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Arkansas Urology is the largest urology practice in Arkansas and continues to offer the latest innovations in medical technology and surgical techniques to patients with a variety of urological conditions.


December 2016

How Does Diabetes Affect Your Kidneys and Bladder?

By: Arkansas Urology

Living with diabetes means a greater risk for a number of health issues especially urological conditions. More often than not, the urological effects of diabetes are directly tied to the damage diabetes can cause to blood vessels and nerves.

Bladder issues like overactive bladder, poor sphincter muscle control around the urethra, urine retention and urinary tract infections are common in both diabetic men and women. The real risk is that when common bladder issues are left untreated, they can quickly cause longer lasting and more widespread damage.

In a lot of cases with diabetic patients, they might experience a combination of classic symptoms from the above-mentioned bladder problems, resulting in what is commonly referred to as “diabetic bladder.” In these cases, the common diabetic problem of neuropathy, or nerve damage, causes the bladder to lose the ability to sense when it is full. The bladder may begin to retain up to twice as much urine as is acceptable for a healthy bladder, stretching the muscles used to control urination and weakening them over time. When urine sits in the bladder, it also allows bacteria to grow and spread throughout the urinary system.

“Diabetic bladder” is when you experience a combination of classic symptoms from the above-mentioned bladder problems. In these cases, the common diabetic problem of nerve damage causes the bladder to lose the ability to sense when it is full. The bladder may begin to retain up to twice as much urine as is acceptable for a healthy bladder stretching the muscles used to control urination and weakening them over time.

The good news is despite what may seem like an intimidating issue is usually very treatable. Even in severe cases of distended bladder, a regular routine designed by your doctor to frequently and completely empty your bladder will lead to an eventual recovery of bladder function. 

Prevention is also very possible, and easier than you might think! It begins with remembering to urinate regularly, whether you feel like you “need to go” or not. Every few hours is a great place to start. Drinking plenty of fluids (especially water!) is also important to continually flush your system. A healthy diet and exercise are also a crucial part in maintaining a healthy digestive and urinary system for everyone.

If you need to talk to one of our doctors or make an appointment, give us a call at 1-877-321-8452. 




November 2016

6 Things to Know About Prostate Cancer

By: Arkansas Urology

Prostate cancer is the second-leading cause of deaths among men in the United States. Yet, it is also one of the most treatable types of cancer today. A prostate cancer diagnosis doesn't have to be cause for panic early. Here are six important facts to know about prostate cancer - 


1. First of all know if you or a loved one is diagnosed with prostate cancer, you are not alone, and this is a highly treatable cancer. This is a fairly common type of cancer. There are many men who have walked this road. It's important to have that support team from family and friends to your physician and nurses. 

2. About one in seven men will have a prostate cancer diagnosis in their lifetime. For African-American men, the odds are slightly higher. The good news is that the five-year survival rate for prostate cancer that is caught early is 99 percent.

3. Know that there are no consistent or noticeable symptoms of prostate cancer while in the early stages. Screenings can help catch it early. Your physician can help you know when to be screened based on your risk factors. Early detection is key. 

4. Treatment can vary from a "wait and see" approach to surgery to radiation. Surgery consists of removing the prostate gland and possibly some of the surrounding lymph nodes. Radiation destroys prostate tissue and cancer cells in a series of forty treatments. There is also current research into less invasive methods of treatment such as HIFU, which is for our "wait and see" patients. 

5. Family history can definitely play a role in developing prostate cancer. For men who have a father or brother with prostate cancer, their risk more than doubles. Also, about six in 10 cases of prostate cancer are in men 65 and older. It's very rare for men to be diagnosed before age 40 even with a family history. 

6. The cause for prostate cancer is unknown. Because of that, researchers don't have a definitive way to prevent the disease, so there’s nothing that your husband could do or should have done differently. Just be reminded that prostate cancer is highly treatable and an elevated PSA doesn’t always mean prostate cancer.

