Urinary tract infection in men

Urinary tract infection (UTI) in men is generally uncommon with men less than 50 years of age having a prevalence of about 0.1%. The low incidence may be due to their:

• longer urethra
• greater distance between the anus and urethral meatus
• drier perimeatal environment
• antibacterial activity of prostatic secretions (1)

Incidence is higher in infancy, the elderly (over the age of 65 years, the prevalence is about 10%) and in institutionalized patients (1).

Previously it was considered that a UTI in a young man was indicative of an underlying urologic abnormality, a bladder outlet obstruction or instrumentation and thus a complicated UTI (2). Now there is evidence that the strains of uropathogenic E. coli that cause pyelonephritis in young women may cause an uncomplicated UTI (generally cystitis) in young men.

The outcomes are potentially more serious in men than in women (3).

UTIs and infections of the male genital tract can be classified according to the predominant clinical symptoms:

• uncomplicated lower UTI (cystitis)
• uncomplicated pyelonephritis
• complicated UTI with or without pyelonephritis
• urosepsis
• urethritis
• special forms: prostatitis, epididymitis and orchitis (2)

Reference:

• (1) Harper M, Fowlis G. Management of urinary tract infections in men. Trends in Urology, Gynaecology & Sexual Health 2007;12(1):30-35
• (2) European Association of Urology (EAU) 2009. Guidelines on urological infections
• (3) Walling AD. Techniques for Investigating Causes of UTI in Men. Am Fam Physician. 2002;65(11)