Urinary tract infections (UTIs) occur when bacteria (often E. coli) enters your urethra, the tube that carries urine out of the body. Sometimes, the bacteria travels even further into your urinary tract, causing a more severe infection. UTIs can be mild or life-threatening, so it’s important to take them seriously.

To understand UTIs, let’s go over some anatomy first.

Your urinary tract has several components that work together to clear urine from your body. Your kidneys start the process by filtering waste from the blood and producing urine. Next, your ureters transport the urine from your kidneys to your bladder, where it’s stored until you urinate. At that point, urine passes from your bladder to the outside through the urethra.

However, bacteria can make its way up the urethra and into the bladder. It can even travel as far as the kidneys. The result is a urinary tract infection or UTI.

UTIs are common. In fact, the American Urological Association estimates that 8.1 million doctor’s visits each year are due to UTIs.

Types of UTIs

UTIs are categorized in several ways. One way is based on their severity:

• A simple UTI is usually easy to treat. You’ll need to take antibiotics for about three days, maybe a little longer. But you’ll start feeling better after a few doses.
• A complicated UTI is more serious. You’ll need antibiotics for a longer period, and you might even need to begin treatment in the hospital.

Another way to describe UTIs is to use the location of the infection:

• A bladder infection (sometimes called simple cystitis) is just in your bladder. It hasn’t spread outside the bladder.
• A kidney infection (also called pyelonephritis) happens when bacteria has moved past your bladder and into your kidneys. Kidney infections are usually considered complicated or more serious UTIs. Without treatment, a kidney infection can cause permanent damage to your kidney(s). The infection can also spread into the bloodstream and around your body. This can lead to sepsis, a life-threatening condition that can affect multiple organs in your body.

Scientists think that in some cases, the tendency to contract UTIs could be genetic.

UTI Risk Factors

Anyone can get a UTI. But some factors increase your risk:

Being female. UTIs are much more frequent in women. In fact, an estimated 60% of women will get a UTI at some point in their life, while only 12% of men will, according to the American Urological Association.

Why? It’s all about anatomy. Women have shorter urethras, so bacteria have a shorter path to the bladder. Also, bacteria like E. coli is found near the anus, which is closer to a woman’s urethra.

Postmenopausal women might be especially prone to UTIs. At menopause, estrogen levels decline. Typically, estrogen can protect from UTIs by promoting antimicrobial substances in the bladder, making tissues less susceptible to infection.

That doesn’t mean men shouldn’t be concerned. Men may have longer urethras, but the bacteria that cause UTIs can also irritate the prostate. For this reason, men with UTIs might need to take antibiotics longer than women do.

A family history of UTIs. Scientists think that in some cases, the tendency to contract UTIs could be genetic.

A medical history of UTIs, kidney stones, or ureteral reflux. If you’ve had a bladder or kidney infection within the past year, you’re more likely to get another one. And you’re at higher risk if you’ve had a urologic condition that alters the way urine flows through your kidneys.

Sexual practices. UTI-causing bacteria can spread from the rectum to the urethra during sex. For example, E. coli can spread to from the rectum to the urethra during intercourse. You might be especially prone to UTIs if you have sex often.

Men who have insertive anal sex are also at higher risk.

Women should be careful about using spermicides for birth control. Some spermicides are thought to kill beneficial bacteria typically found in the vagina. With fewer “good” bacteria available, UTI-related bacteria have more opportunities to grow and spread.

Not being circumcised. Men who have not been circumcised can be more susceptible to UTIs.

Using a catheter or other device. If you’ve had surgery or need a device to help you empty your bladder, there could be more opportunities for bacteria to grow.

Having certain medical conditions. People with diabetes, an enlarged prostate, or a suppressed immune system are at higher risk for UTIs.

UTI Symptoms

If you have a UTI, you will probably have one or more of the following symptoms:

• Pain or a burning sensation when you urinate.
• A need to urinate more frequently or urgently.
• Low urination flow. You might feel like you really need to “go” but find that very little urine comes out.
• Urine leaks.
• Blood in your urine (also called hematuria).
• Smelly urine.
• Pain in your lower abdomen, pelvic, or lower back.

If you have a kidney infection, you might also have a fever, nausea, and vomiting.

UTI Diagnosis

If you have UTI symptoms, come see us as soon as you can. UTIs can be treated, but it’s better to catch them early before they become more serious. (Note: If you’re pregnant and think you might have a UTI, seek medical attention immediately. Left untreated, a UTI can harm both you and your baby.)

You might not need extensive testing to be diagnosed with a UTI. But certain tests can help us pinpoint the cause of your symptoms and treat them appropriately. Here’s what you might expect:

• Medical history and physical exam. We’ll ask you questions about your symptoms and conduct a urological exam.
• Urinalysis. We’ll take a urine sample and analyze its color, odor, and any bacteria present. We’ll also look for white blood cells. If we find them, we’ll know that your body is fighting an infection. A urinalysis give us details about your infection, which will help us make treatment decisions.
• Urine culture. This is another type of urine test that can tell us about bacteria or yeast in your urine.