If you or a loved one has been diagnosed with prostate cancer or needs to schedule a screening, give us a call today. We can help you through this journey from diagnosis to treatment, call 1-877-321-8452.


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November 2016

AU adds chief nursing officer to management team

By: Arkansas Urology

Jason Ketcher of Little Rock has joined Arkansas Urology as its Chief Nursing Officer. In this role, he will manage all aspects of clinical operations to include strategic planning, clinic workflow, patient engagement, and quality improvement.

“The CNO guides much of the patient’s experience in our clinics,” said E. Scot Davis, CEO of Arkansas Urology. “We are fortunate to have Jason serve as this liaison for our patients.”

Jason completed his post-graduate coursework in Nursing Administration and Education from the University of Arkansas for Medical Sciences (UAMS). He earned his Bachelor of Science in nursing at UAMS as well. Ketcher has been involved in numerous professional organizations such as American Assembly for Men in Nursing and American Society for Healthcare Risk Management.

Prior to joining Arkansas Urology, he has served in various leadership roles with organizations such as UAMS, Baptist Health, and Arkansas Children’s Hospital in Little Rock, AR.

“To have someone as skilled as Jason is vital,” said Dr. Tim Langford, president of Arkansas Urology. “His experience with patients, staff, and operations will benefit our patients and our staff.”






November 2016

AU begins construction on ambulatory surgery center

By: Arkansas Urology


Arkansas Urology has begun work on a new outpatient surgery center in Little Rock. The single-story, 12,467-square- foot center represents a nearly $6 million investment by Arkansas Urology in central Arkansas’ healthcare community. The surgery center is expected to open by October 2017.

The new center will provide Arkansas Urology patients with a state-of- the-art facility equipped with the latest technology. All outpatient procedures currently being performed at Arkansas Urology will take place in the new surgery center along with various new procedures to treat BPH, overactive bladder and prostate cancer, as well as other urological conditions.

“With the surgery center being located at our central clinic campus, patients from throughout our service area will have their surgeon-physicians and their staffs readily accessible, which will increase efficiency, reduce costs and provide better patient outcomes,” said E. Scot Davis, CEO at Arkansas Urology. “This integrated approach to addressing urological issues will enhance the already exceptional service our patients have come to expect from our staff and providers.”

The new building will house two 450+-square- foot operating rooms and four procedure rooms and will be an accredited facility to ensure safety and quality standards. The building is designed to accommodate future expansions.

“The physicians of Arkansas Urology are committed to providing the latest technology and innovative processes to enhance the quality of life for our patients,” said Dr. Tim Langford, president of Arkansas Urology. “We are honored to be able to bring this state-of- the-art facility to the residents of central Arkansas and will continue our long history of exceptional care to the patients we serve.”

Johnny Kincaid of Commercial Realty Development Services LLC is providing project development services. Danny Bennett and Clark Contracting LLC are handling general construction of the building. The architect is Laura Morrison with Morrison Architecture. Dan Beranek and McClelland Consulting Engineers are handling civil engineering and landscape design. The project is being financed by Iberia Bank.




November 2016

Questions To Ask When You Have Cancer

By: Arkansas Urology

"You have cancer." These are words that no one wants to hear. The feelings that result from a cancer diagnosis can be overwhelming and unfamiliar. Amongst all these feelings is typically a whirlwind of questions. It is important to speak openly and honestly with your doctor.

Regardless of the type of cancer, there are facts that you need to know and questions that you need to be sure to ask. Start with the basics. Make sure you know some of the most important details about what type of cancer, where and what stage of cancer. Many times technical terms and phrases that may not mean much to you, but having your personal diagnosis put into plain terms can help more than you might expect.

While you doctor will tell you the recommended treatment, you should also know the goal of treatment. Your treatment strategy will involve a combination of symptom treatment and a cure, and you will want to be able to distinguish them. Ask how your treatment will affect your day-to- day life. Will you need to make diet or lifestyle changes?

