shown that sperm have cannabinoid receptors on them, which suggests that cannabis has the ability to disrupt sperm function.  Additionally, studies have shown a high correlation of men using marijuana who have reduced sperm counts and concentration. In fact, men who use marijuana more than once a week have nearly a 30% reduction in sperm count and sperm concentration, and this has been shown to last five to six weeks even after they stop using marijuana.

In studies across both the US and the UK, research shows that men who have used marijuana three months prior to giving a semen sample also have abnormal sperm shape, also known as morphology.  This is even the case in younger men – those who were 30 years old or less.  Use of cannabis at both therapeutic and recreational dosages also showed a reduction in sperm motility, the ability for sperm to move efficiently, as well as viability, how long the sperm live.

In addition to the changes in sperm quality, counts, and viability, marijuana also impacts the reproductive hormones, such as the luteinizing hormone (LH). This hormone plays an important role in fertility, especially through its role in regulating testosterone levels. Research has shown that the recent use has a more detrimental impact than the frequency of use when looking at testosterone levels in men.

Another effect of cannabis use is that men who have prolonged and consistent exposure can experience testicular atrophy, a condition where the testes diminish in size and can even lead to the loss of function. This is due to direct damage to the seminiferous tubules (the tubes where the sperm is produced). While this condition can often be reversible, it is a factor to consider when evaluating male fertility in those individuals who have a long history of frequent marijuana use.

Lastly, there is strong evidence that erectile dysfunction, known as ED, is also a side effect for men who use marijuana. Long considered an aphrodisiac in past cultures, research today actually shows that it has a negative impact on sexual performance. In fact, in one study 78% of men who reportedly experienced ED were frequent marijuana users vs only 3% who did not.  It is believed that cannabis induces ED by causing damage to the endothelial cells, those cells that live on the interior surface of the blood vessels and help to maintain an erection.

If you are thinking of having a family in the near future, it’s important to know the impact that marijuana use may have on fertility. If you are interested in talking to a doctor or getting tested, please contact the Center for Male Fertility and Reproductive Medicine at Urology Associates.  Our team works with the regional fertility experts and stands ready to help you.

Da Vinci Prostatectomy Allowed Mark to Get Back To His Athletic Lifestyle!

Mark tells his story of a prostatectomy and traveling the road to recovery with the team at Urology Associates


Senior man on his mountain bike outdoors after bladder cancer treatment | Urology Associates | Denver, CO

I want to give shout out to Urology Associates on the great care I received on my recent Prostate Cancer diagnosis and treatment.

Here is my story and a bit of background about myself for context – I am 61 years old, and retired in 2018.  I am very active. I road cycle year round ~5000 miles a year with ~400,000 ft of climbing and do 2-3 weight and stretching workouts a week to maintain my core strength and flexibility.  Also, I am a hiker, back country skier and peak bagger. I have a replaced left hip (2017); right rotator cuff repair (2017 – cycling accident), scoliosis and L4 nerve compression (steroid injection treatment in 2017), AFIB (only one incident – cardioversion after a century ride in 2017), and a left ACL repair (1996). I am 5’ 8’’ and weigh 150 lbs.

My PSA score had risen from 2.5 to 5.0 over 24 months, so at the suggestion of my primary care doctor (Thank you Celinde Strohl!) I got a prostate biopsy. Biopsy  (12 samples) showed >50% cancer (Gleason 3+4) in all 6 samples on the left side, and >20% cancer (Gleason 4+3) in 1 sample in the center on the right side. Left side was a tumor, and its increasing size was creating some issues with urinating, both frequency and flow rate.

My wife and I had a consultation with Dr. Cowan after he did the biopsy. Dr. Cowan did a great job of laying out the treatment options, explaining the pros and cons, and patiently answering all of our questions. We felt no pressure to pick a specific treatment (surgery or radiation), and were encouraged to do some research and meet with both radiation specialists and surgeons. After that meeting, and some follow-up research (my wife and I are both scientists by training), we felt educated, informed, and empowered enough to make our own decision about the best treatment option

Choosing Da Vinci Surgery with Dr Eigner

My advice – do your homework on the treatment; take advantage of the information and consultations that are offered by Urology Associates, certainly not one size fits all. In my decision, the downside of radiation was the combined hormone therapy. I need the Testosterone for muscle recovery, and core strength / back health, based on a bad experience with induced testosterone deficiency while using Diclofenac (anti-inflammatory) for back issues.  After a very honest and informative discussion with Dr. Eigner (surgeon), we landed on the Da Vinci robot assisted laparoscopic surgery at Sky Ridge with Dr. Eigner and his team. Sky Ridge is a Center of Excellence for this type of surgery, which his what is recommended by the Prostate Cancer Foundation.

