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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.

What Doctors Want You to Know About Bladder Cancer

Dr. James FagelsonBladder Cancer | Urology Associates | Denver | Healthgrades logo and two other physicians shared with Healthgrades what doctors would like patients to know about bladder cancer. Bladder cancer doesn’t get the same publicity as some other more high-profile cancers, but it’s no less serious.

Dr. Fagelson explains the multiple ways to diagnose bladder cancer and treatment for high-grade bladder cancer.

“Because the presence of bladder cancer is a sign that cancers may be present in other areas of the body—and particularly in the urinary system—the physician may want to do imaging tests, such as CT scan, MRI, ultrasound and X-ray,” says James Fagelson MD.

9 things to know

On Your Mark, Get Set, Go Become a Cancer Survivor

Elaine shares her story of how faith in herself, Dr. Fagelson and God helped her reach the finish line – now her story serves as motivation for others.

Cancer survivor | Elaine running a 5k race | Urology Associates
Elaine fulfilled a lifelong dream of participating in 5K races.

The past few years have been full of refinement, change and emotional ups and downs.

After the passing of my father, my mother and I became roommates so that I could take care of her physical and medical needs. This was certainly an adjustment, but I have strived to use it as an expression of love and servitude.

Then in August of 2015, I suffered an injury that ruptured a disk in my back and left me in severe pain. I was unable to walk or even stand up for several months. I went through extensive chiropractic care and wellness therapy that not only helped the healing process, but also opened my eyes to the importance of leading a healthy lifestyle.

From there on out, I have made a point to improve my health and wellness. Through it all I got a job promotion, and on top of that I have dropped 77 pounds – and counting! This allowed me to fulfill a long-time dream of participating in 5K races.

Unfortunately, among all of these peaks and valleys, I also heard the words that no one ever wants to hear: “You have cancer.”

From finish line to emergency room

After recovering from my back injury and making a point to improve my health, I was feeling great. I had even started participating in many other races.

When I got home from one of my races, I started to feel sick. I thought maybe I had the flu, but did not think much of it until I went to the restroom and noticed blood in my urine. Even though I did not have any other pain or concerning symptoms, I went to the emergency room right away.

In the ER I underwent a variety of scans and testing that revealed a mass on my right kidney. From there I was referred to a urologist through UCHealth who performed more invasive testing to determine that the mass was kidney cancer.

This is news you just hate to hear in any sentence. It causes the body to be numb. It causes the mind to race. In that brief instant you go through a whirlwind of thoughts that range from What am I going to do? to How do I tell my family? to Is this a death sentence?

Then, just as quickly, you must gather yourself and realize that the doctor is still talking to you. After you hang up the phone you sit in silence, try to collect your thoughts and figure out what the next step will be.

I would be lying if I didn’t say that one of my first thoughts was I’m going to see my father sooner than I thought. But I knew I had to pull myself together. I had to put one foot in front of the other and lean on my loving God. I had to muster the strength to inform those closest to me of the news and make sure to protect those who needed to be protected (my mom). Then, I did the best I could to move forward with my life.

The run for my life

The first doctor I saw encouraged a very aggressive treatment plan that would include eight weeks of chemotherapy and a surgery that would require cutting my back open to remove my kidney. In my heart, I just knew this was not the right plan.

I decided to do some research on my own and trusted that God would help me find a better treatment option for my diagnosis. During my search, I came across a book called The Cancer Killers that explains nutrition, fitness and detoxification advice essential to confronting cancer. I began adjusting my eating habits and lifestyle choices accordingly.

Around that time a friend from my church revealed that she had also battled kidney cancer and shared that she received her treatment at Urology Associates. Not long after, I learned that a co-worker had received care from Urology Associates as well. They both had wonderful things to say about the facility and doctors, so I took a leap of faith and contacted the clinic.

After just one appointment with Dr. James Fagelson I knew that I had made the right choice to forego the treatment plan suggested by my first doctor. Dr. Fagelson was optimistic from the very beginning and took my concerns into consideration. He was also confident that he could use a minimally invasive surgery to remove my kidney, which meant that he would not have to cut into my back.

On August 23, 2016, I underwent the surgery, which was successful. I was up and walking the next day and follow-up tests revealed that the cancer had remained contained to just my kidney. Dr. Fagelson believes that the work I put into getting healthy probably made a difference in the results of my treatment.

As I learned from The Cancer Killers, good health helps healing. Dr. Fagelson also told me that if I had not lost weight after my back injury, the tumor may still be hiding and undetected.

As a preventive caution, Dr. Fagelson had me undergo a bladder scope about three months after my surgery to make sure that additional tumors had not developed. Unfortunately the scope results showed three malignant tumors on my bladder. On January 5 I had a surgery to remove all of those. I am so thankful that Dr. Fagelson recommended this scope, because who knows how long those tumors could have gone undetected if he had not.

Today I am blessed with good health. Recent CT scans have come back clean, indicating that there are no other cancerous tumors in my body.