The question that might come first to your mind is about the future. What is the prognosis or the potential outcome of this diagnosis? Your doctor will be realistic with you about what expectations you should have about your treatment and its effectiveness.

Finally, the most helpful question you could ask is how you will be able to communicate with your treatment team in the future. Keeping an open line of communication will only help your treatment plan as you move forward.

If you have  any questions or need to consult with a physician, please give us a call at 1-877-321-8452.



October 2016

Fundamental Concepts About Testosterone Deficiency, Treatment

By: Arkansas Urology

 To address widespread concerns regarding the medical condition of testosterone (T) deficiency (TD) (male hypogonadism) and its treatment with T therapy, an international expert consensus conference was convened in Prague, Czech Republic, on October 1, 2015.

Experts included a broad range of medical specialties including urology, endocrinology, diabetology, internal medicine, and basic science research. A representative from the European Medicines Agency participated in a nonvoting capacity.

Nine resolutions were debated, with unanimous approval:

(1) TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life;

(2) symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of whether there is an identified underlying etiology;

(3) TD is a global public health concern;

(4) T therapy for men with TD is effective, rational, and evidence-based;

(5) there is no T concentration threshold that reliably distinguishes those who will respond to treatment from those who will not;

(6) there is no scientific basis for any age-specific recommendations against the use of T therapy in men;

(7) the evidence does not support increased risks of cardiovascular events with T therapy;

(8) the evidence does not support increased risk of prostate cancer with T therapy; and

(9) the evidence supports a major research initiative to explore possible benefits of T therapy for cardiometabolic disease, including diabetes.

These resolutions may be considered points of agreement by a broad range of experts based on the best available scientific evidence. Full text

(c) 2016 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2016;91(7):881-896




October 2016

Did PSA Testing Save Ben Stiller's Life?

By: Arkansas Urology

Ben Stiller, one of the few comedians on this side of the pond who can make me laugh, said that PSA testing saved his life. I suspect he wasn't being funny. Mr Stiller had Gleason Grade 7 localized prostate cancer.

Is he right?

The honest answer is that we don't know for certain. Before I get granular, we must visit proof, level of proof, and burden of proof. The statement "there's no proof that Stiller's life was saved by testing for PSA" is correct. But the statement can't be made without determining on whom the burden of proof lies. Is it on those who say that PSA saved Stiller's life, or on those who say that PSA did not save Stiller's life?

We can't ask for proof without stating what level of proof we'll accept. Many won't believe immaculate conception unless they witness it. You can disprove that Julius Caesar existed if the only proof you'll accept is photographic evidence of his existence. In medicine, level of proof is a sliding scale which you can arbitrarily choose depending on what you wish disproven. Observational studies are no proof unless they prove what you want proven. RCTs are proof unless they disprove what you don't want disproven.

It's easy to confuse evidence for proof. To say there's no proof that screening saved Stiller's life is really saying there's no evidence that screening has a net survival benefit. The key word is "net," which, as you may recall from your tax returns, involves subtraction. If the "net" is zero, it doesn't mean it was zero before the subtraction. Net benefit from screening can be zero if treating prostate cancer found by screening causes the same number of deaths as lives saved by screening.

What does "saving a life" in screening even mean? It should mean making a person live longer than they would have lived if they weren't screened. This is difficult to capture. Statistically, "screening saves lives" means fewer deaths from the cancer that is being screened—in the case of PSA screening, fewer deaths from prostate cancer.

If PSA screening, hypothetically, saves Peter, Tom, and Rajeev but kills—because of complications of surgery—Dick and Anil, the net benefit is one. If it also kills Donald, the net benefit is zero. But here is the important point: Even if the net benefit of screening is zero, it still means that Peter, Tom, and Rajeev were saved by screening. I'm amazed that this elementary logic, which can be understood by most middle schoolers, eludes many doctors.

