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His Successful Prostatectomy Proves All Urologists Are Not Equal

Our patient wrote this story about his life-changing treatment for BPH and elevated PSA with us, after he lost confidence in his previous urologist.

Let me begin by saying that I had suffered with an enlarged prostate for about 20 years.

I was referred in 2012 to a urology practice by my primary care physician. After examining me, the urologist suggested that I have a prostate biopsy, which I refused. I was then prescribed medication to help with frequent urination and was advised to monitor any changes in PSA (prostate-specific antigen) levels along the way. This mode of treatment continued for a number of years with moderate relief.

Doctor getting ready for a prostatectomy | Urology Associates | Denver, CO

Eventually I wound up seeing the surgeon at that practice in February 2017 for a consult.

I was given his opinion, which was to have a robotic assisted laparoscopic simple adenomectomy (nodule removal) of the prostate for large volume BPH (benign prostatic hyperplasia).

I remember afterwards saying to my wife that there was no way that I would elect to have the surgery described, due to a lack of confidence in the surgeon.

The surgeon stated the most significant benefit I would likely experience after the surgery would be somewhat lessened overall frequency of urination and fewer sleep interruptions.

Potential benefit as explained to me did not outweigh invasive surgical risk in my mind.

I said, at the time, that the procedure described would have to be on an emergency basis.

Fast forward to the ER

Well, fast forward to July of 2018. I went to the bathroom one night and was unable to urinate, wound up in the emergency room of my local hospital and was consequently catheterized. This was not good. I asked the doctor in charge if he had a recommendation for a urologist. He referred me to Dr. Brad Bell at Urology Associates, and I made an appointment with Dr. Horne, who is one of the founders of the practice.

I must say that from the initial visit with Dr. Horne I was very impressed. His bedside manner was excellent and the way he explained my options for fixing the problem, which was a simple prostetectomy, was clear and concise. [A prostatectomy is partial or complete removal of the prostate.] When he was done with the exam and subsequent explanation, I felt so confident that I wanted the surgery as soon as possible.

I was scheduled for a follow-up appointment with Dr. Bell and Jakob his physician assistant. I again was impressed with the way I was treated from the front desk to the consultation with Jakob. Dr. Bell was in surgery that day.

Put at ease before prostatectomy surgery

The initial surgery date of September 13 was cancelled due to a urinary tract infection. After taking medication to treat the infection, a surgery date was set for October 24.

I met Dr. Bell for the first time a few days before the surgery and was made to feel at ease and confident that all would be okay. And indeed it was.

Dr. Horne assisted with the procedure.

It is now January 2019 as I write this and my recovery, I am told, was faster than expected.

My overall experience at Urology Associates was excellent and one of the best decisions I have ever made. If I had to do it again, I would in a heartbeat.

Dr. Bell is an excellent surgeon, he genuinely cares for his patients and it shows. Jakob, his right-hand man, is integral to the functioning of the unit. I am so glad to have had the opportunity to meet and benefit from his care. Overall I could not have had a better experience under such dire circumstances.

I am now free from having to map out where bathrooms are prior to leaving my home.

I no longer get up every two hours during the night to pee.

I no longer take prescribed medication for overactive bladder.

I no longer worry about where I am seated in a crowded room or theatre.

Thanks again for all that you do at Urology Associates.

– Clifton B.

Protect Your Male Athletes from Genital Injuries & Testicular Pain

When should a boy or young man wear an athletic cup? Always when playing a sport that could cause a genital injury & testicular pain.

Football playing suffering from testicular pain | Urology Associates | DenverWe all have experienced a time when a boy or man was injured in the genital area during a sporting event and we hear the crowd gasp. This is because most men know how much pain it can cause. Even women have an idea from movies, TV shows and conversations with men in their life–and from the afflicted athlete holding the area and obviously suffering.

But it can trigger more than testicular pain, it can also cause a significant genital injury. This can include internal bleeding, severe bruises, fracture of a testicle and more. The most serious injuries are testicular rupture, when the testicle smashes against the pubic bone and bleeds internally, and testicular torsion, which cuts off the flow of blood and requires immediate medical care.

A new school year has begun and that means the start of football, soccer and wrestling, three sports that can cause genital injuries and testicular pain. But it is not just fall sports; lacrosse and baseball also account for a high number of testicular injuries. In fact, it may come as a surprise that the sports in order of the highest to lowest rate of testicular injury are lacrosse, wrestling, baseball and football.

While sports-related genital injuries are not very common, they can cause more than testicular pain including some significant injuries, especially if not treated. The ideal situation is to avoid testicular injuries to begin with. Genital injuries are seen in higher numbers in those who play a contact sport without the proper protective gear.

A Geisinger Health System 2016 study published in the Journal of Urology found that only 12.9 percent of athletes wore an athletic cup. That same study showed that 18 percent of athletes have experienced a testicular injury. There are more reported injuries than those who are trying to protect themselves. I am here to try to educate male athletes and their parents of the importance of the right protection and what can result from that genital injury.

