Urethral cancer affects the urethra — the tube that allows urine to flow from the bladder out of the body. Along with the bladder, ureters, and kidneys, it forms the urinary tract.
For females, the urethra is short — about 1.5 inches long. It extends from the bladder to the opening where urine flows out.
Males have much longer urethras — about 8 to 9 inches long. In this group, the urethra starts at the bladder, goes through the prostate gland, and runs the length of the penis to the opening. Men also ejaculate semen through the urethra.
Urethral cancers make up less than 1% of all cancer diagnoses and is the rarest of all urologic cancers.
Urethral cancer occurs when abnormal cells accumulate and form a tumor. Urethral cancers make up less than 1% of all cancer diagnoses and is the rarest of all urologic cancers.
Read on to learn more about urethral cancer.
Types of urethral cancer
There are 3 types of urethral cancer:
Squamous cell carcinoma. This is the most common type. In men, it forms in the lining of the urethra in the penis. In women, it starts in the area near the bladder.
Transitional cell carcinoma. In men, this type starts in the section of the urethra that goes through the prostate. In women, it begins near the urethral opening.
Adenocarcinoma. In both men and women, this type of cancer forms in the glands around the urethra.
Urethral cancer is also categorized based on the part of the urethra it affects. Distal urethral cancer is found closest to the opening where urine leaves the body. Proximal urethral cancer is found in the area closest to the bladder.
Causes and risk factors
Researchers don’t know what causes urethral cancer, but they have found that it’s more common in people with certain risk factors:
Chronic urinary tract infections (UTIs)
Sexually transmitted infections (STIs)
HPV (human papillomavirus) infection, a type of STI
A history of:
Bladder cancer
Urethral stricture disease (narrowing of the urethra)
Urethral caruncle (a growth that forms on the urethra)
Urethral diverticulum (a pouch that forms along the urethra)
Long-term catheter use
Smoking
Older age (60 and over)
African descent
Men and people assigned male at birth are also more likely to develop urethral cancer.
Symptoms of urethral cancer
People with urethral cancer don’t always have symptoms at the beginning. When symptoms do develop, they may include:
Pain or bleeding during urination
Poor urine flow (“stop-and-go”)
Needing to urinate more often
Lump on the urethra
Clear or white discharge from the urethra
Lump or swelling in the groin or perineum (the area between the anus and the vulva in women, and between the anus and the scrotum in men)
Men may have a lump or thickness in the penis
Diagnosing urethral cancer
To diagnose urethral cancer, doctors usually start by taking a medical history. They ask questions about a patient’s symptoms and past health issues, such as STIs, UTIs, or other problems with the urinary tract.
There is also a physical exam. For men, this might include a digital rectal exam to check the prostate. Women might have a pelvic exam.
Other tests may include:
Cystoscopy. The doctor uses a tool called a cystoscope to see inside the bladder and urethra.
Ureteroscopy. This test allows the doctor to see inside the ureters — the tubes that connect the kidneys and bladder.
Urine tests. During urinalysis, a specialist checks a urine sample for substances that might indicate urethral cancer. During urine cytology, a urine sample is checked specifically for cancer cells.
Blood tests. A blood sample is checked for substances that may indicate cancer.
Imaging tests. Information from a CT (“cat”) scan, MRI scan, bone scan, or chest X-ray can help doctors stage cancer by showing whether cancer cells have spread to other parts of the body.
Biopsy. A small sample of cells from the urethra, bladder, or prostate gland are removed. A specialist then examines the samples under a microscope and checks for cancer cells.
If cancer is found, doctors will determine the grade of the tumor.
Low-grade tumors tend to grow slowly and often don’t spread. Their cells may look almost like normal urethral cells.
High-grade tumors tend to grow quickly and spread. Their cells usually look abnormal, lacking clear differentiation, structure, or discernible patterns.
Treating urethral cancer
Once a diagnosis is made, a doctor and patient will discuss treatment options. The type of treatment chosen depends on the location and extent of the cancer and the patient’s overall health. Sometimes, a combination of treatments is chosen.
Surgery
Surgery to remove the tumor is the most common treatment for urethral cancer. In some cases, the bladder, urethra, prostate, or lymph nodes are also removed.
If the tumor hasn’t spread to nearby areas, the surgeon might remove it by burning it with an electrical loop passed through a cystoscope. More invasive tumors may need more extensive surgery.
In some uncommon situations, surgery may be recommended that might involve removing all or part of the genitals. This type of surgery is considered when the cancer is found to be aggressive or has spread to the surrounding tissues and organs, making it necessary to remove it completely to try to cure the cancer or prevent it from spreading further.
The goal of this surgery, known as radical surgery, is to remove all of the cancerous cells. The urethra plays a critical role in the genitourinary system, and because of its anatomical location, sometimes the cancer can involve nearby structures. By removing the affected areas, doctors aim to ensure that the cancer does not have a chance to grow or spread.
It is a decision made with utmost care, and physicians understand the profound impact this can have on a person’s identity, self-image, and sexual function. Healthcare providers are committed to providing the utmost support and resources, including counseling and reconstruction options where possible, to help patients navigate this challenging journey.
The healthcare team, which includes doctors, nurses, and specialists, will be there to offer all the medical and emotional support needed. They will explain the reasons behind such a recommendation, explore all possible alternatives, and ensure that the patient has access to the support services needed for recovery and adaptation.
When a complete removal of the penis is necessary, a surgical opening may be created in the scrotum to allow for seated urination. When only a portion of the penis is removed, efforts are made by surgeons to preserve as much tissue as possible, enabling the possibility of urinating while standing.