Racing on as a cancer survivor inspiration 

Cancer survivor | photo of Elaine Brimage after weight loss and cancer free | Urology Associates
Elaine has taken control of her health and wellness by continuing to lose weight and following her dreams.

I thank God every day for Dr. Fagelson and the care that I received at Urology Associates. Every step of the way the doctors and staff have been so sensitive and understanding to my fears and needs. I have truly never felt so cared for in my life, which is comforting when facing something as challenging as cancer.

I strive to use my journey as a tool of inspiration and hope for others. Through this process, I have found a passion for motivating others. I have had the honor of sharing my story at a Cancer Killers workshop and I also write monthly blogs dedicated to uplifting others. It is hard to put the journey of life into words, but I hope I can help others believe in the power that they have to overcome difficulties.

The past few years have been filled with ups and downs, but through it all I have found personal passions and improved my health and wellness. In fact, on April 22, 2017, I will be participating in Pat’s Run, a 5K race in Phoenix, Arizona.

This race just so happens to be on the one-year anniversary of my kidney cancer diagnosis.

I would like to leave you with a poem that I wrote while I was dealing with the challenges of the past few years.

This is my heart today…

To Be Free From Pain

Elaine Brimage II

The heart deals with many emotions
We sometimes don’t know how to channel
And when they all come falling down around us
Fears and tears can also be hard to handle. 

It’s not always easy to find the right words
When someone who cares asks if they can help
But what a comfort to know people care for you
And it makes your heart want to truly melt. 

With the complications and pains we’re dealt
It gets hard not to want to give in
Then we’re reminded of the wonders of His love
And muster up the faith to want to win.

Though the battles may prove to be challenging
Something in us says let’s fight the fight
And when the enemy is attacking against you
You know in your spirit you are doing right.

So, through all the pains and tears
We must remember to look toward the light
Cause in that we find the sun and rainbow
And remember things again will soon be bright.

Simple Cancer Screening Saved Gary’s Life

Controversy over getting a PSA test caused him to pause screening for two years, but a change of heart in year three found prostate cancer.

Cancer screening | Urology Associates CO and the title attribute Cancer screening | Urology Associates CO | doc and patient talkingGary, from Colorado, had a routine going with his primary care physician: Every year they evaluated his prostate specific antigen (PSA) levels that can indicate possible prostate cancer. Every year the cancer screening showed that levels went up a bit.

“When all this came out about PSA not being effective and all that, my primary care physician (PCP) and I had a conversation about that two years in a row,” says Gary, who is 64 years old. “I had a PSA test every year up until then and we looked at the new evidence and said, Well let’s not do it. So for two years I didn’t have the PSA.”

The controversy about PSA cancer screening refers to the United States Preventive Services Task Force (USPSTF) issuing a recommendation in 2008 against PSA screening, despite objections from the urologic community. As a result, primary care providers, like Gary’s, have since offered fewer prostate cancer screening tests.

Urologists, including all of the physicians at Urology Associates, have been raising the alarm to continue PSA testing. And many primary care physicians, like Gary’s, also rethought it all.

“In the third year, my PCP had done enough research on his own, and he said, Let’s put the PSA back in. My PSA levels were at the threshold when things start to go on,” Gary recalls. “We could look back over the years and see a linear rise with my PSA. So he referred me to Urology Associates, and I went to see Dr. Edward Eigner.”

What followed was a digital rectal exam and an ultrasound-guided biopsy of Gary’s prostate, with Dr. Eigner removing 12 samples for laboratory examination. Four showed prostate cancer of intermediate aggressiveness. If you’re going to have prostate cancer, that’s pretty good news because it means they caught it early – thanks to the wise decision to resume PSA testing.

Good choice on prostate cancer screening & treatment

Next came the big decision of how to treat it, whether to treat it. Dr. Eigner told Gary that if he were 10 years older, they might do nothing.

“My wife and I had a pretty extensive discussion with Dr. Eigner at his office at Swedish Medical Center about all the options. He recommended that I look into two options, surgery or radiation therapy using the CyberKnife,” says Gary. “That discussion with Dr. Eigner was a big help.”

“I learned even more online and particularly via Urology Associates’ patient portal. I had several conversations with Dr. Eigner, and he was able to answer questions I had from my reading,” Gary says. “All of it worked quite well: I knew where I was going, what my options were, what the side effects were. I had really comprehensive information from the start.”

Gary decided to undergo CyberKnife treatment at Anova Cancer Care, which has a clinical partnership with Urology Associates.

“I went through CyberKnife and it was easy. It requires just five treatments instead of 40 with standard radiation,” says Gary. “That’s the route I chose.”

He finished the treatments in July 2015. Gary had a minor bladder issue in March that was easily treated.

CyberKnife turned out to be a good choice for Gary. “Since then, my PSA numbers are down,” he says. “Things are going pretty good.”