The statement "there's no proof that Stiller's life was not saved by PSA" is also correct. Some get nonjudgmental and say, "There's no more proof that PSA saved Stiller's life than a magical sky pixie saved Stiller's life." This cute, yet sophomoric, reasoning misses a point, which is that a PSA test leading to the discovery of a localized prostate cancer of intermediate grade could plausibly have saved Stiller's life. What's plausible is down to expertise and judgment, and such nonjudgmentalism that holds PSA testing in the same evidentiary bracket as a magical sky pixie, that is egalitarian with expertise, is not objective but idiotic.

It is, therefore, plausible and possible that PSA testing saved Stiller's life, but is it probable? This is the crux of the disagreement and depends more on the prognosis of Stiller's tumor than the net survival benefit of PSA screening. Let's consider the latter. The net survival benefit of PSA screening is contentious. The Göteborg trial showed that screening for prostate cancer had a measurable treatment effect and that 293 people had to be invited for screening to prevent one death from prostate cancer. That's impressive. For comparison, the number needed to screen to reduce death from lung cancer in heavy smokers is 320. The Prostate, Lung, Colorectal and Ovarian (PLCO) trial contaminated[2] because 90% in the control gorup had a PSA test. The PLCO trial compared PSA testing with PSA testing and found, unsurprisingly, that the group that recieved PSA testing didn't live longer than than the group that received PSA testing.

What about the prognosis of Mr Stiller's tumor? According to Dr Benjamin Davies, associate professor of urology at the University of Pittsburgh, Gleason 7 is precisely the tumor grade that benefits from early detection. It is neither so innocuous that treatment is redundant, nor is it so aggressive that treatment is forlorn—meaning, if left alone, it has a high chance of metastasizing and causing misery and early death. Ironically, Mr Stiller is the worst example for anti-PSA screening.

Screening is beyond net survival benefits. PSA screening can lead to harms from surgery or radiation therapy to the prostate. The value, or disutility, of a harm is subjective and personal. Whilst no man I know will ask Santa Claus for impotence for Christmas, some men would rather die standing than live hanging—meaning that for them, impotence is a fate worse than dying early from prostate cancer. Others might want to climb mountains rather than summit molehills—ie, they want to live as long as they can. There's no "one size fits all" (pun unintentionally intended). Screening is the mother of all "one size fits all." You might be your neighbor's keeper, but you don't own your neighbor's values.

It gets even more complicated. Urologists are getting better at sparing nerves during prostate surgery. Thanks to advances in MRI, urologists are also getting better at identifying cancers that can safely be watched. Then there is the blue pill, which has softened prostatectomy's most feared complication. The sledgehammer is getting more nuanced. Harms have reduced. Assessment of screening, which incorporates the harms of the past, not the present, is like basing US foreign policy today on the Cold War. This is why USPSTF has erred by excluding urologists, and other specialists, from its panel. Whilst urologists may not know more epidemiology than epidemiologists, they're arguably more likely to pay attention to the strengths and weaknesses of the trials—it's their livelihood. It's a bias for sure, but a bias in the direction of the truth. The war against expertise is the strangest battle in a country that covets expertise.

The only objection to screening is philosophical—ie, what you view the role of medicine in society to be. FWIW, I wouldn't support screening were I the healthcare czar. But I won't pretend that my objections are empirical, because it is impossible to make a rational empirical objection to any one screening test without specifying, ex ante, the precise treatment benefit and its uncertainty needed before approval. The harms, as I alluded to, are subjective and a moving target. It is inconsistent to hold screening for prostate cancer to all-cause mortality reduction (highest standard of proof), yet to approve screening for colorectal cancer, which has not met that bar.[3]

I understand why urologists are pissed off that USPSTF has knocked down PSA testing but not mammograms. On its face, and even exploring more deeply, there seems to be little justification. The prostate, an organ which doesn't have the prettiest real estate—separated, though it is, from the rectum by the tough fascia of Denonvillier—is a neglected child. But someone must look after it. And it's disheartening that whilst us boys wear pink to increase breast cancer awareness, the sisters never return the favor. When was the last time you saw a woman wearing blue to increase prostate cancer awareness?