While the removal of genital organs can impact sexual function, many couples find alternative ways to express intimacy through affectionate gestures like kissing and touching. Furthermore, surgical techniques, such as plastic surgery, can potentially restore sexual function. For instance, a new penis can be constructed using tissue from the forearm, thigh, or back. Similarly, other body tissues, like those from the intestines or peritoneum (the lining of the abdominal cavity), can be utilized to create a new vagina.
If the urethra or bladder is removed, a urinary diversion is created so that urine can still leave the body. There are two types of urinary diversion. The choice of diversion depends on the patient’s overall health and personal preference.
With a non-continent urinary diversion, the surgeon uses a piece of intestine to make an ileal conduit, a tube-like passageway that urine can flow through. The ureters are connected to the conduit, and urine flows out of a stoma — an opening in the abdomen. Once this system is in place, urine flows from the kidneys, through the conduit, out of the stoma, and into a urine collection bag that is worn beneath the clothes.
With a continent urinary diversion, the surgeon uses intestinal tissue to make a pouch where urine can be stored if the bladder is removed. Then a conduit and stoma are created. The person empties the pouch by placing a catheter into the stoma.
Radiation
This treatment uses X-rays and other forms of radiation to destroy cancer cells or slow their growth. Radiation is delivered in two ways:
During external radiation therapy, a special machine delivers radiation from outside the body.
Internal radiation therapy (also called brachytherapy) involves putting radioactive substances inside the body, close to the cancer cells. The substances can be delivered through needles or catheters. They might also be in tiny seeds that are surgically placed in the tissue itself.
Some patients have radiation only. Others have radiation in addition to surgery or chemotherapy.
Chemotherapy
With chemotherapy, strong drugs flow through the bloodstream to kill cancer cells. These drugs may be taken by mouth or given through an IV. Chemotherapy may be used if cancer cells have been found in other parts of the body. It can also be used along with surgery and radiation.
Active surveillance
Patients who choose active surveillance do not receive any treatment unless their situation worsens. Instead, they have routine testing to see if and how the cancer is progressing.
After treatment
After being treated for urethral cancer, patients have regular follow-up visits with their cancer care team. Doctors routinely test to make sure the cancer has not come back.
Can urethral cancer be prevented?
Urethral cancer is rare, and scientists are still studying ways it might be prevented.. But there are known ways to lower risk.
Safe sex. Use condoms and dental dams during every sexual encounter to lower risk for STIs.
Wash the urethral area regularly. Taking this step can lower risk for urinary tract infections. Women should always wipe “front to back” after urinating or having a bowel movement. Menstrual pads and tampons should be changed regularly as well.
Make a plan to stop smoking. Smoking is a risk factor for urethral cancer.
People with urinary incontinence have trouble controlling their bladder function and leak urine from the urethra.
The experience is of course unpleasant and affects a person’s daily life. People might feel embarrassed about their bladder control. They might plan activities around bathroom availability, nervous about having an “accident” when they’re out with friends or at work. They might try pads and other absorbent products, which can be uncomfortable and irritate the skin. And they might shy away from socializing, becoming isolated and depressed.
Fortunately, there are effective treatments for urinary incontinence.
Is urinary incontinence a normal part of aging?
Some people think urinary incontinence is just something to accept as they get older. But that’s not the case. It is possible to improve bladder control and reduce (or eliminate) leaks. Incontinence can be managed by making behavioral changes and doing exercises. There are also devices and surgical procedures that can help.
It’s worth talking to a health care professional about incontinence.
How does the urinary system work?
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For most people, the urinary tract is made up of these key components:
The kidneys are two fist-sized organs that filter blood and produce liquid waste (urine).
The ureters are two tubes that connect the kidneys and the bladder. Urine flows from the kidneys, through the ureters, to the bladder. One ureter is connected to one kidney. Both ureters connect to the bladder on the other end.
The bladder is a flexible, muscular “holding tank” that stores urine until it’s time to empty it (“go to bathroom”). Usually, people start feeling the urge to urinate when the bladder is about half full.
Sphincter muscles keep the bladder closed until it’s time to urinate.
The urethra is the tube connecting the bladder and the outside of the body. When a person urinates, urine flows from the bladder to the toilet through the urethra.
The pelvic floor is a group of muscles that support the pelvic organs. They are sometimes described as a “hammock” that keeps these organs in place.
When the bladder needs emptying, the brain signals for urination to start. Bladder muscles contract, which opens the sphincter muscles, allowing urine to flow from the bladder, through the urethra, and out of the body. When the bladder is empty, it relaxes again and the sphincter muscles close.
If a problem interferes with this process, urinary incontinence can occur.
What are the different types of urinary incontinence?
There are five main types:
Stress urinary incontinence (SUI)
This is the most common type. SUI occurs when there is sudden pressure on the bladder that makes the sphincter muscles open for a short time. A person might leak urine when they laugh, cough, sneeze, stand up, or lift heavy objects. Some people with SUI leak just a few drops of urine. But others might leak enough to need a change of clothes.
SUI is usually caused by damage to or weakening of the pelvic floor. This can happen after pregnancy, childbirth, pelvic surgery, and prostate surgery. Nerve injuries and a chronic cough may also contribute to SUI.
Urge urinary incontinence (UUI)
UUI occurs when the bladder muscles contract at the wrong time, even if there is no urine in the bladder. People with UUI feel an intense, sudden need to urinate and will leak urine if they can’t get to the bathroom in time. UUI is sometimes called overactive bladder (OAB).
UUI can be a symptom of several urological conditions, including bladder cancer, bladder stones, inflammation, and infections. It might also happen in people with neurological conditions, like multiple sclerosis, stroke, or spinal cord injury. Men with an enlarged prostate (e.g., BPH or prostatitis) can develop UUI, too.
Sometimes, no cause is found.
Mixed incontinence
People with mixed incontinence have symptoms of both SUI and UUI.