Finding the right athletic cup to avoid possible testicular pain

An athletic cup should be worn if a male is involved with any kind of activity that can cause a groin injury, regardless of his age. The cup is made of metal or plastic and has padding on the inside. A cup should be worn as soon as a young athlete’s testicles and penis are big enough to fit in one. The cup might have holes in it for airflow.

Boys and men usually wear an athletic supporter, or jockstrap, to hold the cup in place. This will keep the testicles stationary and close to the body. Younger boys can order a smaller size cup than what stores might usually stock, and they can wear briefs instead of boxers to have a tighter fit.

In addition to holding a cup in place, wearing a jockstrap or compression shorts can help keep the testicles pressed against the body. While they are not as protective as a cup, they are better than no support for use in contact sports. They can also be used to prevent jostling around of the testicles in sports like running, basketball and skating. For contact sports, I always recommend taking the extra step of the full security of a cup.

Over the years, manufacturers of genital cups have made many improvements, and now there are many options that are cushioned making a cup more comfortable to wear. Many athletes don’t wear a protective cup because it is uncomfortable or because they feel it restricts their movement. But that’s not a good reason to refuse sensible protection.

Types of genital injuries in sports and treatments

Testicular injuries can be very serious and in worse case scenarios can result in the loss of a testicle if not treated correctly. The types of genital injuries that can occur in sports include:

  • Epididymitis – causing the epididymis, the tube that holds the sperm after leaving the testicles, to become inflamed or infected.
  • Hematoma – a blood clot that can cause bruising on the surface or within the testicle.
  • Scrotal or testicular contusion – injury in the blood vessels that causes internal bleeding in the respective area.
  • Testicular rupture – blood and other contents leak into the scrotum from the testicles after contact causes one or both to smash against the pubic bone.
  • Dislocation – pushing the testicle out of the scrotum.
  • Degloving – The scrotum is torn away.
  • Testicular torsion – at least one testicle gets twisted inside the scrotum, cutting off the flow of blood. This requires emergency treatment.

Treating testicular trauma

At home treatments for testicular trauma include icing the scrotum, resting, over-the-counter pain medication, and wearing supportive underwear. Surgery is needed at times especially in testicular torsion and dislocation cases.

But if your son experiences any of the following symptoms, it is time to visit a urologist:

  • Bruising.
  • Swelling.
  • Nausea.
  • Blood in the urine.
  • Fever.
  • Trouble urinating.

Some problems can cause serious complications. Seeing your doctor promptly can reduce the chances of serious complications. Some complications include the need for the testicle to be removed, the testicle shrinking or infertility.

Our urologists can handle these issues without referring to another provider if advance treatments are necessary.

Make an Appointment Now

Dr. Mazur Talked With Elite Daily About UTIs in Men After Sex

UTIs in men | Elite Daily | Urology AssociatedDr. Mazur explains to the readers of Elite Daily how urinary tract infections (UTIs) in men and women can develop. He answers the question: are UTIs in men something to be concerned about transmitting or contracting from sexual contact?

“Most UTIs occur from pathogenic bacteria entering the urethra and making their way to the bladder,” says Dr. Daniel Mazur. “Men have a significantly longer urethra, which may make it harder for bacteria to enter the bladder.”

Dr. Mazur went onto explain that a man can develop a UTI from having sex, but are much less likely to do so than women.

Read the Full Story: Male UTIs

Urology Associates Welcomes Dr. Daniel Mazur

Mazur brings a unique expertise to Colorado with a focus on men’s sexual health and male infertility.

Dr. Daniel Mazur | Urology Associates | Denver Metro
Dr. Daniel Mazur joins Urology Associates.

(DENVER) August, 6, 2018­­— Urology Associates, a Denver-based general and surgical urology practice, is pleased to welcome Daniel Mazur, M.D., as the newest member of the growing practice.

“Men’s sexual health is often an overlooked condition that can and should be addressed. It can lead to low self-esteem, anxiety and relationship problems,” said Mazur.  “I decided to specialize in men’s sexual health and infertility to help men and their families.”

Dr. Mazur will focus on male infertility and sexual health but will also be available for general urological services. He can treat male infertility when the cause is a varicocele or blockage, and can perform a vasectomy reversal, surgically repair blockages, retrieve sperm, or provide hormonal treatments to increase sperm count or sexual function.

“We are so excited to expand our male sexual health services with Dr. Mazur’s expertise,” said Stanley Galansky, M.D., founding partner of Urology Associates. “He will be a great resource for the men in our community.”

Dr. Mazur completed his medical degree and residency at Northwestern University Feinberg School of Medicine. He completed his fellowship in male reproductive medicine and surgery at Baylor College of Medicine with one of the world’s experts in male infertility, vasectomy reversal, erectile dysfunction and testosterone therapy.

About Urology Associates

Urology Associates has provided general and surgical urology services for children, women and men in the Denver metro area for nearly four decades. Doctors and staff at the Lone Tree, Englewood and Littleton locations work as a team to provide personal, family-centered care, with providers devoted to getting patients back to health and their lifestyles. For more information, visit the Urology Associates website.

