Why You’re Getting Recurring UTIs and How to Treat Them

A urinary tract infection (UTI) appears when bacteria invade the urinary tract, which causes infection as well as inflammation. The urinary tract includes the kidneys, ureters (the tubes transferring urine from the kidneys to the bladder), and urethra (the tube that carries urine to the outside world). It is generally assumed that the urinary tract is sterile. The infection can be in the kidneys (upper UTI) or bladder (lower UTI or what commonly is just called “UTI”). UTIs are common in females, and bladder infection represents most of these infections. Roughly 20% of women develop at least one UTI during their lifetime.

UTI Symptoms

The characteristic symptoms of “UTI” (bladder infection a.k.a. “lower UTI”) in the adult are mainly painful or burning urination with associated urinary frequency and urgency. Additionally, bladder or lower abdominal fullness/discomfort is frequently present. Bloody urine may accompany the above symptoms. Another consideration is urinary incontinence. These “accidents” with uncontrolled loss of urine may be the only symptom in the elderly. Symptoms such as fevers, chills, and low back pain are more frequently reported in patients with a “kidney infection” or “upper UTI”.

The “gold standard” for the diagnosis of UTI is a positive urine culture, which means a certain number of bacteria grow in the patient’s urine over 2 days or so. Initially, a UTI should be categorized as complicated or uncomplicated. E. coli is the most common cause of UTIs. Among the bacteria responsible for the remainder of UTIs are other “colonic” bacteria and some “Staph” species. Overall, the incidence of UTI in women tends to increase with advancing age.

Recurring UTIs

Experts agree the continuous unidirectional flow of urine helps to minimize UTIs by constantly flushing bacteria out, and anything that interferes with this increases the host’s susceptibility to UTI. But what about a recurring UTI? A “recurring UTI” is three or more episodes of a UTI in the last year or two episodes within the previous 6 months. Even with effective treatment, however, about 25% of women will experience a recurrence. Most recurring UTIs are thought to represent reinfection with the same organism. E. coli is responsible for causing approximately 75% of recurring UTIs. Recurring UTIs are common in women. Almost one in five women will get a recurring UTI, including healthy women with normal urinary tract anatomy. Women who have more than three UTIs are more likely to continue having them.

UTI in Men

Men can also have recurring UTIs, but this is not as common in men as in women. In many cases, men with recurring UTIs have some type of urinary obstruction. Symptoms of a recurring UTI in men and women are typically the same as a single acute UTI. Some authorities believe men who have not been circumcised can experience frequent UTIs if there is a build-up of bacteria and urine in the foreskin. The take-home message is a UTI is never a simple one in males and needs urologic evaluation as to why it occurred.

How are Recurring UTIs Contracted?

Common conditions that can lead to recurring UTIs include residence in a nursing home or hospital, diabetes mellitus, kidney or bladder stones, having a catheter, previous urinary tract surgery, sexual activity, having an infected or enlarged prostate (BPH), and being born with an abnormality of the urinary tract. Established risk factors for recurring UTIs include intercourse in the past month (> 9 times), age at first UTI > 15, maternal history of UTI, new sexual partner in the past year, and spermicide use in the past year. In postmenopausal women, the risk of recurring UTI is primarily increased by the sequelae of lower estrogen levels and changes in normal vaginal bacteria that favor easier growth of harmful ones. Interestingly, frequency of sexual intercourse is the strongest predictor of recurring UTIs in women presenting with recurrent UTIs.

How are UTIs and Recurring UTIs Treated?

UTIs are treated based on symptoms diagnosed after a urine culture is obtained. This establishes the diagnosis and guides precise antibiotic therapy based on the reported sensitivity results. Uncomplicated recurring UTIs in women can be treated with a three-day or longer course of antibiotics (single day not recommended) as determined by their healthcare professional. For some cases, antibiotic prophylaxis in form of a small everyday dose for recurring UTIs is prescribed. In fact, continuous daily and post-coital (after sex) low-dose antibiotic regimens have been shown to decrease recurring UTIs by almost 95%. This is utilized only in a small number of cases as determined by the physician since both can lead to rapid development of resistant infections.

