History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include renal tract obstruction (e.g., benign prostatic hyperplasia [BPH], stones, stricture), previous urinary tract infection (UTI), age >50 years, and instrumentation of renal tract.

dysuria

Denotes inflammation of the urinary tract epithelium and most commonly results from infection.[6]

urgency

Presence of this symptom significantly increases the probability of UTI.

frequency

Presence of this symptom significantly increases the probability of UTI.

suprapubic pain

Presence of this symptom significantly increases the probability of UTI.

uncommon

costovertebral angle pain

Suggests extension of UTI to the kidney (pyelonephritis), but UTI without direct renal involvement occurs more often.

Other diagnostic factors

common

hesitancy

Occurs with obstruction of urine flow (e.g., BPH).

nocturia

Occurs with obstruction of urine flow (e.g., BPH).

enlarged prostate

Suggests the presence of BPH.

uncommon

tender prostate

Suggests the presence of prostatitis.

rectal/perineal pain

May occur in patients with UTI associated with prostatitis.

fever/rigors

May occur with underlying prostatitis or with complicated UTI, which can result in spread of the infection to the upper tract.[1][49]

urethral discharge

Occasional discharge has been reported.[6]

Risk factors

strong

benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) and other causes of urine-flow obstruction are often identified as risk factors in trials relating to urinary tract infection (UTI) in men.[3][6][22]

Up to 30% of young men with UTI have anatomical or functional abnormalities of the urinary tract, and this is higher in older men.[10][13][25] In one study of UTI in men with an average age of 54, 53% had abnormal findings on urinary tract imaging.[26]

urinary tract stones

Urinary calculi and other causes of urine-flow obstruction are often identified as risk factors in trials relating to UTI in men.[3][6][22]

urological surgery, instrumentation

Urinary surgery, instrumentation, and other causes of urine-flow obstruction are often identified as risk factors in trials relating to UTI in men.[3][6][22]

Up to 30% of young men with UTI have anatomical or functional abnormalities of the urinary tract, and this is higher in older men.[10][13][25] In one study of UTI in men with an average age of 54, 53% had abnormal findings on urinary tract imaging.[26]

urethral strictures

Urethral strictures and other causes of urine-flow obstruction are often identified as risk factors in trials relating to UTI in men.[3][6][22]

age >50

Up to 30% of young men with UTI have anatomical or functional abnormalities of the urinary tract, and this is higher in older men.[10][13][25] In one study of UTI in men with an average age of 54, 53% had abnormal findings on urinary tract imaging.[26]

The majority of UTIs in men occur after 50 years of age.[6][9][26]

Asymptomatice bacteriuria is present in up to 10% of community-dwelling men who are older than 80 years of age.[10]

previous UTI

Epidemiological data suggest that the risk of acquiring another UTI increases with each subsequent infection.[5]

catheterisation

UTI is the most common nosocomial infection, and the majority of cases result from indwelling catheters.[8]

Removal of a catheter within 5 days of placement decreases the rate of occurrence.[27]

Changing chronic indwelling catheters before initiating antimicrobial therapy has also been shown to improve microbiological cure.[28]​​[29]

weak

anal sex

It is commonly accepted that vaginal sex increases the risk in women, but this seems to be less of a risk factor in men. Anal intercourse has been associated with UTI in women, and in men who have sex with men.[23][24]

vaginal sex

It is commonly accepted that vaginal sex increases the risk in women, but this seems to be less of a risk factor in men. If, however, vaginal colonisation with enteric pathogens has occurred, the risk increases.[19][30]

recent hospitalisation

Most UTIs are not nosocomial in origin.

uncircumcised

Circumcision reduces the risk of UTI development in boys.[31] However, the mechanism by which the prepuce increases risk and whether it contributes to UTI in adult men remains unclear.

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