Six Overactive Bladder Treatment Options When Oral Medication Is Not Working

Unfortunately, there is not a one-treatment-fixes-all answer to overactive bladder, but there are multiple options, some you can do, some we can do.

Woman looking at the ocean considering her treatment options for overactive bladder
Overactive bladder (OAB) affects 33 million Americans, but this number could be much larger because many people living with OAB do not ask for help. OAB is a problem with bladder function that causes the sudden need to urinate and can lead to the involuntary loss of urine.

It can affect both men and women but is more common in women, with about 40 percent of women affected by it at some time. These symptoms do not need to upset anyone’s life.

Oral medication is a common treatment for overactive bladder. These include oxybutynin (brand names Ditropan, Ditropan XL or Urotrol), tolterodine (Detrol) and fesoterodine (Toviaz). But most people do not stick with the pills long term. Around 75 percent of patients who start these prescription medications stop taking them within a year.

Some patients mention they stop taking the pills because they feel the medication is ineffective or has bad side effects, including dry eyes, dry mouth and constipation.

Overactive bladder medication is only one treatment option for the suffering. If medication is not working for you, come talk with one of the doctors at Urology Associates. We have many other options for you to explore, listed below.

When a patient is showing signs of overactive bladder, we start with an initial evaluation where one of our doctors will ask about urgency, frequency and retention as well as rule out infections, diabetes, prolapse and obstruction. Then we will discuss many lifestyle changes mentioned below, focusing on physical therapy.

If the patient has not seen an improvement with physical therapy or medication, we will perform a urodynamic studies to see how well the bladder, urethra and sphincter hold and release urine. These tests will give us a clearer picture to determine the best treatment option.

We have solutions: Patients should see noticeable symptoms improvement (50 percent or better) in a period of 1-3 months without significant side effects. We provide a range of treatment options to find the best option for each of our patients.

Learn What We Can Do for You. Make an Appointment Today.

Lifestyle changes

Lifestyle changes, also known as behavioral therapy, are often the first step when looking to manage overactive bladder. If you did not try any lifestyle changes before you started taking medication, they could be good options. Lifestyle changes can include the following.

  • Limiting drinks and food that irritate your bladder.
  • Maintaining a healthy weight.
  • Trying to empty your bladder twice each time you go to the bathroom, by taking a 30-second break and trying again.
  • Delaying going to the bathroom and training your bladder to be able to wait longer between trips to the toilet.
  • Scheduling when you will use the restroom.
  • Don’t forget to do your Kegels, which will build up the bladder muscles.
  • Pelvic floor physical therapy is also an early option to strengthen the muscles.
  • Practicing quick flicks when you need to go to the bathroom. These are quick squeezes that contract and relax the muscles in your bladder, sending a message to the nervous system to stop squeezing the bladder muscles.


Only an option for women, a vaginal pessary is a small, removable device that is inserted into the vagina to reduce OAB symptoms caused by bladder prolapse.

There are many different shapes and sizes; a doctor can go over the differences to find the pessary that best fits each patient’s lifestyle. If fitted correctly, the woman will not feel when the pessary is in place.

Botox for your bladder

Another possible treatment option for OAB is injections of Botox into the bladder muscle. Similar to when Botox is used to smooth wrinkles, when injected into the bladder it reduces the frequency of the muscle contracting. This treatment needs to be repeated two or three times a year, depending on when a patient notices that the effects are wearing off.

Stimulating nerves

Stimulating the bladder nerves, or neuromodulation therapy, delivers electrical pulses to the nerves to change how they work. There are two types of nerve stimulation treatments, InterStim and percutaneous tibial nerve stimulation.

Both treatment options target the sacral nerve located at the bottom of the spine that regulates and controls the pelvic floor and bladder muscles.

InterStim Therapy

InterStim Therapy uses an implantable device to send mild electrical pulses to the sacral nerve. The device is controlled with a separate handheld control. Prior to implantation of the device, we have a trial period to confirm the nerve stimulation works for the patient.

After that 1-3 week trial period and if there is an improvement, an in-office procedure will be completed to permanently implant the device in the upper part of the buttock. I like to call this device the pacemaker for your bladder.

Percutaneous tibial nerve stimulation

Percutaneous tibial nerve stimulation (PTNS) is a nonsurgical treatment that is completed with multiple office visits. PTNS provides an electrical stimulation through the tibial nerve, located on the inner ankle, which passes to the sacral nerve.

The therapy consists of 12 treatments administered once a week. After the initial 12-week treatment session, there may need to be occasional treatments to maintain the muscle control. It can take a month or more of the 30-minute treatments before a patient will see initial improvements.


Surgery to treat OAB is only for those who have tried other alternative treatments without seeing an improvement. If surgery is needed, the goal is to reduce the pressure on the bladder and improve the bladder’s ability to store urine.

Discuss Treatment Options

New Findings in the PSA Debate Support the Test

Three new studies support the use of PSA testing for prostate cancer, putting to rest the idea that the test does not save lives.

PSA test debate | Urology Associates | Denver | Man fishing

I want to make sure that all men know about new reports that contradict previous studies about the use of the prostate-specific antigen (PSA) tests for prostate cancer. Two were presented in March 2018 at the European Association of Urologists Congress and one was released in September 2017 by the Annals of Internal Medicine.

