From the Guidelines
The diagnostic workup for a suspected male Urinary Tract Infection (UTI) should begin with a thorough history and physical examination, followed by urinalysis and urine culture, as recommended by the European Association of Urology guidelines on urological infections 1. The workup should include obtaining a clean-catch midstream urine sample for urinalysis, which typically shows pyuria (>10 white blood cells per high-power field), bacteriuria, and possibly hematuria.
- A urine culture should be collected before starting antibiotics to identify the causative organism and its antibiotic susceptibilities.
- Blood tests including complete blood count and basic metabolic panel may be warranted if systemic symptoms are present.
- For empiric treatment while awaiting culture results, trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7-14 days) or fluoroquinolones like ciprofloxacin (500 mg twice daily for 7-14 days) are commonly used, as suggested by the European Association of Urology guidelines 1.
- Men typically require longer treatment courses than women due to potential prostate involvement.
- For complicated infections or men with risk factors such as recent instrumentation, immunosuppression, or anatomical abnormalities, imaging studies like ultrasound or CT scan may be necessary to evaluate for structural abnormalities or complications, as outlined in the guidelines 1.
- Recurrent UTIs in men warrant urological evaluation with possible cystoscopy to rule out underlying conditions. The European Association of Urology guidelines on urological infections provide evidence-based recommendations for the diagnosis, treatment, and prevention of UTIs and male accessory-gland infections, and emphasize the importance of antimicrobial stewardship to combat the rising threat of antimicrobial resistance 1.
From the Research
Diagnostic Workup for Suspected Male Urinary Tract Infection (UTI)
The diagnostic workup for a suspected male UTI involves several steps, including:
- A careful history and physical examination, with or without simple adjunctive tests (e.g., uroflowometry, post-void residual, and frequency volume charts) 2
- Urine culture and susceptibility testing to guide antibiotic selection 3
- Consideration of the possibility of urethritis and prostatitis in men with UTI symptoms 3
Initial Evaluation
The initial evaluation of a suspected male UTI should include:
- A patient questionnaire to identify possible reversible causes and determine the type of incontinence (if applicable) 4
- An assessment of other medical problems that may contribute to incontinence 4
- A discussion of the effect of symptoms on the patient's quality of life 4
- A review of the patient's completed voiding diary (if applicable) 4
- A physical examination 2, 4
Laboratory Tests and Imaging
Laboratory tests and imaging studies may be ordered as part of the diagnostic workup, including:
- Urine culture and susceptibility testing 3, 5, 6
- Measurement of postvoid residual urine volume 2, 4
- Urodynamics, cystoscopy, and imaging studies (in select cases when a specific reason is identified, the diagnosis is uncertain, or when patients have failed simple initial treatments and seek further therapy) 2
Antibiotic Selection
Antibiotic selection for male UTIs should be guided by urine culture and susceptibility results, as well as local antibiogram data 3, 5, 6. First-line antibiotics for men with uncomplicated UTI include trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin for seven days 3.