II. Epidemiology
- Significant underlying disorder in 50% of men with UTI
III. Causes
- Upper urinary tract causes
- Hydronephrosis
- Nephrolithiasis (in Kidney or ureter)
- Common cause in younger men
- Scarred or atrophic Kidney
- Pelvic Kidney
- Ureter dilation
- Lower urinary tract causes
- Outflow obstruction with residual urine
- Most common cause in men over age 50 years
- Diverticulum
- Bladder stone
- Outflow obstruction with residual urine
IV. Symptoms
- Dysuria
- Frequency
- Urgency
V. Labs
- Urinalysis
-
Urine Culture
- All male patients with suspected UTI
VI. Differential Diagnosis
- See Dysuria in Men
-
Acute Prostatitis
- Rectal, pelvic or Suprapubic Pain
- Prostate tender on Rectal Exam
- Acute Urethritis
- New sexual partners
- Purulent Urethral discharge
VII. Diagnostic Approach to UTI source
- Initial Studies to consider
- Abdominal Ultrasound including Bladder and renal Ultrasound
- CT Abdomen non-contrast
- Urine flow rate (urodynamics)
- Further evaluation based on initial studies
- No abnormalities
- No further imaging needed
- Upper tract abnormality
- Obtain Intravenous pyelogram
- Lower tract abnormality
- Cystoscopy
- Urodynamics
- Transrectal Ultrasound
- No abnormalities
- Modifications to algorithm
- Consider CT for Ureteral Stone
VIII. Management
- See Urinary Tract Infection
- See Pyelonephritis
- See Urethritis
- First-line antibiotics in male UTI (treat for 7 days)
- Trimethoprim Sulfamethoxazole 160/800 DS orally twice daily for 7 days
- Macrobid 100 mg orally twice daily for 7 days