Recurrent Urinary Tract Infections in Men

  • Stacey C. Carter
  • Mya E. Levy
  • Scott I. ZeitlinEmail author
Part of the Current Clinical Urology book series (CCU)


A urinary tract infection (UTI) refers to an infection of the bladder (cystitis), the upper urinary tract (pyelonephritis), and may also refer to asymptomatic bacteriuria. These types of infections are much less common in men than in women due to anatomical differences in urethral length, lower incidence of periurethral colonization, and antibacterial substances found in prostatic fluid. Thus, men who acquire these types of infections require special consideration and workup. Risk factors for UTIs include urinary stasis secondary to urinary tract obstruction or dysfunction, instrumentation of the urinary tract including catheterizations, procedure related to manipulation such as cystoscopy, prostate biopsy, ascending infections, foreign bodies inside the urinary tract such as catheters or urolithiasis, bacterial prostatitis, and urethritis. Prostatitis may be due to seeding from ascending bacteria from the urethra or reflux of infected urine into the prostatic ducts. Urethritis is generally thought to be caused by bacteria acquired through sexual relations, such as Chlamydia or Gonorrhea. Men with recurrent UTIs may require investigation to identify the etiology. In this chapter, we will focus on the evaluation and management of recurrent infections of the urinary tract in men, specifically lower and upper urinary tract causes, foreign bodies, bacterial prostatitis, and urethritis.