Overflow incontinence
With this type, the bladder reaches its capacity and cannot hold any more urine. Or people may be unable to empty their bladder completely. As a result, leaks occur. Urine flow may be slow or dribbling.
Overflow incontinence can happen if there is a blockage in the urethra or if the bladder muscles are weakened. It can also happen after pelvic surgery or with the use of certain medications. Unlike other types of incontinence, overflow incontinence is more common in men.
Functional incontinence
People with functional incontinence may have trouble recognizing that their bladder is full or be unable to reach the toilet in time. For example, a person with dementia or mental illness might not be aware that it’s time to urinate. Someone who uses a walker might not be able to access the path to the bathroom. And a person with arthritis might have difficulty unfastening buttons, buckles, or zippers on their clothing.
How is urinary incontinence different for men and women?
In general, women are about twice as likely to have incontinence than men are. Pregnancy, childbirth, and menopause can weaken pelvic floor muscles that support pelvic organs, including the bladder. In addition, women have shorter urethras than men do, so there is less muscle keeping urine contained in the bladder.
The anatomical differences between men and women also affect some of the causes and treatments of urinary incontinence. For example, a man might leak urine because of an enlarged prostate; a woman may do so after childbirth. For treatment, men may receive an artificial urinary sphincter, while women may use a vaginal pessary. (Read more about these devices below.)
Doctors use a combination of methods to determine what type of incontinence a person has
How is incontinence diagnosed?
Doctors use a combination of methods to determine what type of incontinence a person has. They will also consider whether related health conditions need to be addressed.
Medical history
Doctors usually start by asking questions about general health, urinary symptoms, and the effects of incontinence on daily life. Some example questions include the following:
What, specifically, are your symptoms?
How much urine do you leak?
Do you have pain, discomfort, bloating, or similar symptoms?
How long have you been having symptoms?
What do you eat and drink regularly? Do you find that symptoms worsen after you’ve had a particular food or beverage?
When do you typically eat and drink?
What medications do you take (both prescription and over the counter)? How much and how often?
Do you take dietary supplements? If so, what are they?
Have you ever had pelvic surgery?
Have your symptoms interfered with your daily life? How?
How do these symptoms make you feel? Are you depressed or anxious?
(For women) Have you given birth to children?
(For women) Have you gone through menopause?
Urinary habits can be awkward to discuss, but it’s best to be open and honest about symptoms. Providing as much information as possible helps doctors come up with an effective treatment plan.
Bladder diary
A bladder diary is a record of how often a person urinates, how frequently they have leaks, and what they eat and drink each day. It also notes a person’s activities (such as coughing or laughing) when leaks occur.
Physical exam
The abdomen, genitals, rectum, and pelvic floor are examined. Women may have an internal pelvic exam. Men may have their prostate gland checked.
Pad test
This assessment involves wearing an absorbent pad for a certain period of time. The goal is to find out if the body leaks urine when it moves a specific way—and if so, how much?
A pad test can be done in two different ways:
The patient wears a pad for an hour at the doctor’s office and does some activities, like exercise. At the end of the hour, the pad is weighed to see how much urine has leaked.
The patient is given a set of pads to use at home for 24 hours. Used pads are stored in an airtight bag and weighed by the doctor at the end of the test. With this test, doctors can see how much urine leaks during a typical day and night.
Urinalysis
A urinalysis is a urine test. The doctor will check a urine sample for substances like bacteria or white blood cells (which might suggest an infection). Urine cytology is a test that checks for cancer cells in the urine.
Urine culture
Similar to a urinalysis, a urine culture also uses a urine sample. However, part of the sample will be placed in a petri dish in a lab for a few days. Lab technicians will check for bacteria or any other growth that could indicate an infection.
Urodynamic tests
Urodynamic tests assess the quantity of urine the body makes, how much the bladder can hold, the quality of the urine stream, and the rate at which urine flows. It also checks the strength of the sphincter muscles.
Imaging tests
With imaging tests, a doctor can see inside the urinary tract. These tests might include a bladder scan, X-ray, or ultrasound.
Cystoscopy
Cystoscopy allows a doctor to see inside the bladder using a special tool called a cystoscope. After a person is given local anesthesia, the doctor threads the cystoscope up the urethra and into the bladder. A camera at the end of the cystoscope provides an interior view.
Post-void residual urine test
This test measures how much urine remains in the bladder after a person urinates.
Treatment
How is incontinence treated?
There are effective treatments for urinary incontinence
Lifestyle changes
Often, the first steps toward better bladder control are lifestyle changes. These options can work well in combination with other treatments. They are also good ways to prevent incontinence from becoming a problem in the future:
Quit smoking.
Reduce fluid intake, especially at bedtime.
Avoid foods and drinks that worsen symptoms. Alcohol, caffeine, spicy foods, and acidic foods are common bladder irritants.
Lose weight if overweight.
Make sure blood sugar is well-controlled.
Take diuretic medication at times when a bathroom is close by.
Bladder retraining
The bladder can be “taught” to hold urine for longer periods of time. This technique starts with a urination schedule. For example, a person might decide to urinate every hour to start. They try to hold the urine for this hour, and when the time is up, they go to the bathroom. Once their body is used to this schedule, they increase the time by 15 minutes. Then 30 minutes. Eventually, they may train their bladder to hold urine for 3 to 4 hours between bathroom visits.
This technique takes time and practice. A person shouldn’t feel discouraged if they can’t increase the time by 15 minutes. Trying a shorter time frame, such as five minutes, is a good goal, too.
Double voiding
Double voiding means urinating twice in one bathroom trip and trying to empty the bladder. This technique can be helpful for people with overflow incontinence.
