- Refer all men with a proven urinary tract infection.
- Take a mid-stream sample before starting antibiotics.
- Start empirical treatment with nitrofurantoin or trimethoprim.
- Emergency referral if pyrexia or loin pain.
- Do not treat UTI in a long-term catheterised man unless systemic symptoms are present.
Refer To: Urologist
UTI is rare in men, but incidence increases with age, and in institutionalised older men particularly.
An underlying urological abnormality needs to be sought, and urological referral is warranted. In men with multiple sexual partners, sexually transmitted infection is a possibility, and should be considered.
After MC&S urine, further investigations will be arranged by a urologist.
PSA has no utility in the presence of UTI, and it is usual to wait six weeks after UTI-resolution before testing.
Typically, an ultrasound scan of the lower and upper urinary tract, with pre and post void residual is helpful and can be arranged prior to urological assessment.
Most patients will need a cystoscopy to rule out lower tract pathology.
Note: microscopic haematuria that persists after UTI resolution needs a full urological workup.
Infection in the presence of urinary stones disease warrants rapid referral.
Infection in the presence of upper urinary tract obstruction is an emergency.