UTI Treatment

Bladder infections:

Urinary tract infections are usually treated with antibiotics, such as nitrofurantoin, trimethoprim-sulfamethoxazole or fosfomycin. We might also prescribe a drug called phenazopyridine, which makes urination more comfortable by numbing the bladder and urethra.

Once you start taking antibiotics, you should start feeling better in a day or two. But make sure you take your medicine exactly as we prescribe it for the full duration. That will make it more effective. (If you have any questions or your symptoms don’t improve, give us a call.)

Kidney infections:

Antibiotics are used to treat kidney infections, too. You might take them by mouth at home or receive them as an injection here at our clinic or intravenously (through an IV) at the hospital. We might also suggest acetaminophen or ibuprofen to treat pain and fever. A heating paid might also relieve pain.

Some people get UTIs several times a year

Recurring Bladder Infections

Some people get UTIs several times a year. If this is the case, we’ll conduct further testing. You’ll likely have urinalysis or a urine culture again along with imaging tests like a CT scan, ultrasound, or cystoscopy (a test that allows to see inside your urethra and bladder).

In this situation, we might prescribe different antibiotics:

• Continuous antibiotic therapy. Depending on the medicine, you’ll take pills once daily or a few times a week. Over time, we’ll monitor your symptoms and progress during follow-up appointments. (This may also be called antibiotic prophylaxis. The word prophylaxis refers to a therapy that is used as a preventative measure.)
• Antibiotics after sex. Since sexual activity can raise your risk for UTIs, we might prescribe a special antibiotic to take right after intercourse.
• Antibiotics as needed. We might give you a prescription for antibiotics you can start taking as soon as UTI symptoms start. This way, we can start treating it early. However, you should still tell us about your symptoms. Since UTIs share symptoms with other health problems, we we’ll want to follow up.

We might also recommend cranberry prophylaxis. Research suggests that women with recurrent UTIs may benefit from using cranberry products as a prevention strategy.

Preventing UTIs

There are several steps you can take to lower your risk for UTIs:

• Drink lots of fluids. How much? Experts recommend about 2 liters (a little more than a half-gallon) a day. This keeps your urinary system in good working order.
• Don’t hold your urine. When your body tells you it’s time to urinate, do so at your first opportunity.
• After a bowel movement, wipe from front to back. This reduces the odds of bacteria from the anus coming in contact with the urethra.
• Wash your genitals before sex. Cleansing the area can wash away some bacteria.
• Urinate after sex. Some experts say that this can “flush out” any bacteria that might be making its way up your urinary tract.
• Take showers instead of baths. Bath water might contain bacteria that can reach the urethra.
• Switch birth control methods. Spermicides (used alone or with a diaphragm), can upset the balance of “good” bacteria in the vagina, leaving the area more vulnerable to UTI-causing bacteria. If you use these products, consider another contraceptive method.
• After menopause, consider vaginal estrogen. Some postmenopausal women find it helpful to use vaginal estrogen to lower their risk of recurrent bladder infections.
• Don’t use products that irritate the urethra. Such products might include soaps and feminine hygiene products, like douches.

Resources

American Urological Association

Anger, Jennifer, MD, MPH, et al.
“Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019)”
(2019)
https://www.auanet.org/guidelines/guidelines/recurrent-uti

Centers for Disease Control and Prevention

“What is sepsis?”
(Page last reviewed: August 17, 2021)
https://www.cdc.gov/sepsis/what-is-sepsis.html

MedlinePlus

“Cystoscopy”
(Review date: April 26, 2020)
https://medlineplus.gov/ency/article/003903.htm

“Sepsis”
(Page last updated: June 20, 2021)
https://medlineplus.gov/sepsis.html

“Urinalysis”
(Page last updated: June 9, 2020)
https://medlineplus.gov/urinalysis.html

“Urine culture”
(Review date: October 8, 2018)
https://medlineplus.gov/ency/article/003751.htm

UpToDate.com

Hooton, Thomas M., MD
“Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics)”
(Topic last updated: December 3, 2020)
https://www.uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics

Urology Care Foundation

“Kidney (Renal) Infection – Pyelonephritis”
(No date provided)
https://www.urologyhealth.org/urology-a-z/k/kidney-(renal)-infection-pyelonephritis

“Urinary Tract Infections in Adults”
(Updated: April 2019)
https://urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults

A vasectomy is a minor surgical procedure performed to block sperm from leaving the body. It’s a highly effective and common birth control option. Experts estimate that one in five men over age 35 in the United States has had a vasectomy. It’s a simple procedure, and it doesn’t take long for most men to recover. As minimally invasive urologic procedures go, vasectomies are inexpensive, even as an out-of-pocket charge, and especially if you have health insurance that covers it.