Screening, an individual choice, has become a societal prerogative. This is bound to cause cognitive dissonance. Some have adopted a middle ground and said that screening should be down to shared decision-making. How will you conduct shared decision-making for PSA screening? It's not as easy as you think. Let me present a vignette.

Rajeev: "My wife wants me to get my PSA tested."

Doctor: "Hold on, Rajeev. Let's first engage in shared decision-making. I'm going to give you possibilities about your future and then explore your values, culture, and expectations before integrating them with the best available evidence so that you can make an informed decision about whether to pursue a PSA test."

Rajeev: "You...what?"

Doctor: "Here is your future:

1. You will dies from a urinary tract infection in a nursing home, abandoned by your family and friends.
2. You will die an early and miserable death from prostate cancer if not screened and will also miss your daughter's wedding.
3. If screened and a cancer is found and treated, you will live much longer and celebrate more birthdays.
4. If screened and a cancer is found and treated, you will die at the same time as you would have if you weren't screened.
5. If screened and a cancer is found and treated, you will be left impotent and still die from a urinary tract infection in a nursing home, abandoned by your family and friends.
6. You and I will both be blown up by ISIS or have to build a wall along the 28th parallel."

Rajeev: "You're confusing me, doctor. Which one of these will happen to me?"

Doctor: "Your guess is as good as mine."

Sure, throw some numbers to help Rajeev make an informed choice. But I suspect that Rajeev, and others from his culture, won't care too much about probabilities. You're the doctor, not he. He has come to you for your opinion, not his.

Which gets me back to Stiller. Some say he's spreading misinformation by advocating PSA screening. I'd argue that it's not possible to spread misinformation about screening because we don't have a clue. Screening is an information problem; some benefit, some are harmed, but we don't know who will benefit or who will be harmed. This has a name. It's called "uncertainty." I'm a huge advocate of public uncertainty. The more uncertain the public is, the less vice-like grip certitude has over them, the less religious and dogmatic they are, the better the world will be.

Ben Stiller has increased the public uncertainty about PSA screening. I think that's a good thing.

From Medscape Radiology, republished by




October 2016

5 Things to Know About Bladder Cancer

By: Arkansas Urology

Bladder cancer is relatively common, accounting for about 5% of all new cancers in the US. It occurs when the cells within the urinary bladder start to grow uncontrollably. The bladder itself is a hollow organ made up of several layers of different types of cells. As with any cancer diagnosis, the immediate reaction of fear and anxiety is understandable, but these feelings can often be eased with a little extra understanding of the type of cancer you are dealing with. Luckily, most bladder cancers are detected early on, before they become invasive, making treatment much more effective.

If you or a loved one is facing a bladder cancer diagnosis, what do you need to know?

1 - More likely to occur in men. It is the fourth most common cancer in men but less common in women. The chance that a man will develop this cancer is about one in twenty-eight, which is about three to four more likely than women. Most bladder cancer cases also occur in older people, with 73 being the average age of diagnosis.

2- Bladder cancer can be invasive or non-invasive. Most Bladder Cancer begins as a mutation of the innermost cells, which is called non-invasive bladder cancer. If the cancerous cells travel into the inner layers of the bladder walls, and/or into other nearby structures, it is known as invasive bladder cancer.