That earlier report of September 2017 found that men between 55 and 70 benefit from getting the PSA test, which can result in a longer life. The two March 2018 reports by researchers at the University of California, Irvine found an increase in more serious prostate cancer cases since the 2012 recommendation by the U.S. Preventive Services Task Force (USPSTF) that men between the ages of 55 to 69 not be screened for PSA unless they were at elevated risk for prostate cancer.

The September 2017 study, which was completed by Dr. Alexender Tsodikov and his colleagues, reviewed data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial. These trials have been reviewed in the past, but this analysis found important differences in the studies. Once they accounted for the dissimilarities, a conclusion was made that PSA testing can lower a man’s risk of prostate cancer death by 25 to 32 percent.

In one of the CU, Irvine studies, Dr. Thomas Ahlering and colleagues analyzed 19,602 men at nine high-volume referral centers in the United States. They compared prostate cancer patients with a Gleason grade 8 or higher and who had seminal vesicle and lymph node involvement before the 2012 USPSTF recommendations were issued with such patients after the recommendations were issued. They noted a 22.6 percent decrease in surgical volume after the recommendations, as well as an increase in median PSA level from 5. ng/mL prior to the recommendations to a median of 5.8 ng/mL after the USPSTF non-screening recommendations.

“Treating high-risk disease has its limitations, because you are not going to cure the majority of patients no matter what you do, so the better answer is to diagnose prostate cancer earlier,” Ahlering told Medscape Medical News. “If our data are correct, the most important thing to do is to start screening more intensely again.”

A related UC, Irvine study by Linda Huynh analyzed data from 1,380,219 men who had undergone radical prostatectomy in one of three time periods assessed, two before and one after the USPSTF 2012 recommendation to reduce screening. The study found that after the 2012 recommendations, the risk in absolute numbers of high-risk prostate tumors with Gleason scores of 8-10 increased in stepwise fashion, while each year saw more cases of high-grade disease.

These studies are welcome news for all of us at Urology Associates, because we have been unflagging champions of PSA testing throughout a long period of controversy.

The history of PSA testing

Doctors have been suggesting men be tested annually for prostate cancer with the use of the PSA test since the 1980s. Testing for prostate cancer is complicated since the tumor tends to grow slowly. Because of this, testing is much different than for diseases like breast cancer where you can easily find the tumor. The PSA blood test has been found the most effective way to detect early signs of prostate cancer.

Once a PSA test is complete, a biopsy might be needed to confirm the findings of the blood test. While this is a comparatively safe procedure, it still carries possible complications like infection. Due to the possible complications and because for most men prostate cancer is not fatal, some doctors in the United States started to view the PSA test as unnecessary.

In 2012, the U.S. Preventive Services Task Force (USPSTF) announced its recommendation that men between the ages of 55 and 69 not get a PSA test unless they have a family history of the disease or are at heightened risk of prostate cancer.

The task force made its conclusions based on two studies published in 2009 from the PLCO in the U.S. and the ERSPC. The U.S. study did not find a difference in deaths caused by prostate cancer in men who were screened with a PSA and those who were not. The European study discovered that PSA tests led to a 21 percent lower risk of prostate cancer being the cause of death during the study compared with those who did not get screened.

Given the uncertainty with these two studies, one finding a reduction in deaths and one seeing no change, the USPSTF stated the data was not convincing enough to recommend men receive a PSA test.

New review, new findings

In Dr. Tsodikov’s September 2017 study, a new team looked at the same data from the PLCO and ERSPC and found that PSA testing does, in fact, reduce the deaths from prostate cancer. Their findings were different from the previous analysis because they found the studies had major differences that made comparing the two like comparing apples and oranges. Once you set up parameters to account for the differences, it was clear that getting a PSA test was the correct recommendation for men between 55 and 70.

When looking at the two studies, you could find that the doctors in the U.S. trial were using a greater threshold for PSA levels for completing a biopsy compared with the European trial. This could have led to men in Europe getting treated sooner, which one could tie to a reduction in prostate-related deaths.

Another jarring difference was that the PLCO study was screening men every year, while the men in the ERSPC were only screened every two to four years.

A final major difference to point out is that prior to the U.S. study, PSA screenings were seen as the norm and many of the men in the control group had a PSA test at least once before. This caused the nontested group to be an inaccurate group to compare the data against.

Taking these differences into consideration, the September 2017 study found that men who get the test can see a 20 to 32 percent decrease in prostate cancer deaths compared with men who are not screened. The two more recent UC, Irvine studies corroborate the earlier one and add more detail and import to the argument for more, not less, PSA screening.

In 2017 the USPSTF updated its recommendations for men to make an individual decision on getting the test. Since these studies have been released the USPSTF has not revised their guidelines for screening for prostate cancer, but I feel that the change will be coming soon.

In the meantime, hopefully these latest studies give men the clarity and confidence needed to ask for a PSA test annually. We are more than happy to oblige.