UTI Prevention

In addition to antibiotics, simple things patients can do to help prevent recurring UTIs consist of drinking plenty of fluids (water), not postponing urination, urinating frequently and to completion. Interestingly enough and contrary to popular belief, comprehensive studies have not shown any benefit for other commonly prescribed methods including cranberry juices or extracts, donning cotton underwear, and cleaning from front-to-back after a bowel movement or urination.

In summary, recurring UTIs can be a major health problem. If you feel you have the symptoms of an acute or recurring UTI, we encourage you to contact our practice. Our highly-qualified team of urologists is here to answer questions and provide treatment options for your recurring UTIs.

Sources
https://www.everydayhealth.com/sexual-health/urinary-tract-infections-keep-coming-back.aspx
https://www.healthline.com/health/chronic-urinary-tract-infection
https://www.aafp.org/afp/2010/0915/p638.html
https://emedicine.medscape.com/article/2040239-overview

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What is HIFU Treatment for Prostate Cancer?

For a man, one of the most dreaded phrases you can hear from a urologist is, “You have prostate cancer.” Today, prostate cancer is one of the most prevalent diseases among men in the United States. The American Cancer Society estimates that 1 in 7 men will be diagnosed with this cancer in their lifetime. Major risk factors for the development of prostate cancer include:

• Advancing age: The majority of men diagnosed with prostate cancer are over the age of 65. It rarely occurs in men younger than the age of 40.
• Race/ethnicity: African-American men are 2.5 times more commonly diagnosed and die from prostate cancer than men of other races/ethnicities (e.g., Hispanic, Asian-American, and non-Hispanic whites). The reason(s) for these racial/ethnic disparities are not fully understood.
• Family history: Prostate cancer can run in families, which suggests a genetic predisposition toward the disease. Having a first-degree relative (i.e., father, brother, or son) with prostate cancer more than doubles a man’s risk of developing the disease.

After skin cancer, prostate cancer is the second most common cancer. It is also the second leading cause of cancer deaths (after lung cancer) among men in the United States. Prostate cancer screening entails both a blood test (prostate-specific antigen [PSA]) and a digital rectal examination (DRE). The recommended age for commencement of screening is:

• 50 years of age for men at average risk who have at least a 10-year life expectancy
• 40 or 45 years of age for African Americans and men who have had a first-degree relative diagnosed with prostate cancer before age 65 years
• 40 years of age for men with several first-degree relatives who had prostate cancer at an early age.

Fortunately, when diagnosed in its earliest stages, prostate cancer can be safely and successfully treated in a variety of ways.

Traditionally, prostate cancer treatment has been restricted to surgery (complete removal of the gland, which is termed a radical prostatectomy) or radiation therapy, both of which can be effective and even life-saving. Surgery is the treatment of choice for disease appearing to not have spread outside of the prostate gland. The surgery can be performed via a single long incision (open), through several small incisions using special tools (laparoscopic), and even robots (robot-assisted laparoscopic). Radiation therapy uses high-energy rays to kill cancer cells. The two main types of radiation therapy are external beam radiation and internal radiation (brachytherapy). Brachytherapy is also known as seed implantation.

Worth noting is the treatment option termed watchful waiting or active surveillance. Other terms utilized by physicians may include observation or expectant management. All of these strategies are based on the fact that prostate cancer is a very slow growing cancer and many men (especially those over the age of 70 with a life expectancy less than 10 years) may succumb to other diseases before the cancer. As a result, there is no need for aggressive or curative treatment of the cancer. Other treatments in the armamentarium (depending on the disease burden) against prostate cancer may include cryotherapy (cryosurgery), hormone therapy, chemotherapy, vaccine treatment, bone-directed treatment, and/or high intensity focused ultrasound (HIFU, which is an emerging treatment option).