3 - Bladder cancers are also divided into two subtypes, papillary and flat, depending on the way that they grow. Papillary carcinomas grow in thin projections from the inner surface of the Bladder to the center, without growing outwards into the deeper layers of the bladder. These carcinomas are often slow growing and tend to have a positive outcome. Flat carcinomas don’t grow towards the center of the bladder at all and stay flat to the bladder wall. They can be of both the invasive and non-invasive variety. Other forms of bladder cancer, such as squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma are extremely rare, making up 1% or less of all bladder cancers.

4 - The cause is unknown. Researchers do not definitively know what causes bladder cancer, and widely believe that the risk for bladder cancer is not hereditary. What they have found is common risk factors such as exposure to tobacco smoke/products and unsafe exposure to industrial chemicals/cleaners.

5 - The most common symptom of early bladder cancer are blood in the urine. Symptoms can also include sudden changes in bladder activity or feelings of irritation. If you notice symptoms like these, or If you feel that you have a higher risk for bladder cancer than average, you should see your doctor right away as early detection is key to effective treatment.

If you have any questions about bladder cancer or would like to make an appointment, give us a call at 1-877-321-8452.



October 2016

Medication Treatment for Kidney Stones

By: Arkansas Urology

Kidney stones can be very painful. Your doctor can recommend a variety of treatment for the small stones. However, the good news is that surgery is not often required, but these small stones can most often be treated with medication. TheraLith XR, a Theralogix, product, is a widely used medication for kidney stones. At Arkansas Urology, we have seen a lot of success with our patients through these medications. The tablets are full of Vitamin B6, magnesium and potassium.

TheraLith XR is designed to help your body maintain normal urine chemistry. You can benefit from this medication if you have had a 24-hour urine test, and they discovered that you have low urinary magnesium or citrate levels or high oxalate or calcium oxalate supersaturation levels.

In a clinical trial at Stony Brook Medical School, experts found that there was a 29% reduction in urinary oxalate levels and a 27% reduction in calcium oxalate saturation in patients who took TheraLith regularly. In a group of individuals with low baseline levels of magnesium and citrate, increases of over 300% were seen after taking TheraLith XR for two months. Another thing that our patients and we love about the medication is the lack of side effects that other medications can have.

Of course, you should consult with your physician before beginning any medication to make sure this is a good fit for your individual circumstances. Don't try to self-medicate yourself for kidney stones, always see your doctor first. Your doctor may also recommend some dietary changes along with medication. However, at Arkansas Urology we have definitely seen patients have a good deal of success with TheraLith XR and kidneys stones.

Don't let kidney stones interfere with your life especially when treatment can be easy! If you have any more questions about kidney stones and medication available, please contact us and see one of our physicians at Arkansas Urology.



September 2016

Overactive Bladder Is Never Normal

By: Arkansas Urology


Overactive bladder, or OAB, is defined as a problem with bladder function that causes the sudden need to urinate. When people start to get older, they often accept this as a normal part of life. The good news is that it is actually a very treatable disorder by a change in behavior or medication.

Overactive bladderWhile many older women may start to experience overactive bladder, it is a condition that affects about 17% of women over age 18, and 16% of men. After age 40, it changes to 20% for both men and women.

Two of the most highly practiced options are pelvic floor exercises and behavioral training. These options help strengthen your system and provide systematic awareness and control over your urinary habits and needs. Medication can be prescribed along with behavior changes. Medications can help combat OAB by blocking nerve signals related to bladder muscle contractions. Some research suggests that medications may event increase your bladder capacity and decrease your urge to go. In some cases, your doctor may also recommend “third-line” therapies such as Botox, PTNS and Interstim if other treatment methods have not been successful.

While sometimes doctors prescribe a change in your daily fluid intake, trying to self-treat with this method may make your OAB worse. Withholding water can lead to dehydration, and can result in more concentrated urine, which actually irritates the bladder more. It is typically recommended to increase water intake and reduce your intake of coffee, sodas and juices.

If you think you or a loved one is struggling with overactive bladder, please consult with a doctor for an official diagnosis and treatment. Call Arkansas Urology at 1-877-321-8452.