Gary to men: “Get your PSA tested”

Gary was wary of prostate cancer treatment at first, well aware of the problems that can arise from surgery and the side effects, such as incontinence, erectile dysfunction and others.

“One of the down sides I’d heard was why bother with a PSA test because of all the false negatives and positives. And the biopsy could be more damaging than the cancer itself sometimes,” Gary recalls.

“But that turned out not to be the case. It was really simple. It sounds unpleasant, and it’s not going to be on your top five things to do, but it was not bad,” he says. “I was fine in a couple of hours. With that ultrasound-guided biopsy technique, the doctor can see pretty well. And Dr. Eigner is a quite skilled, dedicated surgeon.”

Once he learned he had prostate cancer, Gary got in touch with his three brothers and advised them they should have a PSA test. All now monitor their PSA level through routine testing.

“It’s our genetic makeup,” says Gary. “I was having prostate issues years ago, and my urologist asked if prostate cancer ran in the family. I didn’t know, so I called my dad and asked, Have you had any prostate issues? He said, I don’t even have a prostate anymore. That’s how I learned it ran in our family.”

That’s one thing Gary says men should know: The medical history of prostate cancer in their families. That puts them at higher risk.

“I take my hat off to my primary care physician for deciding to go back to the PSA testing,” Gary says. “And sure enough we caught it. If not, in 10 years it would have been all over my body.

“Get the PSA test: It’s really cheap and really easy,” advises Gary. He adds that if men see the PSA number rising, they should have a good discussion with their urologist. The doctor will let them know if they need a biopsy.

He says to find a doctor like Dr. Eigner who does ultrasound-guided biopsies to determine if you have prostate cancer. “That’s the best thing a man can do.”

Ready to schedule your own PSA test? Request an appointment

Rising PSA Had Gary Down in the Dumps, But CyberKnife Changed All That

A typical man who avoided prostate diagnostics, Gary turned to CyberKnife when the tests found cancer – and now recommends it to others.


Anova Cancer Care patient Gary and his wifeMeet Gary, your typical 69-year-old man. He enjoys being part of his grandson’s quarter midget race team traveling the United States, working part time at Evergreen Day School repairing everything that gets broken and working out regularly using a high-intensity slow motion routine to keep him strong, activities not uncommon for many men his age. Similarly, Gary shares something else in common with thousands of other American men ­– his PSA (prostate-specific antigen) has been rising steadily for years.

In response to this, Gary’s primary care physician was constantly nagging on him to run diagnostics, a reasonable request Gary resisted for as long as he could. Finally, he gave in and his doctor discovered lumps in his prostate. A subsequent biopsy confirmed that Gary had prostate cancer.

“I went home, I did all of the internet research and I basically found out that if you have prostate cancer you have three choices: you end up with impotence, incontinence or death,” said Gary. “After that I was really down in the dumps.”

This wasn’t Gary’s first cancer rodeo. In fact, a few years back Gary had been diagnosed with stage 4 melanoma and given six months to live. Spoiler alert: he fought a hard fight and has been cancer-free since 2004.

This time Gary visited Urology Associates’ Dr. James Fagelson, a urologist who specializes in minimally invasive robotic surgery using the da Vinci system to treat prostate disease and prostate cancer. Despite his expertise in removing the prostate, Dr. Fagelson suggested that Gary speak with Anova Cancer Care, a partner of Urology Associates, about an innovative type of robotic radiosurgery called CyberKnife.

Saving his prostate, saving his virility

The doctors at Anova Cancer Care really convinced me that CyberKnife treatment was the way to go, said Gary. “I had my doubts because it sounded too good to be true, but I really did not want to have my prostate removed.”

After years of a good relationship as Dr. Fagelson’s patient, Gary relied on his opinion as to whether or not he should have the CyberKnife treatment or a prostatectomy using the da Vinci robotic device. Dr. Fagelson told Gary that if he were his age and going through the same ordeal, he would go with CyberKnife.

“That was surprising to me because he’s an expert in da Vinci robotic surgery,” said Gary. “That made up my mind. I did some research, relied on the doctor’s expert opinion and decided to undergo CyberKnife treatment.”

It was a “piece of cake,” according to Gary. He received five rounds of CyberKnife radiation treatment with virtually no discomfort. The staff at Anova Cancer Care gave him kind and thorough explanations, and Gary felt at ease calling in the days after the treatment with questions and concerns.

“When the Anova clinical team tells you to call them with problems, they mean it. You aren’t bothering them. They are there to help and they make that very clear,” Gary said.

“And I didn’t anticipate feeling this good. I’m 69 years old, just got off of my FloMax and my sex life is better than it was before the treatment.”

Gary still fervently recommends Anova Cancer Care to patients considering CyberKnife treatment.

“[The Anova Cancer Care] team are geniuses with the procedure,” said Gary. “I would tell anyone who is worrying about CyberKnife treatment to not even think about it and just do it. Don’t worry!”