Medications
There are medications available that can relax the bladder. Here are some examples:
Anticholinergics (such as oxybutynin and tolterodine). These drugs improve the neurological connection between the brain and the bladder so messages can transmit properly.
Beta agonists (such as mirabegron). These drugs relax bladder muscles and increase the amount of urine the bladder can store.
Alpha blockers (such as alfuzosin and tamsulosin). An enlarged prostate can cause urinary symptoms, including incontinence, in men. Alpha blockers treat those symptoms by relaxing prostate muscle fibers and bladder neck muscles.
Topical estrogen. The decline of estrogen at menopause can weaken the urethra and tissues around the bladder. Estrogen may strengthen these areas.
Botox injections are another possibility. Like the medications noted above, Botox injections can relax the bladder and allow it to hold more urine. Injections are delivered through a cystoscope—a hollow tube that is gently placed into the urethra. (Local anesthesia may be given.) The effects of Botox injections do wear off over time, and some people need to repeat treatment every 3 to 12 months.
Doctors may also prescribe drugs used to treat underlying conditions, such as an enlarged prostate or urinary tract infection.
Note: Currently, the FDA has not approved any medications to treat stress urinary incontinence.
Pelvic floor muscle training
At the gym, people do lunges to strengthen their hamstrings or pushups to tone their upper body. The same principle applies to the pelvic floor muscles. Exercising this area can support the muscles that control urine flow.
Sometimes, this approach is called pelvic floor physical therapy. Specialists help patients identify the correct muscles and teach specific exercises, such as Kegel exercises.
Pelvic floor muscle training might also include the following methods:
Biofeedback. This technique, done by a specialist, uses a sensor (placed in the vagina or anus) to help patients find and control their pelvic floor muscles. When they squeeze these muscles, they can see their movements graphed on a monitor.
Electrical stimulation. A physical therapist delivers a mild electrical current to the pelvic floor area through a probe in the vagina or anus. The current contracts bladder muscles.
Vaginal cones. Women place a weighted cone in the vagina and squeeze the pelvic floor muscles to keep it in place. This technique can be done at home.
Percutaneous tibial nerve stimulation (PTNS)
Located at the lower end of the spine, the sacral nerves help transmit sensory messages that are important for good bladder and pelvic floor function. Percutaneous tibial nerve stimulation (PTNS) applies gentle electrical pulses to these nerves by way of the tibial nerve, which is found in the leg. To access it, a doctor places a small needle electrode in the ankle. The electrical pulses then move up the tibial nerve to the sacral nerves. There might be a tingling sensation, but the process shouldn’t hurt.
People undergoing PTNS may need several treatments before they start seeing results. Some patients have additional treatments every once in a while to maintain improvements.
Sacral nerve stimulation
This approach uses a special device that is surgically implanted in the belly. The device sends a mild electrical current to the sacral nerves, which play a role in bladder function. A person can manage the current with a hand-held controller.
Vaginal pessaries (for women)
A vaginal pessary is a flexible device that a woman inserts into her vagina. It reduces leaks by putting pressure on the vaginal wall, which helps support the bladder and urethra. Pessaries are available by prescription and over the counter. If a pessary is fitted well, it shouldn’t be uncomfortable.
A prescription pessary is custom fitted, and it’s important to follow a doctor’s directions on its care. Women might be able to remove, clean, and reinsert the pessary themselves. In other cases, they’ll have the pessary removed, cleaned, and replaced at the doctor’s office.
A doctor will also advise on how long to wear the pessary at one time. Often, women wear their pessary during the day and remove it at night. Wearing it for too long might lead to irritation. Pessaries might be removed before intercourse as well.
Over-the-counter pessaries are disposable, intended for just one use. Inserted with an applicator, they can be used for up to 8 hours and removed by pulling a string that’s attached.
Penile clamp/clip (for men)
Men with incontinence may choose to try a penile clamp or clip. These devices are worn on the penis and reduce urine leaks by placing pressure on the urethra.
The clamp is worn only during the day, not during sleep. It also needs to be removed every 1 to 2 hours so that urine can be released. Each time the clamp is put back on, it should be in a different spot from the time before. Avoid setting the clamp too tight.
A doctor will recommend what type of device to use.
Urethral injections
With this approach, a doctor injects a synthetic bulking agent into the urethra. This method helps the sphincter close more effectively.
Urethral injections can be administered at the doctor’s office under local anesthesia. Eventually, the injected material is absorbed by the body, so additional injections may be necessary.
Urethral sling
A urethral sling is a strap of material that is surgically implanted to support the urethra. Slings may be made from tissue from a patient’s own body or from synthetic material (mesh). They can be implanted in several ways.
In women, the sling may be implanted through an incision in the vagina or urethra. In men, the sling is usually placed between the scrotum and rectum.
Bladder neck suspension (for women)
Women may opt for bladder neck suspension surgery. With this technique, sutures starting in the vagina are attached to ligaments near the pubic bone. In this way, the urethra and sphincter muscles are supported and less likely to open by accident.
Patients undergoing bladder neck suspension may be given general anesthesia. The surgery may be open (using an abdominal incision to reach the area) or laparoscopic (using a smaller incision, specially designed instruments, a camera, and a video monitor).
Other terms for this procedure include retropubic suspension, colposuspension, and Burch suspension.
Artificial sphincter (for men)
An artificial sphincter system is a 3-part device that is surgically implanted. The system includes an inflatable cuff (which wraps around the urethra), a balloon reservoir (placed in the belly), and an activation pump (placed in the scrotum).
The cuff acts as the sphincter itself. Normally, it is filled with fluid. This arrangement keeps the urethra closed so urine won’t leak out.
When a man needs to urinate, he presses the pump in his scrotum. Then, the fluid flows out of the cuff into the balloon reservoir, which holds the fluid temporarily. At this point, the urethra opens, and urine can flow out.