The Guys Guide to Male Incontinence

Leaking urine isn’t a female-only problem, as millions of American men know, though they are likely not forthright in talking about it with their buddies, or their urologist.

male incontinence | Urology Associates | Denver Metro | senior father and adult son fishingI frequently see men with incontinence or bladder control problems who are not aware of the many options to stop the plumbing problems keeping them from the activities they love. Colorado is an active state, and I would like to keep men hiking, biking, fishing, playing with kids or grandkids, camping, throwing around the football or whatever activity they like best. I am here to share some options for male incontinence so you can get back to your favorite activity.

According to the Urology Care Foundation, women are about three times more likely than men to experience urinary incontinence, but about 25 percent of men have it, too. Understanding the problem and taking steps to relieve it, either on one’s own or with my urologic care, can help men overcome this bothersome obstacle that often carries emotional worries as well.

For instance, the psychological aspect can affect social life, preventing men from pursuing their normal activities. They might pass on going fishing or playing golf because they know they can’t be that far away from a bathroom for that long. Not many men want to go to a Rockies game with their friends if they know they might have to make a run (literally) for the bathroom when the bases are loaded with two outs.

Have a bladder control problem? We can help, if you’ll just make an appointment

Men can experience three general kinds of urinary incontinence.

Overflow incontinence is dribbling urine regularly. This is due to the bladder not emptying all the way when urinating.

Stress urinary incontinence (SUI) is when a cough, sneeze, lifting a heavy object or other activity causes the man to leak urine.

Overactive bladder (OAB) is the sudden, often strong urge to urinate. In this case, men can leak urine before making it to the bathroom in time.

Men may also experience OAB and SUI together. In addition, a man can have total incontinence, which means he leaks urine all the time due to failure of the sphincter muscle.

These kinds of issues can often be efficiently addressed. And most men’s urinary incontinence can be reduced significantly or cured altogether.

Interestingly, men are quicker than women to seek care once they start having bladder control problems. On average, women wait 6.5 years before seeing a healthcare provider; men wait 4.2 years. Perhaps women are much more used to hearing about or experiencing leakages, which causes them to wait longer to go to the doctor. I wish both would seek help sooner, but it is, of course, a touchy subject for anyone.

The mechanics of male incontinence

Each type of bladder control issue is caused by different factors. Bladder control problems can be short-term or long-term. Most cases of short-term male incontinence result from a specific health issue or recent treatment. For example, taking certain medications, such as those for colds, depression, sedatives, narcotics and diuretics, can cause short-term bladder control problems.

Chronic male incontinence is a long-term condition, and thus of greater concern to the man who has it and to his urologist as well. ­Chronic male incontinence issues are often related to prostate problems or treatments for them.

A lot of men I see think urinary incontinence is another of those things that always happens with age. While it is more prevalent at older ages – and more than 10 percent of men over 65 have bladder control problems – it is not a normal condition.

Let’s address why each type of chronic bladder control issue is likely to occur.

Cause of overflow incontinence. Two things can happen: you make more urine than the bladder can hold or the bladder can’t empty when it is full. Maybe the bladder muscle can’t contract as it should to squeeze the bladder, or there could be something blocking the flow. The result is urine dribbling (a constant drip) or only urinating a small amount, but having to do so frequently. An enlarged prostate gland or benign prostate hyperplasia (BPH) can cause overflow, as can a urethra that is too narrow.

Cause of SUI. This happens when the pelvic floor muscles have been stretched, causing them to weaken. That results in reduced support for the lower part of the bladder, leaving all the work of retaining urine in the bladder to the sphincter muscle. And when physical activity (or a sneeze or cough) pressures the bladder, urine leaks out. SUI is more common in women, but that does not put men in the clear. Heavy lifting can increase the chance for SUI, which is an activity many men participate in whether for their job or while working out.

Cause of OAB. The brain signals your bladder to empty, even though it may not be full, and the bladder muscles contract, squeezing out urine. This can also be caused by malfunctioning bladder muscles that contract on their own, squeezing out urine when the bladder isn’t full. These both result in a sudden, often strong need to urinate. One of the more common causes of male OAB symptoms is the prostate getting larger. This can be caused by aging or prostate cancer.

What can we do about it?

First off, go see a urologist. I’ll do a physical exam, talk to you about your symptoms and how long they’ve been going on, and run a test on your urine. If these don’t give us a solid diagnosis of the problem, we may do other tests.

How we treat male incontinence is based on what we find out as the cause, and also on how much the control problems are affecting your life. At Urology Associates, we generally like to start with what you can do on your own and go from there.

If lifestyle changes (listed below) don’t solve your problems, we may move to medications. Some cases may require surgery, but not that many do.

Deciding factors on pursuing surgery include severity of symptoms, recurring blood in the urine, recurring urinary tract infections and the need to remove blockages that may harm kidney functions. Sometimes surgery has to be done to correct ongoing incontinence after the prostate gland has been previously removed. We can perform the following surgical procedures for male incontinence.

