Male UTI


Referral criteria

  • Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI)
  • Consider acute admission if severely unwell, with symptoms and signs of urosepsis
  • Refer to urology men who:
    • Have ongoing symptoms despite appropriate antibiotic treatment and  2nd UTI in a man of any age
    • May have an underlying cause or risk factor for the UTI (such as suspected bladder outlet obstruction, or have a history of pyelonephritis, urinary calculi, or previous genitourinary tract surgery).
    • Have recurrent episodes of UTI (for example two or more episodes in a 6-month period).
    • Are younger than 50 years of age and have persistent microscopic haematuria with otherwise normal renal function.
    • LUTS not responding to primary care management
    • Pyelonephritis without an obvious predisposing cause
  • Refer to nephrology men who:
    • Have persistent microscopic haematuria with proteinuria or impaired renal function.


 Primary Care Management

  • Younger (<40) consider: stones, anatomy eg. stricture, STI. If older (>40) consider benign prostatic hypertrophy
  • Ask about uti risk factors such as poor fluid intake, anal sex, previous instrumentation/catheter that might suggest urethral stricture
  • Ask about risk factors for TCC: Smoking and industrial exposure and include in letter if referring.
  • Examine to assess BPH, bladder emptying – consider bladder scan esp if over 40yr
  • USS to look for stones, anatomical abnormalities, and screen for tumour
  • Treat BPH – link to LUTS guidance
  • Wait at least 6 weeks after a proven UTI before PSA testing


Recurrent UTIs

  • Address behavioural/self care measures- adequate hydration/avoid delaying habitual/postcoital urination
  • Consider antibiotic prophylaxis- Discuss risk resistance/adverse effects & review use every 6months


If UTI with indwelling catheter

  • Check catheter correctly positioned/draining
  • Consider removing/changing catheter if in situ>7days
  • Do not routinely prescribe Antibiotics prophylaxis at catheter change but consider this if:
    • History of recurrent symptomatic UTI after catheter change
    • Significant trauma during catheterisation




NICE, CKS Lower UTI in men, October 2018



Mr Christopher Blake, Consultant Urologist, RCHT

Dr Bridgitte Wesson, GP  & Kernow RMS GP Guidelines Lead Urology


Reviewed: March 2022

Next review due: March 2023