Once he’s finished urinating, the man presses the pump again. The fluid flows from the reservoir back to the cuff, closing the urethra once again.
Catheterization
In rare cases, people with overflow incontinence might need to use a catheter—a flexible tube that drains urine from the bladder into the toilet or into a collection bag. There are several type of catheters. Some are permanent, but others can be inserted and removed as needed by the patient or a caregiver at home.
Surgery to remove blockage
If incontinence is caused by an obstruction, surgery can be done to clear the pathway. For example, men with an enlarged prostate might have excess prostate tissue removed, relieving pressure on the urethra. This makes it easier for urine to flow out.
Augmentation cystoplasty (bladder enlargement)
This procedure makes the bladder larger, so it can hold more urine. People who undergo augmentation cystoplasty might still be unable to completely empty their bladder. They may need to use a catheter for the long term.
Resources
American College of Obstetricians and Gynecologists
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
Urologic Emergencies
The urinary tract is a complex group of organs that includes the kidneys, ureters, bladder, and urethra, plus nerves and muscles. Working together, these components clear waste from the body in the form of urine. For most people, urinating several times a day is part of their daily routine.
There are times, however, when the urinary tract doesn’t work as well as it should. Whether it’s from injury or infection, a person can have a range of symptoms, including pain, trouble with the urine flow, and blood in the urine.
When a person has symptoms like these, it can be hard to know what to do. Should a person wait and see what happens? Or could there be an emergency that needs immediate care?
It’s important to know what constitutes a urologic emergency and how to handle it. This article covers the following urologic emergencies and discusses the definition, symptoms, causes, and treatments for each one. It also explains how one might reduce the risk of such an emergency:
As you read about the conditions below, you’ll see that blood in the urine (hematuria) is a common symptom of urologic emergencies. Indeed, it can be upsetting to discover blood in your urine. This situation does not always signify an emergency, but it’s best to have it checked out by a doctor, along with any other symptoms you’re having.
Paraphimosis
What is paraphimosis?
Men who are not circumcised still have the foreskin of their penis. Typically, they pull back the foreskin when they clean their penis, urinate, or have sex. The foreskin may also be retracted if a man has a catheter during a surgical procedure.
Paraphimosis happens when the foreskin gets stuck in this retracted position. The man is unable to pull the foreskin forward over the head of the penis.
What are the symptoms of paraphimosis?
In addition to being unable to pull the foreskin forward, men with paraphimosis may have pain, swelling, trouble urinating, and discoloration of the penis (blue or black).
What causes paraphimosis?
Paraphimosis may develop if the penis has been injured. Infection is another cause, especially if a man has poor hygiene. It can also happen if a man does not pull the foreskin forward again after bathing or urinating.
Why is paraphimosis an emergency?
Without treatment, paraphimosis can lead to poor blood flow to the tip of the penis, cutting off the blood and oxygen supply. If this happens, there can be tissue damage or tissue death (gangrene).
How is paraphimosis treated?
Men with paraphimosis should seek treatment immediately.
To start, the doctor will try to reduce swelling at the tip of the penis. This can be done by gently squeezing the area for up to 30 minutes. Sometimes, ice is applied. Once the swelling is reduced, it may be possible to move the foreskin forward.
If this approach isn’t successful, there are other options:
Using medications to reduce swelling.
Cutting a small slit into the foreskin to loosen it so that it can be pulled forward.
Doing a circumcision (surgically removing the foreskin).
If there is an infection, the doctor may prescribe antibiotics.
How might paraphimosis be prevented?
Getting circumcised is the only way to completely prevent paraphimosis. But men can reduce their risk by making sure the foreskin is pulled forward again to cover the tip of the penis after urinating, sex, washing, and medical procedures.
Priapism
What is priapism?
Priapism is an erection that lasts for 4 hours or longer.
Typically, when a man has an erection, his penis fills with blood, which makes it firm. Veins constrict to keep the blood in. After he ejaculates (or when sexual stimulation stops), the veins open again and the blood flows back into the body.
Priapism usually isn’t related to sexual activity.
There are two types of priapism:
Ischemic priapism (also called low-flow priapism) occurs when blood cannot flow out of the penis. This is the most common type.
Nonischemic priapism (also called high-flow priapism) occurs when more blood than usual flows into the penis.
What are the symptoms of priapism?
The main symptom of priapism is an erection lasting several hours. However, other symptoms can vary depending on the type of priapism.
Ischemic priapism is usually painful. The shaft of the penis may be hard, but the tip may be soft.
Nonischemic priapism tends to be less painful, but the shaft and tip may remain firm.
What causes priapism?
Priapism can have several causes. Some of the more common ones include:
Blood diseases, such as sickle cell anemia or leukemia
Side effects to medications, like some erectile dysfunction drugs and antidepressants
Trauma to the genital area or spinal cord, such as from an accident
Use of alcohol or recreational drugs, such as marijuana or cocaine
Why is priapism an emergency?
When blood is trapped in the penis, it does not receive enough oxygen. If this situation lasts a long time, tissues in the penis can be severely damaged. Erectile dysfunction can also result.
The longer the delay of treatment, the greater the risk of damage.
How is priapism treated?
Doctors make treatment decisions based on the type of priapism a person has.
If a man has ischemic priapism, blood will need to be drained from the penis as soon as possible. Doctors may use one of the following techniques:
Aspiration. Blood is drained with a surgical needle and syringe.
Injection of medication or saline. This helps blood flow out of the penis.
Surgery. Surgical procedures might be done to drain the blood. A shunt may be placed to reroute the blood flow.
Men with nonischemic priapism may not need treatment, as the erection may go away on its own. Ice packs and pressure on the perineum (the area between the anus and the scrotum) might help. If blood vessels have been damaged, they may be repaired with surgery.