You will, of course, want to consider your decision to have a vasectomy carefully. It’s possible – and not uncommon – to reverse a vasectomy, but a reversal procedure is generally more invasive and more expensive than a simple vasectomy. The success rate of a reversal depends on many factors. That said, there are ways to retrieve sperm cells from the testes for in vitro fertilization, so if a vasectomy reversal is not successful, there may still be options for starting a family.

If you aren’t sure a vasectomy is right for you, there are a number of other contraception options to consider.

Vasectomy: How Does It Work?

To review the essentials of male reproductive anatomy, sperm cells are made by your two testes (testicles). Attached to each testis is a coiled area called the epididymis. Once the sperm cells are created, they move to the epididymis where they mature. They’re stored in the epididymis for up to 6 weeks until they’re ejaculated.

When sexual stimulation starts, sperm cells move from the epididymis to the vas deferens (sometimes just called the “vas”), a tube that connects the epididymis to the urethra. Sperm cells can be stored in the vas as well. In fact, it’s common for some sperm cells to overflow into the vas before ejaculation. Sperm cells that aren’t ejaculated can stay behind in the vas, too.

Along the way, seminal fluid and sperm cells mix to form semen, which is expelled through the urethra out the tip of your penis when you ejaculate.

During a vasectomy, the vas is cut, so the sperm cells can’t make it to the urethra. (You have two vas deferentia – one vas for each testicle. In a vasectomy, both tubes are cut.)

After a vasectomy, your testes will continue to make sperm, but your body will simply absorb them. You’ll still ejaculate semen, but the fluid won’t contain sperm (once sperm has cleared from your system, which takes roughly three months). Your orgasms won’t feel any different. There is a minimal loss in semen volume.

Vasectomy Advantages

It takes time for a vasectomy to fully take effect. But once it does, the success rate for pregnancy prevention is around 99.95%. Sex can be more spontaneous, and for some, sex is more pleasurable without the worry of an unplanned pregnancy.

Vasectomy Disadvantages

As already mentioned, a vasectomy isn’t effective immediately. You’ll need to use another form of birth control until your semen is clear of sperm.

Also, while a vasectomy is estimated to be 99.95% effective, there is still a less than 1% chance that pregnancy may occur. And it does happen. Only abstinence is 100% effective for any type of birth control.

Safe sex is still critical after a vasectomy, too. Vasectomy does not provide any protection against sexually-transmitted infections (STIs). You’ll still need to use condoms or dental dams every time you have sex unless you know your partners do not have STIs.

What to Expect

Before your vasectomy

We’ll schedule an informational visit to explain the procedure. This is a good time to ask questions. Consider writing down your questions beforehand. Your partner is welcome to join you and ask questions too.

In the week or so before your vasectomy, it’s important not to take any nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen. These medications can thin your blood and put you at higher risk for bleeding. If you’re not sure about a specific drug, just give our office a call.

As with most minor medical procedures, you should also have someone drive you to and from your vasectomy appointment.

The vasectomy itself

Vasectomy is actually a straightforward procedure, and it usually takes about a half hour. Vasectomies are typically performed in our office. A local anesthetic is used. If you’re feeling especially anxious, you may choose to be sedated. In some cases, general anesthesia may be used.

After your scrotum is shaved and washed, the local anesthesia will numb the vas deferens area. Your surgeon will locate the vas deferens, which will be accessed in one of two ways:

• Conventional vasectomy. With this type of procedure, your surgeon will access your vas deferens through 1 or 2 small incisions in your scrotum.
• No-scalpel vasectomy. The vas deferens will be accessed through a small puncture in your scrotum. The puncture is made with forceps that stretch the skin.

At this point, a small section of your vas deferens will be cut and, in some cases, removed. Next, your surgeon will clip, tie, or cauterize (seal with heat) the ends of the remaining vas segments. This blocks the sperm’s travel path. You might feel a pulling sensation.

The procedure is then repeated for your other vas.

If you’re having a conventional vasectomy, the incisions will be closed with sutures. If it’s a no-scalpel procedure, you shouldn’t need sutures.

You should be able to go home shortly after the procedure is finished. As noted earlier, plan to have someone bring you home.

Potential complications

According to the American Urological Association (AUA), about 1% to 2% of men undergoing vasectomy experience surgical complications, such as hematoma (where blood collects outside a blood vessel).

Recovery

When you get home

We’ll give you detailed instructions to follow while you recuperate.

The most important element of a successful recovery is rest. Be prepared to limit your activities for five days to a week, especially lifting heavy things. Wearing a jockstrap might make you more comfortable. Don’t bathe or swim for up to two days.

