Urinary Tract Infection in Men

Aka: Urinary Tract Infection in Men, UTI in Men

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II. Risk Factors

  1. Significant underlying risk factor in 50% of men with UTI
  2. Upper urinary tract causes
    1. Hydronephrosis
    2. Nephrolithiasis (in Kidney or ureter)
      1. Common cause in younger men
      2. Infected Ureteral Stone is a medical emergency
    3. Scarred or atrophic Kidney
    4. Pelvic Kidney
    5. Ureter dilation
  3. Lower urinary tract causes
    1. Outflow obstruction with residual urine (e.g. Benign Prostatic Hyperplasia)
      1. Most common cause in men over age 50 years
    2. Bladder Diverticulum
    3. Bladder stone
    4. Posterior Urethral valves
    5. Uncircumsized males

III. Symptoms

  1. Dysuria
  2. Frequency
  3. Urgency

IV. Labs

  1. Urinalysis
  2. Urine Culture
    1. All male patients with suspected UTI

V. Causes: Bacteria

  1. Escherichia coli (50 to 90% of cases)
  2. Other Gram Negative Bacteria (e.g. Proteus, Klebsiella, seratia species)
  3. Sexually Transmitted Infection Urethritis (e.g. Chlamydia trachomatis, Neisseria gonorrhoeae)

VI. Differential Diagnosis

  1. See Dysuria in Men
  2. Acute Prostatitis
    1. Rectal, pelvic or Suprapubic Pain
    2. Prostate tender on Rectal Exam
  3. Acute Urethritis
    1. New sexual partners
    2. Purulent Urethral discharge

VII. Diagnostic Approach to UTI source

  1. Initial Studies to consider
    1. Abdominal Ultrasound including Bladder and renal Ultrasound
    2. CT Abdomen non-contrast for Ureteral Stone
    3. Post-void residual urine
      1. POCUS Bladder Ultrasound followed by a measured void (or repeat Ultrasound after voiding)
      2. Urine flow rate (urodynamics) may be considered later in specialty urology clinic
  2. Further evaluation based on initial studies
    1. No abnormalities
      1. No further imaging needed
    2. Upper tract abnormality
      1. Obtain Intravenous pyelogram
    3. Lower tract abnormality
      1. Cystoscopy
      2. Urodynamics
      3. Transrectal Ultrasound

VIII. Management

  1. See Urinary Tract Infection in Children
  2. First-line Antibiotics in male UTI that is otherwise uncomplicated (treat for 7 days)
    1. See Urinary Tract Infection for other Antibiotic options
    2. Trimethoprim Sulfamethoxazole 160/800 DS orally twice daily for 7 days
    3. Macrobid 100 mg orally twice daily for 7 days
  3. Consider Sexually Transmitted Infection
    1. See Urethritis
  4. Consider management as a complicated infection with ascending infection (Pyelonephritis, Prostatitis)
    1. See Pyelonephritis
    2. See Acute Prostatitis

IX. References

  1. McGann, Deal and Paparella (2024) Crit Dec Emerg Med 38(7): 25-30
  2. Andrews (2002) BMJ 324:454-6 [PubMed]
  3. Kurotschka (2024) Am Fam Physician 109(2): 167-74 [PubMed]

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