Only a doctor can determine the type of priapism, so it’s critical to seek emergency care.
How might priapism be prevented?
Men with blood disorders may reduce their risk for priapism by following the treatment plan prescribed by their doctor. Men should also be careful about the prescription medications they take and limit their use of alcohol and recreational drugs. If priapism is a side effect of medication, the drug may be changed, but this should be done under a doctor’s care.
Decreasing risk of injury, such as wearing seatbelts in the car, may also reduce risk of priapism.
Penile Fracture
What is penile fracture?
Penile fracture refers to a tear in the tunica albuginea, the layer of tissue that coats and protects the corpora cavernosa—two cylinders in the penis that fill with blood during an erection. (Note: There are no actual bones in the penis.)
A fracture happens when there is trauma to the erect penis. For example, if the penis is hit or severely bent, it may fracture.
What are the symptoms of penile fracture?
A popping or cracking sounds when the fracture occurs
Sudden, intense pain
Swelling
Bruising
Blood at the tip of the penis or in the urine
Loss of erection
What causes penile fracture?
Penile fracture can happen:
During intercourse.
If a man masturbates vigorously.
If a man falls on or rolls over on his erect penis.
During taqaandan, a cultural practice in which men bend the tip of their penis to stop an erection.
Why is penile fracture an emergency?
Without treatment, a penile fracture can lead to a curved penis or erectile dysfunction (ED). Men may also start having trouble urinating, and scar tissue could form.
How is penile fracture treated?
Men with penile fracture usually have surgery to repair the tunica albuginea.
How might penile fracture be prevented?
Men can reduce their risk for penile fracture by being especially cautious during sex and by not practicing taqaandan.
Fournier’s Gangrene
What is Fournier’s gangrene?
Fournier’s gangrene is a rare, but life-threatening, bacterial infection that can affect the genitals and perineum. (In men, the perineum is the area between the anus and the scrotum. In women, it’s the area between the anus and the vulva.) In more severe cases, it may affect the thighs, stomach, and chest.
If not caught early, Fournier’s gangrene can cause serious tissue damage, organ failure, and death. Patients with this illness may need to spend several weeks in the hospital.
Fournier’s gangrene is 10 times more common in men than in women.
What are the symptoms of Fournier’s gangrene?
A person with Fournier’s gangrene may have the following symptoms:
Pain
Tenderness and swelling in the genitals or perineum
Discolored skin (such as red, purple, brown, or black)
Itching
Fever and chills
Nausea and vomiting
Foul odor
Mental changes
Dehydration
Lethargy
What causes Fournier’s gangrene?
Fournier’s gangrene can be caused by several types of bacteria, including E. coli, staphylococcus (“staph”) and streptococcus (“strep”). Sometimes it’s caused by a combination of bacteria.
There are many ways bacteria can enter the body. Examples include genital piercings, scratches or burns on the body, urinary tract infections, insect bites, and sex.
Why is Fournier’s gangrene an emergency?
Fournier’s gangrene is a type of flesh-eating disease. It can quickly destroy blood vessels, muscles, and nerves.
Without prompt treatment, a person can go into septic shock, a life-threatening condition that causes organs to shut down.
How is Fournier’s gangrene treated?
Surgery to remove damaged tissue is often necessary. (Reconstruction surgery to rebuild these areas might occur at a later date.) Antibiotics and other medicines may also be prescribed.
Some patients undergo hyperbaric oxygen therapy, where they inhale pure oxygen. This type of therapy is often associated with scuba divers who get decompression sickness, but it is also used to fight bacteria and heal wounds.
How might Fournier’s gangrene be prevented?
Good hygiene and proper wound care can reduce a person’s risk for Fournier’s gangrene and infections in general. People should also make sure they seek urgent medical care if they notice any redness, tenderness, or swelling in their genitals. For best outcomes, Fournier’s gangrene must be treated as quickly as possible.
Urethral Injuries
What are urethral injuries? What causes them?
The urethra is the tube that allows urine to exit the body. It can be torn or crushed during trauma.
There are several situations that can cause urethral injuries:
Trauma, such as from a car accident or serious fall
Straddle injuries, when a person is hit hard between the legs
Vaginal childbirth
Problems with catheters or other urological devices
Sexual assault and violence involving weapons
Vigorous sexual intercourse
What are the symptoms of urethral injuries?
Common symptoms of urethral injuries include:
Pain in the genitals or abdomen
Swelling
Trouble with urination
Blood in the urine (hematuria)
Blood at the tip of the penis
Bruising on the perineum
Why are urethral injuries an emergency?
Without prompt treatment, urethral injuries can make a person more prone to infections that can affect the urinary tract and kidneys. Urethral injuries may also make it difficult for urine to leave the body, increasing the risk of infections and kidney damage.
Urethral stricture—a narrowing of the urethra—is another potential complication. When this happens, it becomes difficult to empty the bladder.
How are urethral injuries treated?
Urethral injuries are often treated with surgery to repair the tear and other damage. In some cases, a catheter may be placed in the urethra or bladder so that urine can drain while the urethra heals. Patients may receive antibiotics if they have an infection.
How might urethral injuries be prevented?
A person can reduce their risk for urethral injuries by taking the following precautions:
Drive safely and wear seat belts.
Operate other motor vehicles and machinery safely.
Use protective gear, such as athletic supporters, while playing sports.
Make sure the home is safe and use assistive devices to prevent falls.
Be gentle during sexual activities. Use lubricant.
Testicular Torsion
What is testicular torsion?
Testicular torsion affects the testicles (also called the testes) — two egg-shaped organs found in the scrotum (a sac located beneath the penis). Testicles produce hormones and sperm cells. Each testicle is attached to a spermatic cord, which provides the blood supply needed to keep the testicle healthy.
