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
  • In otherwise healthy males ages 15 to 50 years, UTI is uncommon and considered uncomplicated.
  • In male newborns, infants, and elderly men UTI is considered complicated, with associated functional/structural mechanisms.

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 per 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
  • Fecal incontinence
  • Urinary incontinence
  • Recent urologic surgery
  • Urinary tract instrumentation/catheterization
  • Infection of the prostate/kidney
  • Immunocompromised
  • Diabetes
  • Bladder diverticula
  • Neurogenic bladder
  • Cognitive impairment
  • Institutionalization
  • Uncircumcised
  • Anal intercourse
  • Intercourse with an infected female partner (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.
  • Cranberry products are not recommended for preventing UTI.

Commonly Associated Conditions

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

Geriatric Considerations
Bacteriuria is more common among the elderly, usually is transient, and may be related to functional status. 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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