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Urinary Tract Infection in Men

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Urinary Tract Infection in Men, UTI in Men

  • See Also
  1. Urinary Tract Infection
  • Epidemiology
  1. Significant underlying disorder in 50% of men with UTI
  • Causes
  1. Upper urinary tract causes
    1. Hydronephrosis
    2. Nephrolithiasis (in Kidney or ureter)
      1. Common cause in younger men
    3. Scarred or atrophic Kidney
    4. Pelvic Kidney
    5. Ureter dilation
  2. Lower urinary tract causes
    1. Outflow obstruction with residual urine
      1. Most common cause in men over age 50 years
    2. Diverticulum
    3. Bladder stone
  • Symptoms
  1. Dysuria
  2. Frequency
  3. Urgency
  • Labs
  1. Urinalysis
  2. Urine Culture
    1. All male patients with suspected UTI
  • 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
  • Diagnostic Approach to UTI source
  1. Initial Studies to consider
    1. Abdominal Ultrasound including Bladder and renal Ultrasound
    2. CT Abdomen non-contrast
    3. Urine flow rate (urodynamics)
  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
  3. Modifications to algorithm
    1. Consider CT for Ureteral Stone
  • Management
  1. See Urinary Tract Infection
  2. See Pyelonephritis
  3. See Urethritis
  4. First-line antibiotics in male UTI (treat for 7 days)
    1. Trimethoprim Sulfamethoxazole 160/800 DS orally twice daily for 7 days
    2. Macrobid 100 mg orally twice daily for 7 days
  • References
  1. Andrews (2002) BMJ 324:454-6 [PubMed]
  2. Kurotschka (2024) Am Fam Physician 109(2): 167-74 [PubMed]