Unfortunately, traditional prostate cancer treatments (i.e., surgery or radiation therapy) not only affect the entire prostate gland and cancer cells in it, but also cause other adverse effects in adjacent organs/tissues. When it comes to prostate cancer treatment, these adverse effects may lead most commonly to the “troublesome trio”:

• Urinary incontinence (loss of bladder control after surgery) or bladder irritation (after radiation therapy)
• Residual (remaining) cancer cells or lesions after surgery and/or radiation therapy
• Adverse effects on sexual function (most notably erectile dysfunction [ED])

A Less Invasive Alternative: High-Intensity Focused Ultrasound (HIFU)

Accordingly, many men seeking treatment for prostate cancer are searching for alternative procedures that are as potent as the traditional choices (if not greater) but with fewer negative/adverse effects. Moreover, patients want alternative options that do not negatively impact traditional cancer treatments and provide quicker recovery times. HIFU is a cutting-edge, alternative and emerging prostate cancer treatment option. It can treat the entire prostate or only the parts that have cancer cells. Depending on the area being treated, the HIFU procedure can take between one and four hours. The procedure has the potential to provide a cure while maintaining sexual function and urinary control in appropriate patients.

HIFU Procedure

HIFU is a procedure that utilizes high-frequency ultrasound waves to heat and destroy/kill cancer cells within the prostate gland. The HIFU probe is inserted into the rectum (which provides the easiest access to the gland) and (using computer imaging) situated at the precise position near the prostate gland. The probe focuses the ultrasound waves on an exceedingly small area (no larger than a grain of rice) and heats up to almost 100 degrees Celsius in as little as three seconds. The highly focused treatment area ensures that the normal tissue outside of its focus remains undisturbed as the ultrasound waves pass through the body, resulting in minimal to no adverse side effects while providing a chance for cure.

Who is a Candidate for and What are the Benefits of HIFU Treatment of Prostate Cancer?

HIFU is an ideal treatment for men who have been diagnosed with prostate cancer that has not yet spread beyond the prostate gland (also termed organ-confined prostate cancer). HIFU has numerous benefits over traditional treatments for prostate cancer (i.e., surgery, radiation therapy, and/or hormone therapy), including the following:

• Minimally invasive procedure – HIFU is state of the art treatment for prostate cancer and its innovative design allows precise, targeted ultrasound wave therapy, ensuring only cancer cells are affected. Traditional treatments (i.e., surgery and radiation) are inherently invasive. Additionally, ultrasound waves are benign (i.e., do not harm/damage surrounding tissue).

• Quicker recovery time – Because it is a minimally invasive treatment, HIFU causes only minimal cell damage to the prostate as a whole, as well as no blood loss or similar trauma. As a result of their invasiveness, traditional prostate cancer treatments tend to have prolonged recovery times. HIFU allows patients to return to a normal schedule within a few days after treatment.

• Decreased risk of ED/sexual impotence – Since HIFU is a minimally invasive procedure, the risk of ED/sexual impotence is decreased. Traditional prostate cancer treatments such as surgery, radiation therapy, and hormone therapy can negatively impact sexual function and ultimately interfere with the ability to have and maintain an erection. Today, this is a very important consideration for men who have the potential to remain virile well beyond the age of 50.

• No hospital stay required – As a result of it being minimally invasive, HIFU can be performed as an outpatient/same-day procedure, which does not necessitate a hospital stay. Patients are discharged home after treatment to convalesce.

• Better preservation of bladder control (i.e., less urinary incontinence) – Because treatment with HIFU uses precise, targeted ultrasound technology to target cancer, the risk of urinary incontinence is greatly reduced. Many men report minimal to no urine leakage and greater bladder control following the procedure. Traditional prostate cancer treatment methods often cause urinary incontinence as a potential adverse effect.

• Quick procedure – Treatment with HIFU is typically a one-time outpatient procedure that can last anywhere between one and four hours (about two hours on average) with no need for a hospital stay. However, it should be emphasized that this does depend on the size of the prostate, as well as the stage or extent of cancer.

• Minimal side effects – In addition to reduced risks of both urinary incontinence and ED, other side effects from HIFU treatment are normally mild or minimal. Patients suffer no loss of blood and there is no need for radiation, incisions, and scars, bandages, or an inpatient hospital stay. Patients may have the need for an indwelling catheter several days after treatment with HIFU, but it is only a temporary precaution.

If you have any questions or would like to learn more about the treatment of prostate cancer with HIFU, please contact Comprehensive Urology in Los Angeles today. As pioneers of HIFU, Comprehensive Urology offers this innovative, alternative approach to the treatment of prostate cancer, along with more traditional methods of treatment for this highly prevalent condition of men. The prostate cancer specialists at Comprehensive Urology have over 125 years of collective experience and have performed more than 3000 prostate surgeries.

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