Urinary Tract Infection in males

It is unusual for men to have a urinary tract infection (UTI)

  • If a UTI is confirmed further investigations will be required
  • A single UTI in males does not require referral to secondary care

Out of Scope

  • Chronic prostatitis/chronic pelvic pain
  • Epidydimo-orchitis
  • Catheter infections
  • Males with retention caused by infection

Definitions

Urinary tract infection (UTI) is infection of any part of the urinary tract, usually by bacteria, but rarely by other micro-organisms such as fungi, viruses, or parasites.

  • Lower UTI is infection of the bladder. In theory urethritis and prostatitis are also considered lower UTIs, the term 'lower UTI' implies infection of the bladder with no clinical evidence of urethritis, prostatitis, epididymitis, or orchitis.
  • Upper UTI includes pyelitis (infection of the proximal part of the ureters) and pyelonephritis (infection of the kidneys and the proximal part of the ureters).

Risk factors

Most urinary tract infections (UTIs) in men are not associated with any risk factor. Men with a single UTI can be manged in the community and do not require secondary care referral.

The following risk factors may predispose men to a single episode or recurrent UTIs

  • Abnormalities of urinary tract function (for example, neurogenic bladder, vesicoureteric reflux) or structure (renal tract anatomical abnormalities, urinary stones).
  • Incomplete bladder emptying (for example caused by bladder outlet obstruction in men with prostatic enlargement). Previous urinary tract instrumentation or surgery.
  • Men who are immunocompromised (may be more prone to viral and fungal infections).
  • Recurrent UTI is repeated UTI, which may be due to relapse or reinfection, and may be defined as 2 or more episodes of confirmed UTI in 3 months.
    • Relapse is a recurrent UTI with the same strain of micro-organism. Relapse is the likely cause if infection recurs within a short period after treatment (for example within 2-4 weeks).
    • Reinfection is a recurrent UTI with a different strain or species of micro-organism. Reinfection is the likely cause if UTI recurs more than 2 weeks after treatment.
  • Asymptomatic bacteriuria is the presence of significant bacteria in the urine without symptoms or signs of infection. These patients do not require antibiotics or referral.

Assessment

Signs and Symptoms

  • A lower UTI should be suspected if the man has:
    • Dysuria, frequency, urgency, nocturia, or suprapubic discomfort
    • Suprapubic tenderness, and cloudy, bloody, or foul-smelling urine
    • Systemically unwell
    • Confusion or cognitive impairment in the elderly

History and Examination

Focused history and examination

  • Lower urinary tract symptoms (IPPS questionnaire following resolution of infection)
  • Sexual history
  • Digital Rectal Exam (DRE)

Red Flags

Persistent non visible and visible haematuria - see haematuria guideline

Suspected urological cancer - see 2ww guideline

Investigations

  • Midstream Urine Sample (MSU)
  • Consider chlamydia testing
  • Renal and bladder US to exclude anatomical abnormality and check on bladder masses and stones (KUB x-ray where available)
  • Post void residual (<150mls unlikely to be significant)
  • IPPS questionnaire and if available urinary flow test to exclude significant LUTS

True male UTI is rare and if suspected warrants thorough investigation.There is therefore no point in performing a urine dip as MSU is always required.

Management

Men with a single UTI can be manged in the community and do not require secondary care referral.

Relapsing UTI can be managed in the community with a longer course of appropriate antibiotics.

See Formulary chapter 5

Referral

Referral Criteria

  • Indications for acute referral patient systemically unwell (temperature over 38°) not responding to initial antibiotic therapy
  • Signs of upper urinary tract infection/ pyelonephritis
  • Microbiological proven recurrent UTIs
  • A complication of proven UTI not responding to initial therapy for example epidiymo-orchitis
  • UTIs in men with risk factors
    • Abnormalities of urinary tract function (for example, neurogenic bladder, vesicoureteric reflux) or structure (renal tract anatomical abnormalities, urinary stones)
    • Incomplete bladder emptying (for example caused by bladder outlet obstruction in men with prostatic enlargement)
    • Men who are immunocompromised (may be more prone to viral and fungal infections)

Referral Instructions

e-Referral Service Selection

  • Specialty: Urology
  • Clinic Type: Not Otherwise Specified
  • Service: DRSS-Western-Urology-CCG-99P

Referral Forms

DRSS referral form

Supporting Information

Evidence

NICE UTI - men

European Association of Urology

Pathway Group

This guideline has been signed off by NEW Devon CCG and South Devon and Torbay CCG

Publication date: February 2019

 

Home > Referral > Western locality > Urology > Urinary Tract Infection in males

 

  • First line
  • Second line
  • Specialist
  • Hospital