You might be able to return to work in a few days, depending on how you’re feeling. But you might have to modify some of your work activities for a short time. That will be part of our follow up discussion.

Placing an ice pack on the affected area (over your clothing) can help reduce pain and swelling. You might also try taking some Tylenol (acetaminophen), but we recommend that you avoid aspirin or ibuprofen, as these drugs can raise the risk of bleeding or bruising. We can prescribe a stronger medication if you need it.

What to watch for

Most men go through vasectomy without any serious complications. But you should be on the lookout for bleeding, swelling, fever, redness, and signs of infection. Give us a call if you experience these symptoms.

Some men develop a mass called a sperm granuloma after vasectomy. This forms as part of your immune system’s response to stray sperm cells coming from the cut vas deferens. It’s usually nothing to worry about and should go away on its own, but it can be uncomfortable. In severe cases, it may need to be surgically removed.

Post-vasectomy pain syndrome

Some men develop significant chronic pain in their testicles or scrotum after a vasectomy, although this is not common. Usually, this pain can be treated with medications and warm baths. If it becomes severe, we might have you see a pain specialist. Surgery or vasectomy reversal might be considered at some point.

What about sex?

After your vasectomy, you’ll also need to avoid ejaculation for about a week. And for the next 16 to 18 weeks, you’ll still need to use birth control.

Why? Remember, each vas deferens is connected to the epididymis, a storage area for sperm cells. And sperm cells can be stored in the vas as well. When the vas is cut, there can still be residual sperm cells lingering, and these cells can still mix with semen when you ejaculate. So, until these remaining sperm cells clear, you will still be able to get a partner pregnant.

We’ll be monitoring the situation, though. During your follow-up appointments, we’ll do a semen analysis to check how much sperm is left in your semen. Once we’ve determined all the sperm have cleared, your vasectomy should be effective.

For most men, it takes about three months – or 20 ejaculations – for sperm to clear. But every man is different, and it might take more or less time. It’s important to keep all of your follow up appointments.

Aside from the need to use birth control until your semen clears, you shouldn’t see any major changes in your sex life. You’ll still ejaculate semen like you did before, but once cleared, the semen won’t contain any sperm. (Sperm makes up about 5% of semen, so the volume you ejaculate shouldn’t change significantly.) You’ll still feel the same pleasure from orgasm. Your partner won’t be able to tell you’ve had a vasectomy.

Your body will still produce sperm cells, but they’ll simply be absorbed by the body.

Vasectomy reversal

Oftentimes life circumstances change. You might at some point consider a vasectomy reversal (vasovasostomy).

As noted earlier, the reversal procedure is more complex than the vasectomy itself. It may also be more expensive, and it’s not always covered by insurance.

The success rate of a reversal depends on several factors and can vary widely. The more years that have passed between your vasectomy and your reversal procedure, in particular, is a determinant of whether a vasectomy reversal will be successful.

But an unsuccessful vasectomy reversal doesn’t mean there aren’t viable sperm cells available. For some men, sperm cells can be surgically retrieved from the testes.

It used to be commonly believed that over time, sperm antibodies damaged all the sperm in a man’s body. We now know how to find and identify healthy sperm, even in men who had vasectomies many years ago. The retrieved sperm can be used for IVF (in vitro fertilization) procedures.

Also, some men decide to freeze their sperm before a vasectomy, just in case they change their minds later.

Resources

American Urological Association
“Vasectomy: AUA Guideline”
(Approved by AUA Board of Directors in May 2012. Amended in 2015)

Johns Hopkins Medicine
“Overview of the Male Anatomy”
https://www.hopkinsmedicine.org/health/wellness-and-prevention/overview-of-the-male-anatomy

Medical News Today
Villines, Zawn
“What to know about sperm production”
(July 31, 2019)
https://www.medicalnewstoday.com/articles/325906

MedlinePlus
“Sperm release pathway”
(Reviewed: January 15, 2020)
https://medlineplus.gov/ency/anatomyvideos/000121.htm

UpToDate.com
Viera, Anthony J., MD, MPH
“Patient education: Vasectomy (Beyond the Basics)”
(Topic last updated: June 12, 2019)
https://www.uptodate.com/contents/vasectomy-beyond-the-basics

Urology Care Foundation
“What is a vasectomy?”
https://www.urologyhealth.org/urologic-conditions/vasectomy

“What is sperm retrieval?”
https://www.urologyhealth.org/urologic-conditions/sperm-retrieval

Verywellhealth.com
Boskey, Elizabeth, PhD
“The Anatomy of the Epididymis”
(Reviewed: September 1, 2020)
https://www.verywellhealth.com/epididymis-anatomy-4774615

Hayes, Kristin, RN
“The Anatomy of the Vas Deferens”
(Reviewed: July 9, 2020)
https://www.verywellhealth.com/vas-deferens-4846228