Urinary Tract Infection (UTI) in Males

Urinary Tract Infection (UTI) in Males is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • See Also:
    • Cystitis is an infection of the lower urinary tract, usually resulting from a single gram-negative enteric bacteria. (“Prostatitis,” “Pyelonephritis,” and “Urethritis.”)
  • System(s) affected: renal/urologic
  • Synonym(s): urinary tract infection (UTI); cystitis
  • Conventional consideration of UTI in male newborn, infant, and elderly men is complicated, with associated functional/structural mechanisms.
  • In otherwise healthy males ages 15 to 50 years, UTI is uncommon and considered uncomplicated.

Epidemiology

Incidence
  • Approximately 20% of UTIs occur in men.
  • Predominant age: increases with age
  • Uncommon in men <50 years of age
  • 6 to 8 infections/10,000 men aged 21 to 50 years (1)

Prevalence
Lifetime prevalence approximately 14%

Etiology and Pathophysiology

  • Escherichia coli (majority of infections)
  • Klebsiella
  • Enterobacter
  • Enterococcus
  • Proteus
  • Serratia
  • Citrobacter
  • Providencia
  • Streptococcus faecalis and Staphylococcus sp.
  • Pseudomonas and Morganella (more common in elderly and catheterized patients)
  • Pathogenesis—bacterial entry into urinary tract via ascension or bladder instrumentation

Genetics
Not applicable

Risk Factors

  • Age
  • Obesity
  • History of prior UTI
  • Outlet obstruction
    • Benign prostatic hypertrophy (BPH)—incidence of 33% of men with UTIs (2)
    • Urethral stricture
    • Calculi
  • Cognitive impairment
  • Fecal incontinence
  • Urinary incontinence
  • Anal intercourse
  • Recent urologic surgery
  • Infection of the prostate/kidney
  • Urinary tract instrumentation, catheterization
  • Immunocompromised host
  • Diabetes
  • Bladder diverticula
  • Neurogenic bladder
  • Institutionalization
  • Uncircumcised
  • Engaging in sex with an infected female partner or in anal intercourse (1)

General Prevention

  • Prompt treatment of predisposing factors
  • Use a catheter only when necessary; if needed, use aseptic technique and closed system and remove as soon as possible.
  • Currently, cranberry products are not recommended for preventing UTIs in men.

Commonly Associated Conditions

  • Acute bacterial pyelonephritis
  • Chronic bacterial pyelonephritis
  • Urethritis
  • Prostatitis
  • Prostatic hypertrophy
  • Prostate cancer

Geriatric Considerations
Bacteriuria is common among the elderly; may be related to functional status and usually is transient. Of men >65 years of age, 5–10% have asymptomatic bacteriuria (ASB). If ASB is noted, no treatment is needed (3,4).

Pediatric Considerations
Can be associated with obstruction to normal flow of urine, such as vesicoureteral reflux. Unique diagnostic criteria and evaluation recommendations exist (see below).

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Citation

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TY - ELEC T1 - Urinary Tract Infection (UTI) in Males ID - 1688035 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688035/all/Urinary_Tract_Infection__UTI__in_Males PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -