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Male UTI

Referral criteria

  • Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI).
  • Refer to urology men who:
    • Have ongoing symptoms despite appropriate antibiotic treatment and  2nd UTI in a man of any age
    • May have an underlying cause or risk factor for the UTI (such as suspected bladder outlet obstruction, or have a history of pyelonephritis, urinary calculi, or previous genitourinary tract surgery).
    • Have recurrent episodes of UTI (for example two or more episodes in a 3-month period).
    • Are younger than 50 years of age and have persistent microscopic haematuria with otherwise normal renal function.
  • LUTS not responding to primary care management
  • Refer to nephrology men who:
    • Have persistent microscopic haematuria with proteinuria or impaired renal function.
  • Arrange an urgent 2-week wait referral if a urological cancer is suspected

 

 Primary Care Management

  • Younger (<40) consider: stones, anatomy eg. stricture, STI. If older (>40) consider benign prostatic hypertrophy
  • Ask about uti risk factors such as poor fluid intake, anal sex, previous instrumentation/catheter that might suggest urethral stricture
  • Ask about risk factors for TCC: Smoking and industrial exposure and include in letter if referring.
  • Examine to assess BPH, bladder emptying – consider bladder scan esp if over 40y
  • Do an USS to look for stones, anatomical abnormalities, and screen for tumour
  • Treat BPH – link to LUTS guidance
  • Wait at least 6 weeks after a proven UTI before PSA testing

 

References

NICE, CKS Lower UTI in men, October 2014

 

Contributors

Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology

 

Reviewed: July 2018