Sometimes, a testicle and its spermatic cord become twisted, blocking the blood supply to the attached testicle. This is called testicular torsion.
What are the symptoms of testicular torsion?
Men experiencing testicular torsion usually have sudden, intense pain in the testicle. The pain may spread to the abdomen. One testicle may be higher than the other.
There may also be:
Swelling
Discoloration of the scrotum
A lump on the testicle
Nausea and vomiting
Fever
A need to urinate more often
Testicular torsion is possible in both testicles, but it usually affects just one.
What causes testicular torsion?
Testicular torsion usually affects people with a “bell clapper” deformity in their scrotum. Typically, there is tissue that attaches the testicle to the wall of the scrotum, which keeps it from twisting. But some men are born without this attaching tissue, so the testicle swings as a bell clapper would.
Often, there is no specific event that triggers testicular torsion. It can happen while a man is active or sedentary.
Why is testicular torsion an emergency?
The testicle cannot live long without an adequate blood supply. If testicular torsion is not treated within 6 hours, there can be permanent damage to the testicle, and it may need to be surgically removed.
Some men have lower sperm counts after testicular torsion.
How is testicular torsion treated?
Testicular torsion is treated with surgery. The surgeon untwists the spermatic cord so that blood flow can resume. If the testicle can be saved, the surgeon uses stitches to attach it to the scrotum wall, so that it cannot twist again. The other testicle may also be stitched to the scrotum wall to prevent twisting on that side.
If the testicle cannot be saved, it is removed.
How might testicular torsion be prevented?
Men with bell clapper deformity may prevent future episodes of testicular torsion by having their testicle surgically attached to the scrotum wall.
Testicular Rupture
What is testicular rupture?
A man’s two testicles are important for his reproductive health. They produce the hormone testosterone as well as sperm cells.
The testicles are found in the scrotum, a sac near the penis. Each testicle is protected by a membrane called the tunica albuginea. However, the testicles are not protected by muscles or bones, so they can be especially vulnerable to injury.
Testicular rupture occurs when there is forceful trauma to the testicle. Without prompt treatment the testicle can be severely damaged or lost.
What are the symptoms of testicular rupture?
Men feel intense pain when their testicle is ruptured. They may also have:
Bruising and swelling in the area
Blood in the urine
Problems with urination
A fever
What causes testicular rupture?
Testicular rupture is caused by blunt force or piercing injuries, such as the following:
Vehicular accidents
Falls
Injuries while playing sports
Violence involving knives or guns
Why is testicular rupture an emergency?
If a testicular rupture is not treated quickly, there is a greater risk of infection. Blood supply to the testicle can also be compromised. Without good blood supply, the testicle cannot survive.
How is testicular rupture treated?
Men with testicular rupture usually have surgery to repair it. If the rupture is severe, the testicle may need to be removed.
How might testicular rupture be prevented?
Men can reduce their risk for testicular rupture by taking these precautions:
Drive safely and wear seat belts.
Operate other motor vehicles and machinery safely.
Use protective gear, such as athletic supporters, while playing sports.
Being careful to avoid injury to the genital area.
Acute Kidney Injury
What is acute kidney injury?
Acute kidney injury (AKI) is a sudden instance of kidney failure. When AKI happens, the kidneys can no longer filter the blood effectively. As a result, waste products like creatinine and urea accumulate in the blood.
AKI usually begins over the course of a few hours or days. It often affects older people and patients who are already in the hospital for another illness. Chronic kidney disease, diabetes, and dehydration can increase a person’s risk for AKI.
When it is severe, it can be life-threatening.
An older term for AKI is acute renal failure.
What are the symptoms of acute kidney injury?
Many people don’t have symptoms until the later stages of AKI. However, symptoms typically include:
Passing less urine than usual
Swelling
Fatigue
Nausea
Shortness of breath
Chest pain
Confusion
Seizures or coma
What causes acute kidney injury?
There are many conditions and situations that can lead to AKI. Here are some examples:
Conditions that decrease blood flow to the kidneys, such as low blood pressure, severe diarrhea, heart failure, and organ failure
Conditions that cause kidney damage, such as sepsis, multiple myeloma, vasculitis, and interstitial nephritis
Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
Why is acute kidney injury an emergency?
Without treatment, AKI can lead to permanent kidney damage and, in rare cases, death. It can also upset the balance of fluids and electrolytes in the body as waste products accumulate in the blood.
How is acute kidney injury treated?
Doctors treat AKI by treating the condition that causes it. For example, if medication is the cause, the doctor may prescribe alternatives. If there is an infection, then that will be treated.
In severe cases, patients with AKI are put on dialysis. Dialysis is a procedure that filters the blood when the kidneys are unable to do so.
How might acute kidney injury be prevented?
People can lower their risk for AKI by paying attention to their kidney health and managing conditions that are risk factors, like dehydration, diabetes, high blood pressure, and heart disease.
Obstructed Pyelonephritis (Pyonephrosis)
What is obstructed pyelonephritis?
The word pyelonephritis refers to a kidney infection. A person with obstructed pyelonephritis has a kidney infection along with a blockage in the urinary tract.
What are the symptoms of obstructed pyelonephritis?
Symptoms of obstructed pyelonephritis tend to come on suddenly, over the course of a few hours or within a day. They may include:
Pain in the lower back or flank
Pain or burning sensation during urination
Fever or chills
Nausea or vomiting
Bloody urine
Needing to urinate more frequently or urgently
Releasing less urine than usual
Confusion or changes in mental state
Shortness of breath
What causes obstructed pyelonephritis?
Most of the time, obstructed pyelonephritis is caused by a bacteria, although sometimes it’s caused by a virus. The bacteria typically enter the body through the urethra, then travel up the urinary tract.
