Urinary Tract Infection (UTIs) in Males

Question 1

Background

Answer 1

Rare in male adults <50 yrs.
Increases after 50.
- Pathophysiology: Older males with prostatic hypertrophy have incomplete bladder emptying, predisposing them to UTI.

Causes:
- prostatitis,
- epididymitis, (inflamed tube that carries and stores sperm)
- orchitis, (Ball/s inflammation)
- pyelonephritis,
- cystitis, (bladder inflamed)
- urethritis, and
- urinary catheters

Question 2

Signs and Symptoms

Answer 2

Most common:
dysuria, urinary frequency, and urinary urgency
Less common:
hesitancy, urinary dribbling, and slow stream
Other symptoms:
Nocturia, suprapubic pain, odorous urine, cloudy urine, haematuria

Question 3

Complications

Answer 3

Renal function impairment.
Prostatitis.
Pyelonephritis.
Sepsis.
Urinary stones.
epididymitis,
seminal vesiculitis

Question 4

Diagnosis/ Assessment

Answer 4

Men <65 suspected UTI:
- Check other causes for symptoms
- Check pyelonephritis, prostatitis, systemic infection, or suspected sepsis.

Men >65 suspected UTI:
- Exclude other stuff
Check for new signs of UTI. New dysuria alone or 2 or + of others.

Confirm diagnosis by:
- MSU or catheter specimen of urine

DONT use dipstick if:
- >65
- for <65 can be used for working diagnosis only.

Question 5

Treatment

Answer 5

MSU B4 taking. ALL 7 days

Oral 1st line:
Nitrofurantoin (100mg MR BD ALT IR 50mg QDS), or trimethoprim (200mg BD)

Oral 2nd line (if no improvement after at least 48 hours, or first line not suitable):
- Consider pyelonephritis or prostatitis.

IF catheterised:
1st line: Trimethoprim, nitrofurantoin or amoxicillin (500mg TDS)
ALT pivmecillinam (intial 400mg then 200mg TDS)

Dose for T/N is same as above.
Follow up after 48 hours.

Question 6

Recurrent UTI treatment

Answer 6

Trail of daily antibiotic prophylaxis:
1st line: Trimethoprim 200mg single dose when exposed to trigger ALT 100mg ON OR
nitrofurantoin 50–100 mg ON ALT 100mg singe dose when exposed to trigger.

2nd line: amoxicillin 500mg single dose when exposed to trigger or 250mg ON (off label use) OR
Cefalexin 500mg when exposed to trigger or 125 mg ON

Refer if still on going, underlying cause/ risk factors or Recurrent UTI