What is the workup for a man with a Urinary Tract Infection (UTI)?

From the Guidelines

For a man with a urinary tract infection (UTI), the initial workup should include a thorough history, physical examination, urinalysis, and urine culture, with consideration of broader-spectrum antibiotics and a longer treatment duration of 10-14 days due to the high likelihood of complicated UTI in men 1. The presence of pyuria (>10 WBCs/hpf), bacteriuria, and positive nitrites on urinalysis suggests a UTI. Start by obtaining a clean-catch midstream urine sample for urinalysis and culture before initiating antibiotics. Key considerations in the workup include:

• Assessing for risk factors such as urinary obstruction, recent instrumentation, immunosuppression, or diabetes 1
• Evaluating for systemic symptoms such as fever, flank pain, which may indicate pyelonephritis or prostatitis and require more aggressive management 1
• Considering imaging studies like renal ultrasound or CT scan to rule out structural abnormalities, especially in men with recurrent UTIs 1 Empiric antibiotic therapy should be tailored based on local resistance patterns and specific host factors, with options including trimethoprim-sulfamethoxazole (TMP-SMX) or fluoroquinolones like ciprofloxacin, and adjusted according to culture results and clinical response 1. It's also important to manage any underlying urological abnormality or complicating factors, as recommended by the European Association of Urology guidelines 1. Recent studies suggest that short-duration antibiotic courses (7-10 days) may be effective for complicated UTIs, including in men, although more data are needed to confirm this 1. Given the potential for complicated UTI in men, a thorough and individualized approach to diagnosis and treatment is necessary to optimize outcomes and minimize morbidity, mortality, and impact on quality of life 1.

From the Research

Workup for a Man with a Urinary Tract Infection (UTI)

The workup for a man with a UTI typically involves several steps, including:

• Identifying the underlying cause of the infection, which can be due to various factors such as anatomic or functional conditions 2
• Determining the type of UTI, which can be acute or chronic, and whether it is complicated or uncomplicated 3
• Obtaining a urine culture to identify the causative organism and determine its antibiotic susceptibility 4, 5
• Selecting an appropriate antibiotic therapy based on the results of the urine culture and the patient's medical history 2, 3, 4, 5

Antibiotic Therapy

The choice of antibiotic therapy for a man with a UTI depends on several factors, including:

• The type of UTI (acute or chronic, complicated or uncomplicated) 2, 3
• The causative organism and its antibiotic susceptibility 4, 5
• The patient's medical history and risk factors for antibiotic resistance 3, 5, 6
• The availability of antibiotics with a narrow spectrum of activity and little collateral damage 6

Treatment Duration

The duration of antibiotic therapy for a man with a UTI varies depending on the type of UTI and the patient's response to treatment, including:

• 1 to 2 weeks for cystitis 2
• 4 weeks for acute bacterial prostatitis 2
• 6 to 12 weeks for chronic bacterial prostatitis 2
• 7 to 14 days for acute urinary tract infection in men 3