  • Nerve stimulation for OAB. Also called neuromodulation therapy, this involves implanting a small device under the skin near the tailbone that sends electrical impulses to the nerves going to the bladder. It acts like a heart pacemaker by controlling bladder contractions. Other neuromodulation therapies may also help.
  • Sling surgery for severe urinary incontinence. A bulbourethal sling goes under the bulb part of the urethra and is secured to bone or muscle. This lifts up and compresses the urethra, helping it resist pressure from the abdomen.
  • Urethral bulking. To prevent urine leakage, we close a hole in the urethra or thicken its wall by adding material to it.
  • Adding an artificial sphincter. This is an inflatable silicone device we place around the urethra that acts like the sphincter muscle.

In persistent cases of male incontinence in which treatment options above aren’t sufficient or desired, you may need to consider wearable absorbent products. Another management option is surgical insertion of an indwelling catheter that drains urine into a holding bag.

What you can do about it

Hopefully, your bladder control issue can be taken care of primarily by your own actions. Here are things you can do.

  • To strengthen your pelvic floor muscles, do exercises like Kegels, the ones women do that are essentially tightening your muscles like you’re trying to hold back urine.
  • Maintain a healthy weight, as carrying too many pounds means more pressure on the bladder.
  • Reduce caffeine consumption because it’s a diuretic that increases urination.
  • Don’t have more than one alcoholic drink a day.
  • Also limit carbonated beverages.
  • Avoid constipation, which adds stress to the bladder, by eating a high-fiber diet.
  • Don’t smoke (you’d be surprised at all the urologic trouble smoking can cause).
  • Practice the double void: urinate as much as you can, relax, urinate again.
  • Try to modify your bladder’s behavior by scheduling bathroom trips at set times during the day.

Those tips on lifestyle can often be very effective. If they don’t work, you really should see me or another urologist – at Urology Associates, of course.

Do yourself a favor. Don’t be the average guy with male incontinence and wait 4.2 years to make an appointment. Start taking control of that bladder today.

Talking Prostate Cancer Awareness with the Senior Advisor

prostate cancer awareness | Urology Associates | Denver | logoProstate cancer is the third most common type of cancer, affecting over 3 million men in the United States – most of them seniors. Over 90 percent of all cases are diagnosed in men over the age of 55. If you’re an aging man, prostate cancer is something you should be on the lookout for.

Dr. Austin DeRosa spoke with Senior Advisor on what seniors, and all men, should know about prostate cancer and how to keep control in a situation that can make men feel powerless.

“Most forms of prostate cancer are treatable and curable. We have many different ways of preventing prostate cancer from affecting your overall survival, but this requires PSA screening and an active ongoing relationship with a urologist,” said Dr. DeRosa.

Read the article to get all the facts

Tios to Prevent and Treat UTI’s

The first line of defense against these troubling and pervasive bacterial infections is you, then your primary care doctor, then a urologic specialist like me.

I understand how alarming it can be when the first symptoms of a urinary tract infection (UTI) appear. The frequent and painful urge to urinate, an achy abdomen, pain during urination and an unsightly color in the toilet bowl can be petrifying. It may even have you cringing as the phrase “Not again,” crosses your lips.

We’ve prepared some tips to help prevent UTIs. I’ll also share treatment options and insight into when to see your primary care doctor, and when to see me for a UTI. Some basics first.

Urinary tract infections occur when bacteria enter the urinary tract, typically through the urethra, the passage where urine is released from the body. After entering the urethra, troublesome bacteria begin to multiply and spread through the system that processes and removes urine from the body. These bacterial infections often occur within the lower urinary tract – the bladder and urethra. If left untreated in its early stages, the infection can spread to the ureters and kidneys.

A majority of UTIs are caused by E.coli (Escherichia coli), a type of bacteria commonly found in the digestive system, which breaks down and absorbs nutrients from your food and also expels solid waste from the body. Other bacterium like Klebsiella, Proteus mirabilis and Staphylococcus saprophyticus are also common culprits. The type of bacterial infection will influence how a doctor treats your UTI.

UTI’s account for more than 8.1 million healthcare visits in the United States each year. Despite how common they are, most UTIs do not require care and treatment from a urologist. Understanding how to prevent a UTI, their symptoms, what symptom severity means, and potential treatment options can help you make the right move in caring for it.

Where do you stand when it comes to UTI risk?

It’s normal for a woman to experience one or two urinary tract infections each year. Due to their anatomy, women are much more likely to develop a UTI than men. Women have shorter urethras than men, and a woman’s rectum is much closer to the urethra than a man’s, leaving a much shorter distance for E. coli bacteria from the digestive tract to travel. Additional risk factors for UTIs in women include:

  • Sexual activity, new sexual partners
  • Certain types of birth control such as diaphragms
  • Diabetes or other diseases that suppress the immune system
  • Urinary tract abnormalities or blockages (kidney stones)
  • Catheters
  • Being postmenopausal.

Urinary tract infections don’t always cause symptoms, or the symptoms may be so minor you might not notice them. The most common symptoms of UTIs are:

  • Strong urge to urinate
  • Frequently passing small amounts of urine
  • Painful, burning sensation while urinating
  • Pain in the lower abdomen or pelvis
  • Urine that is cloudy, dark or bloody (may appear slightly pink or brown in color)
  • Urine with a strong odor.