Very happy with the surgery and the result. Nerves on the right side were spared, cancer had escaped the prostate capsule on the left side, so Dr. Eigner removed those nerves. No cancer in surrounding lymph nodes or other tissue outside the prostate based on pathology. I just had my post-surgery (9 week) high resolution PSA test and it is down to 0.014 (very low score), which means that I don’t need any more treatment at this time, but will need periodic testing to ensure the cancer is not spreading.

If you have had surgery, you know that a lot of your treatment, pre-operative, and post-operative care is not only tied to your surgeon but to the larger medical team, both in the hospital and in the specialty practice. I continue to be very impressed with the PAs, nurses and staff at Urology Associates, and particularly Dr. Eigner’s team. My care at Sky Ridge was excellent. Liz Kelly answered my questions and gave me some good advice and tips prior to my discharge. Anna Willis has been a great advisor and coach in my overall recovery, and is very responsive to my questions, concerns, and suggestions.

My recovery has gone very well, and at 8 weeks, I am back to doing everything I was doing pre-surgery, including bike riding, weight lifting, and core exercises (though February weather has not been very outdoor cycling friendly). I am house cleaning with my wife again (no excuses), and gearing up for some spring home improvement projects!

Also, often after surgery, you never really see the surgery or specialty practice again. I can tell that Urology Associates is in it with me for the long haul on my recovery. From the start, it has felt like real partnership with a reciprocal commitment to my treatment. They are very honest and open about the ED issues that take awhile to work through after prostate surgery (nerve related) and have a treatment plan in place to help me monitor and improve this in my long-term recovery. They are surprisingly easy to talk to about post-operative ED and treatment options.

Weighing the Positives and Negatives of Surgery

Again encourage you to talk to the folks at Urology Associates and let them help you figure out the best cancer treatment option for you!

Pluses

  • Surgery seems to have gotten rid of the cancer, and unless there is some change in my PSA going forward, my treatment is done!
  • Surgery was minimally invasive, fast recovery with minimal side effects. Stopped wearing pads after 4 weeks (incontinence ended – except for stress events)
  • Was able to stay active and see real progress in recovery. Could exercise (walk) immediately, do pelvic floor / core rehab exercises after 2 weeks, do 50% effort weights, core and cardio workouts after 4 weeks, and bike riding (30 miles – 2 hours) after 6 weeks. After 8 weeks back to full effort on core, strength and cardio, and relatively normal bike riding (can’t be  100% sure due to winter weather restrictions).
  • Urination post surgery is amazing, I can empty my full bladder in <20 seconds, which prior to surgery was often a 2 minute long dribble fest.
  • I did not have to do the hormone therapy (associated with radiation) which based on my previous experience with drugs that suppressed my testosterone was not good for me with respect to building and maintaining strength in my back and cardiovascular fitness.
  • Most surprising, I can still have an orgasm (yes, I AM going to talk about this), even though I cannot yet have an erection. I spoke with Anna about this and did some reading and ejaculation, erection, and orgasm, while related are actually independent. Obviously, also requires a partner willing to try some different approaches to sexual intimacy. Reminding yourself and your partner that you were not killed by cancer sort of puts things in the right perspective!

Minuses

  • Surgery is well, surgery. You have to spend time in the hospital, you have to get general anesthesia and be intubated. There are risks of complications like bleeding and infections. You have to have a catheter for 10 days, and put up with the exercise restrictions, incontinence, and erectile dysfunction, which is a longer-term effect; however, considering the complexity of this surgery and all the detailed “re-plumbing and re-wiring” that gets done, the recovery is amazingly fast, and in my case, the results are outstanding!

Could not be happier with the quality of care I am receiving from Urology Associates!

 

– Mark S.