- 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
- Arrange an urgent 2-week wait referral if a urological cancer is suspected
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
- 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