Once a urinary tract infection has spread to the kidneys it can cause irreversible damage. Go to an urgent care facility or emergency room if you have a UTI and are experiencing nausea, vomiting, fever and chills, or pain in your lower back or ribs.

Diagnosis and treatment

Urinary tract infections can typically be diagnosed in a short office visit involving urine analysis or culture to identify signs of infection. Doctors typically prescribe antibiotics to treat UTIs. The type and duration of treatment depends on the severity of the infection and where it has occurred in the urinary tract. Medication has to be taken for at least two to three days, but treatment can last as long as several weeks.

There’s power in prevention

There are some steps you can take to avoid the pain and discomfort a UTI can present. Since urinary tract infections occur when bacteria enter the urinary tract, common sense says that the best way to avoid that is to prevent bacteria from entering the urinary tract, multiplying and spreading infection. You can do this by maintaining proper hygiene and making certain lifestyle and habit changes.

Drink more water

Many health professionals recommend drinking at least eight cups of water daily. Water is always a good idea. A recent study shows that increased water intake in women who only drink about six cups of water daily can prevent the occurrence of UTIs and reduce the need for antibiotics. Drinking more water dilutes urine, which decreases the concentration of bacteria and increases the frequency of urination, helping to flush your urinary system of bacteria.

Go cranberry crazy … or not

The efficacy of cranberry products in preventing and treating urinary tract infections has been researched very l, and the results are mixed. Some researchers believe the antioxidants in cranberries make it harder for bacteria to grow within the body, others believe that the increased fluid intake from cranberry juices works similarly to the flushing properties of water. As long as you are not allergic or taking blood thinning medications, consuming cranberries and cranberry products hasn’t proven to do any harm. If consuming 100% cranberry juice helps you to feel better, enjoy your cranberry juice.

Give probiotics a go

Not all bacteria are bad. Though research in the area is still evolving, we do know that naturally occurring bacteria can help the body fight infection. Probiotics, which occur naturally in the body, notably in the digestive tract, have been shown to help prevent UTIs. Probiotic supplements are readily available, and you can also get probiotics by drinking kombucha or Kefir, eating yogurt or other fermented foods like kimchi, sauerkraut and tempeh.

Change those bathroom habits

With increased water intake comes an increased need to urinate. Holding urine for long periods of time exposes the body to the harmful bacteria that can cause a urinary tract infection. Voiding the bladder as needed helps eliminate that risk. Wiping from front to back can also decrease the risk of spreading bacteria from the rectum and vagina to the urethra.

Bedroom habits, too

Urinary tract infections are not sexually transmitted, but are a result of bacteria that builds up and is pushed into the urethra during intercourse. Urinating prior to and promptly after intercourse can help remove unwanted bacteria from the urinary tract. Be mindful that your birth control may also be contributing to the spread of bacteria: diaphragms or spermicidal agents can increase your risk of developing a UTI. Women can wash their genital area before and after intercourse to also reduce bacteria buildup, which leads me to our next order of business.

Be conscious of hygiene products

Feminine products and treatments such as douches, powders and deodorants should be avoided, as they can irritate the skin and cause bacteria growth in the pelvic area. Washing with mild, unscented soaps and rinsing thoroughly is more than sufficient.

Don’t DIY your UTI: When to see a doctor

If you’ve had a UTI in the past, you may be able to recognize the symptoms more easily and much earlier. If you’re concerned that you’re getting a UTI, you can start a course of treatment in the comfort of your own home. The rest should be left to a healthcare professional.

  1. Start drinking water immediately after noticing potential symptoms. This will help dilute the urine and flush out infection-causing bacteria.
  2. Urinate frequently. The constant, painful urge to urinate is a symptom, but increased water intake will also require you to urinate more. The more you urinate the more difficult it is for bacteria to build up in the bladder.
  3. Visit your doctor. While increasing the amount of water you’re drinking may stave off the infection and improve your symptoms, it cannot cure a UTI. Your primary care provider or local clinic can provide you with a diagnosis and medication. If needed, your doctor may then refer you to a urologist for specialty care.

There are a lot of steps you can take to prevent getting a urinary tract infection. Should those prove unsuccessful and you find yourself struggling with a bacterial infection in your renal system, it can likely be treated without a trip to your friendly neighborhood urologist, me.

If you experience more than three urinary tract infections a year or your urinary tract infections are physically debilitating, you should call our practice and set up an appointment. A more serious condition, such as a structural abnormality, may be at play.

How Smoking Affects Five Urologic Conditions

Erectile dysfunction, bladder cancer, kidney cancer, infertility and overactive bladder can all be negatively affected by smoking.

Urologic Condition impacted by smoking | Denver Urology Associates | man breaking cigarette

Many lifestyle choices can affect your risk of cancer and other urologic conditions. If you want to reduce your chances for erectile dysfunction, infertility, overactive bladder and cancer of the bladder and kidneys, smoking is at the top of the list of habits to ditch.

