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

• 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  2^nd 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

 

 

References

NICE, CKS Lower UTI in men, October 2018

 

Contributors

Mr Christopher Blake, Consultant Urologist, RCHT

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

 

Reviewed: March 2022

Next review due: March 2023