Urologic care in South Denver
At Sky Ridge Medical Center, our board-certified and subspecialty-trained urinary, kidney and pelvic/reproductive-region specialists provide expert, compassionate care from diagnosis through treatment and follow-up.
Our specialists emphasize minimally invasive procedures, including laparascopic and robot-assisted urologic and pelvic prolapse surgery that reduces pain, scarring and blood loss, allowing our patients to recover and get back to normal life more quickly.
Common urologic conditions we treat and services we provide
We treat and provide services a wide variety of bladder, urinary, kidney and pelvic floor conditions, including:
- Bladder cancer
- Bladder infection
- Diabetes insipidus
- Diabetic kidney problems
- Enlarged prostate (benign prostatic hyperplasia, or BPH)
- Erectile dysfunction
- Interstitial cystitis
- Kidney issues
- Chronic kidney disease
- Kidney cancer
- Kidney failure
- Kidney stones
- Kidney transplant
- Pelvic pain
- Pelvic prolapse: uterine and vaginal prolapse (urogynecology)
- Prostate cancer
- Testicular cancer
- Ureteral disorders
- Urinary incontinence
- Urinary tract infections (UTIs)
- Sexual dysfunction (male and female)
- Wegener’s granulomatosis
- Wilms’ Tumor
- Vasectomy and vasectomy reversal
Those affected by fecal incontinence—the inability to control stool, which results in seepage, soiling and “accidents,”—are often emotionally devastated and isolate themselves from friends, family and social gatherings. Some individuals may not be able to go to work, avoid dining out and don’t attend their children’s or grandchildren’s soccer games, dance recitals or school functions. Some completely avoid long travel.
If you are suffering with this condition, you are not alone. According to Sky Ridge colon and rectal surgeon Dr. Kenneth Blake, two to 10 percent of the U.S. population is afflicted by some degree of fecal incontinence. In the elderly, it is the second most common reason for admission into nursing homes.
There are multiple causes of fecal incontinence, with the most common being a history of obstetrical trauma. Other risk factors include diabetes, prior anorectal surgery and radiation therapy to the pelvis and neurologic diseases of the spine or peripheral nerves. Contributing factors include diarrhea, Crohn’s disease or colitis.
Treatment for fecal incontinence
“Treatment of fecal incontinence starts with a complete evaluation of a patient’s history including prior surgery, obstetrical procedures and any associated medical problems. We have to look at how all of these factors combine to affect an individual patient,” says Blake.
Initial treatment includes dietary modifications and medications, such as Imodium or Lomotil, to slow bowel transit time. If these measures don’t work, patients can be considered for more advanced treatments.
Pelvic-floor muscle retraining (biofeedback) can help up to 60 percent of patients. Biofeedback is a method in which the patient is visually shown his or her muscle function and is taught how to use the muscle and nerve function more effectively.
If symptoms are severe and not completely resolved by these measures, patients can be considered for surgical therapies. The first of these is often sphincteroplasty, or repair of anal sphincter muscle. During this operation, the surgeon will reconnect the ends of a torn sphincter muscle. This operation is most helpful for relatively young patients after major obstetrical trauma.
However, for some patients with or without muscle injury, there is a contributing nerve problem. Similar to patients with spinal disc disease that sometimes weakens the affected arm or leg, patients with pelvic nerve problems can have weak sphincter muscles. We have known the influence of the nerves for several decades, which has led to studies using sacral nerve stimulation (SNS). In a multi-center clinical trial, SNS this has led to a significant reduction of symptoms in about 80 percent of the patients.
Dr. Blake was part of the first group of surgeons in the U.S. to be trained to implant the SNS device. The “rectal pacemaker,” as he calls it, is inserted as an outpatient procedure in the small of the back. The device, which is about the size of a “C” battery, is manufactured by Medtronic and is a modification of (and functions much like) a cardiac pacemaker. A temporary stimulator is used for two weeks to see if the patient will have a positive response, and if so, a permanent power generator is placed. It is a safe procedure with minimal risks of bleeding or infection, and post-operative discomfort is minimal.
Most patients report significant improvements, less use of protective pads and greater willingness to more fully engage in social outings and functions.
An enlarged prostate, known as benign prostatic hyperplasia (BPH), is a common condition that can affect men as they age. According to the University of Rochester Medical Center, more than half of men over age 50 and nearly all men over age 80 experience some degree of BPH.
At Sky Ridge, we are committed to providing the best treatment options for BPH, prostate cancer and other prostate-related conditions. Our expert surgeons and specialists use the latest technology to improve treatment outcomes and a patient’s quality of life. Men experiencing symptoms of BPH should talk to their doctor about their treatment options, which could include prostate artery embolization (PAE) and other non-surgical methods.
Symptoms of an enlarged prostate
Symptoms of BPH typically include:
- Frequent urination or feeling an urgent need to urinate
- Needing to urinate often at night, which interrupts sleep
- Dribbling at the end of urination
- Difficulty emptying one’s bladder
- Weak urine stream or trouble beginning urination at the start
For most men, the symptoms of BPH tend to worsen over time.
BPH causes and diagnosis
The causes of BPH are unclear or uncertain, but there are several risk factors related to developing an enlarged prostate. The main factor is age, but other risk factors for BPH could include family history, excessive DHT (a sex steroid and hormone), obesity, diabetes, high cholesterol and high blood pressure, among others.
In order to diagnose BPH, a physician will perform a physical exam and administer some tests, including a blood test and a urine test. Some men with an enlarged prostate might have minor urinary symptoms. However, in general, symptoms of BPH do worsen over time as men age.
Sky Ridge Medical Center is the only medical facility in Colorado that offers prostate artery embolization (PAE), an innovative, minimally invasive treatment method for BPH. Other types of enlarged prostate treatments include, but are not limited to: medication, transurethral resection of the prostate (TURP), laser therapy and robotic surgical intervention.Prostate artery embolization (PAE)
For men with an enlarged prostate, some BPH medications can result in unwanted or unpleasant side effects, such as erectile dysfunction (loss of sexual dysfunction), urinary incontinence (loss of bladder control) or retrograde ejaculation (where semen flows backwards into the bladder).
Approved by the U.S. Food and Drug Administration in 2017, PAE is a low-risk, non-surgical treatment option for BPH. The procedure involves inserting a catheter into the patient’s wrist or groin. When the catheter reaches the enlarged prostate gland, the surgeon injects microscopic beads (called embosphere microspheres) through the artery and toward the gland. These beads cut off the blood supply to the prostate gland, which causes it to shrink.
PAE is an outpatient procedure, and the majority of patients are discharged from the clinic within a few hours. Dr. Charles Nutting, DO, FSIR, surgeon at Sky Ridge Medical Center, is one of the very few surgeons in the U.S. to have performed over 100 PAE procedures.
Dr. Nutting says that in one to three months after the procedure, a vast majority of patients see a great improvement in their symptoms related to BPH.
“[After the PAE procedure], 90 percent of patients have significant improvement in their lower urinary tract symptoms,” Dr. Nutting says. “They’re able to sleep through the night and not have to look for a bathroom at every grocery store.”
Another common treatment option is transurethral resection of the prostate (TURP). Men who have undergone a transurethral resection of the prostate might experience retrograde ejaculation (which is not harmful and does not affect one’s pleasure) or experience some degree of urinary incontinence. While TURP is considered a relatively safe procedure, there are some potential side effects.