It is not just cigarettes that are the problem. E-cigarettes, hookas and smokeless tobacco are often underestimated as health risks but they can be just as harmful as cigarettes. You could also be at a high risk if you are exposed to second-hand smoke.

According to the Centers for Disease Control and Prevention, 15 percent of Americans over 18 currently smoke cigarettes. This is the leading cause of preventable disease and death in the United States. Smoking accounts for 1 in 5 deaths, that is more than 480,000 deaths each year.

Smoking doesn’t always lead to death. It can cause urologic conditions and other major health concerns. More than 16 million Americans are living with a smoking-related disease.

If you are a smoker, I recommend you talk to your doctor about stopping. The longer and more frequently you smoke, the more your risk for many conditions increases. I am going to focus on the urologic conditions that are affected by smoking.

Erectile dysfunction

Erectile dysfunction (ED) impacts 20-30 million American men and is caused by a range of psychological and physical factors. Among them is smoking cigarettes. This should come as no surprise since smoking can damage your blood vessels, and ED is often the result of poor blood supply to the penis.

The urologic condition of erectile dysfunction is more common as a man gets older but it can develop at any age. A 2005 study found that ED was more likely in men who smoked, and for younger men experiencing ED, smoking is very likely the cause.

Quitting smoking can often improve your vascular health and in turn your erectile health.

Bladder cancer

According to the National Cancer Institute, bladder cancer is estimated to represent nearly 5 percent of all new cancer cases in 2017 in the U.S. More than 79,000 new cases are expected in 2017, with 16,870 estimated deaths. Bladder cancer becomes more common as a person ages, and men are 3 to 4 times more likely to get it than women.

Tobacco is the most common risk factor for developing cancer. Smokers are 4 to 7 times more likely to develop bladder cancer than nonsmokers. Fifty to sixty-five percent of bladder cancers are attributable to smoking in men, and 20-30 percent in women.

Why? Smoking causes harmful chemicals and drugs to collect in the urine. These chemicals affect the lining of the bladder and raise the risk of bladder cancer.

Kidney cancer

Smoking affects the kidneys because tobacco makes its way into the bloodstream, which is then filtered by the kidneys.

In 2017 nearly 64,000 U.S. adults will likely be diagnosed with kidney cancer. The main risk factors for kidney cancer are being a male, age, obesity, genetic factors and smoking. A review of the United Kingdom kidney cancer cases found that an estimated 29 percent of cases in men and 15 percent of cases in women were caused by or associated with smoking. That data also showed that the risk is greater in those who have been smoking longer and more frequently.

Overactive Bladder

Overactive bladder (OAB) affects an estimated 33 million Americans. OAB includes urinary urgency, frequent urination, leaking of urine and the need to wake up from sleep to urinate. Urge incontinence in specific is 3 times more common in women who smoke cigarettes compared with those who have never smoked.

One cause of OAB is smoking. Smoking bothers the bladder, which can cause frequent urination. Smoking also causes chronic coughing in many patients, which can lead to urine leakage due to the muscles in the bladder weakening.


Smoking has always been strongly discouraged during pregnancy, but many people do now know that it can also have detrimental effects on the ability to conceive a child. This is because smoking can harm the genetic makeup of eggs and sperm, reduce hormone production, and affect the environment of the uterus, leading to infertility. The infertility rate for smokers is twice as high as for those who don’t smoke.

Studies have found that success from in vitro fertilization is diminished if either partner is a smoker. The chance of a miscarriage is also higher, as well as for birth defects in your child.

The good news is that the effects of smoking on infertility can be reversed within a year of quitting. Some studies even show that two months after stopping smoking your chances of conception can be higher.

Poor healing after surgery for urologic conditions

If you are a smoker about to have surgery, you should be aware of some extra concerns. The chemicals in cigarette smoke can increase the chance that your bones or tissue may not heal well. They also bring an increased chance of infection and pain after surgery.

Smokers have anywhere from 2 to 10 times the risk for their bones or wounds not healing after surgery. They also often take longer to heal than nonsmokers.

Smoking affects how our bodies heal by changing the way we handle oxygen, restricting blood vessels. This makes it difficult for hemoglobin and oxygen to get to the tissue where they are needed. It also makes your blood thicker, impeding its flow through narrowed blood vessels.

Make a plan to quit smoking

If you are interested in quitting smoking and using tobacco, give yourself the best chance of success by talking to your doctor openly and honestly. Being truthful about your use will help your doctor find the best treatment for you to quit, whether that’s behavior and/or medical therapy.

Another great resource is the Colorado QuitLine. They offer a free program to Colorado residents over the age of 15, providing special tools, research-based information, a support team, and a community of others trying to become tobacco free.

Quitting smoking even after you have been diagnosed with a disease that may have been caused by the tobacco can improve your health. Regardless of your age, you can substantially reduce the risk of urologic conditions and disease, including cancer, by quitting.

Stopping the use of tobacco can have many mental and physical benefits including:

  • Better quality of life
  • Longer life
  • Easier breathing
  • More energy.

It is the job of my fellow physicians and myself to help our patients follow a healthy lifestyle that includes ending their dependence on tobacco and nicotine.