In addition to the bacteria, there is a blockage in the urinary tract. This obstruction might be caused by kidney stones, an enlarged prostate, uterine prolapse, or another condition. Because the blockage makes it harder for urine to leave the body, bacteria can grow in the backed-up urine.
Why is obstructed pyelonephritis an emergency?
Without treatment, obstructed pyelonephritis can lead to kidney failure, kidney damage, abscesses, sepsis, or blood clots in the veins of the kidney.
How is obstructed pyelonephritis treated?
Obstructed pyelonephritis is treated with antibiotics and other medicines. Some patients need to be hospitalized. In some cases, surgical drainage may be needed.
How might obstructed pyelonephritis be prevented?
People might lower their risk for obstructed pyelonephritis by:
Staying properly hydrated.
Emptying the bladder whenever they urinate.
Wiping from front to back after using the bathroom.
Urinating before and after sexual activity.
Keeping the genital area clean.
Bladder Injury
What is a bladder injury? What causes it?
The bladder is the organ that stores urine after it is produced by the kidneys. It can be damaged through blunt force (such as in a motor vehicle accident or while playing sports). It may also be torn by penetrating injuries (such as knife or gunshot wounds).
What are the symptoms of a bladder injury?
A person with a bladder injury may have symptoms like these:
Pain in the abdomen or back
Blood in the urine
Blood or urine coming from the vagina.
Difficulty with urination or inability to urinate at all
Painful or frequent urination
Fever
Bruising
Why is a bladder injury an emergency?
Without prompt treatment, a bladder injury can have complications such as:
Sepsis
Infections
Kidney problems
Permanent bladder damage
Urinary incontinence
Fistulas (connections between two organs that don’t typically connect, such as the bladder and the intestines)
How is a bladder injury treated?
Treatments for bladder injuries depend on the severity of the injury.
In mild cases, patients may have a temporary catheter to drain urine out of the body. This gives the bladder a chance to heal.
More serious cases may require surgery to repair the tear or other damage.
Medications to manage pain and treat any infections may also be prescribed.
How might a bladder injury be prevented?
People may lower their risk of bladder injuries by following safety precautions when operating motor vehicles and playing sports.
Acute Urinary Retention
What is acute urinary retention? What are the symptoms?
Acute urinary retention occurs when a person is unable to urinate, even if they have a full bladder. (In some cases, people may urinate only a very small amount.) It comes on suddenly and can be quite painful. People may have abdominal swelling and still feel the need to empty their bladder.
This condition is different from chronic urinary retention, in which a person can still urinate, but their bladder doesn’t empty. Chronic urinary retention occurs gradually and is not an emergency.
Acute urinary retention is more frequent in older men, and the risk increases with age. Women and children are less likely to develop acute urinary retention.
What causes acute urinary retention?
In men, acute urinary retention is often caused by an enlarged prostate gland. The prostate is a walnut-sized gland in a man’s reproductive system. The urethra (the tube that allows urine to exit the body) runs right through the middle of the prostate.
As men get older, their prostate tends to get larger. However, the direction of this growth is inward rather than outward. As a result, excess prostate tissue can squeeze the urethra, making urination more difficult. And in some cases, the growth can block urine flow completely.
Other causes of acute urinary retention may include:
Urethral stricture (narrowing of the urethra)
Urinary stones
Side effects of medications, such as some antihistamines and antidepressants
Without treatment, acute urinary retention can lead to bladder and kidney damage. Bacteria that remain in the bladder can cause a urinary tract infection.
How is acute urinary retention treated?
In the emergency department, the doctor will insert a urinary catheter into the bladder to drain it.
After the initial emergency is addressed, the doctor may suggest treatments for the underlying cause of the retention. For example, an enlarged prostate may be treated with drugs or medical procedures. Urethral stricture may be treated with surgery. If medications are the cause, the doctor may adjust the dose or change the prescribed drug.
How might acute urinary retention be prevented?
People might lower their risk for acute urinary retention by:
Not holding their urine
Staying hydrated
Getting enough fiber in their diet
Exercising regularly
Doing pelvic floor exercises
Taking medicine as prescribed
Kidney Stones
What are kidney stones? What causes them?
Kidney stones are small masses that form in your kidney. They form from a buildup of substances, like calcium and uric acid, that crystallize and form stones. Some stones pass on their own, but others get stuck in the urinary tract.
What are the symptoms of kidney stones?
Some of the common symptoms of kidney stones are:
Pain
Blood or “sand” in the urine (Sand refers to tiny stones that pass in the urine, which resemble sand or gravel.)
Changes in urination
Nausea
Fever or chills
Why might kidney stones be an emergency?
Kidney stones are not always an emergency. In fact, some people with kidney stones have no symptoms at all. Others have mild symptoms that can be managed with medication at home until the stones pass.
However, for some people, the pain of kidney stones is intense. Also, the size of the stone and the potential for hydronephrosis (swelling of the kidney) can be concerns. In those cases, going to an urgent care clinic or emergency room is recommended.
How are kidney stones treated?
Severe kidney stones can be treated in several ways:
Ureteroscopy. A thin, long tube is threaded through the urinary tract and into the kidney. This tool can remove stones or break them down to be passed through urine.
Shock wave lithotripsy (SWL). Shock waves, administered through the skin, break down the stones so they can pass.
Percutaneous nephrolithotomy (PNL). Stones are surgically removed through a small incision in your back or side.
Kidney stones are not always an emergency. However, for some people, the pain of kidney stones is intense.
How might kidney stones be prevented?
You can lower your risk for kidney stones by staying hydrated (drinking plenty of water). If you have had stones before, your doctor may recommend a special diet or taking prescribed medications.
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