Lower Urinary Tract Symptom Bladder Outlet Obstruction Urethral Stricture Ureteral Stents Clean Intermittent Catheterization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Schaeffer AJ. Role of vaginal colonization in urinary tract infections. Adv Exp Med Biol. 1999;462:339.PubMedCrossRefGoogle Scholar
  2. 2.
    National Health and Nutrition Examination Survey III, 1988–1994.Google Scholar
  3. 3.
    Sobel JD. Pathogenesis of urinary tract infection: role of host defenses. Infect Dis Clin North Am. 1997;11:531.PubMedCrossRefGoogle Scholar
  4. 4.
    Platt R. Quantitative definition of bacteriuria. Am J Med. 1983;75(1B):44–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Patel HD. Can urine dipstick testing for urinary tract infection at point of care reduce laboratory workload? J Clin Pathol. 2005;6(1):18–31.Google Scholar
  6. 6.
    Wilson ML. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis. 2004;38(8):1150–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Miller LG. Treatment of uncomplicated urinary tract infections in an era of increasing antibicrobial resistance. Mayo Clin Proc. 2004;79(8):2048–53.CrossRefGoogle Scholar
  8. 8.
    Wagenlehner FM. Hospital-acquired urinary tract infections. J Hosp Infect. 2000;46:171.PubMedGoogle Scholar
  9. 9.
    Brown PD. Prevalence and predictors of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan. Clin Infect Dis. 2002;34:1061.PubMedCrossRefGoogle Scholar
  10. 10.
    Karaca Y. Co-trimoxazole and quinolone resistance in Escherichia coli isolated from urinary tract infections over the last 100 years. Int J Antimicrob Agents. 2005;26(1):75–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Heyns CF. Urinary tract infection associated with conditions causing urinary tract obstruction and stasis, excluding urolithiasis and neuropathic bladder. World J Urol. 2011 [July 1; Epub ahead of print].Google Scholar
  12. 12.
    Thorpe A. Benign prostatic hyperplasia. Lancet. 2003;361(9366):1359–67.PubMedCrossRefGoogle Scholar
  13. 13.
    Takeda M. Diagnosis and treatment of voiding symptoms. Urology. 2003;62(5):11–9.PubMedCrossRefGoogle Scholar
  14. 14.
    May M. Post-void residual urine as a predictor of urinary tract infections—is there a cutoff in asymptomatic men? J Urol. 2009;181(6):2540–4.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Leary MP. Lower urinary tract symptoms/benign prostatic hyperplasia: maintaining symptom control and reducing early complications. Urology. 2003;62(3 Suppl 1):15–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Zivan I. New modality for treatment of resistant anstamotic strictures after radical prostatectomy: UroLume Urethral stent. J Endourol. 2001;15(8):869–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Jepsen JV. Comprehensive patient evaluation for benign prostatic hyperplasia. Urology. 1998;51(Suppl 4A):13–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Blaivas JG. Obstructive uropathy in the male. Urol Clin North Am. 1996;23(3):373–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Gould CV. Guideline for prevention of catheter-associated urinary tract infections, 2009. Infect Control Hosp Epidemiol. 2010;31:319.PubMedCrossRefGoogle Scholar
  20. 20.
    Schaberg DR. Nosocomial bacteriuria: a prospective study of case clustering and antimicrobial resistance. Ann Intern Med. 1980;93(3):420–4.PubMedGoogle Scholar
  21. 21.
    Kass EH. Entry of bacteria into the urinary tracts of patients with inlying catheters. N Engl J Med. 1957;256(12):556.PubMedCrossRefGoogle Scholar
  22. 22.
    Schumm K. Types of urethral catheters for management of short-term voiding problems in hospitalized adults. Neurourol Urodyn. 2008;27(8):738–46.PubMedCrossRefGoogle Scholar
  23. 23.
    Horgan AFB. Acute urinary retention. Comparison of suprapubic and urethral catheterization. Br J Urol. 1992;70:149–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Warren JW. Antibiotic irrigation and catheter-associated urinary-tract infections. N Eng J Med. 1978;299:570.CrossRefGoogle Scholar
  25. 25.
    Burton DC. Trends in catheter-associated urinary tract infections in adult intensive care units—United States, 1990–2007. Infect Control Hosp Epidemiol. 2011;32(3):748–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Clarke SA. Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. J Pediatr Surg. 2005;40:568–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Johnston JH. The pathogenesis of hydronephrosis in children. B J Urol. 1969;41:724–34.CrossRefGoogle Scholar
  28. 28.
    Johnston JH. Pelvic hydronephrosis in children: a review of 219 personal cases. J Urol. 1977;117(1):97–101.PubMedGoogle Scholar
  29. 29.
    Anderson GG. Intracellular bacterial biofilm-like pods in urinary tract infections. Science. 2003;301(5629):105–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Bass PF. Urinary tract infections. Prim Care. 2003;30(1):41–61.PubMedCrossRefGoogle Scholar
  31. 31.
    Pollock HM. Laboratory techniques for detection of urinary tract infections and assessment of value. Am J Med. 1983;75(1B):79–84.PubMedCrossRefGoogle Scholar
  32. 32.
    Pfaller MA. Laboratory evaluation of leukocyte esterase and nitrite tests for the detection of bacteriuria. J Clin Microbiol. 1985;21(5):840–2.PubMedGoogle Scholar
  33. 33.
    Silverman SG. What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology. 2009;250(2):309–23.PubMedCrossRefGoogle Scholar
  34. 34.
    Leyendecker JR. MR urography: techniques and clinical applications. Radiographics. 2008;28(1):23–46.PubMedCrossRefGoogle Scholar
  35. 35.
    Sfakianakis GN. A renal protocol for all ages and all indications: mercapto-acetyl-triglycine (MAG3) with simultaneous injection of furosemide (MAG3-F0): a 17-year experience. Semin Nucl Med. 2009;39(3):156–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Roberts JA. Management of pyelonephritis and upper urinary tract infections. Urol Clin North Am. 1999;26(4):753–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Chen MT. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. 1997;157(5):1569–73.PubMedCrossRefGoogle Scholar
  38. 38.
    Eastham J. Xanthogranulomatous pyelonephritis: clinical findings and surgical considerations. Urology. 1994;43(3):295–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Nickel JC. The management of acute pyelonephritis in adults. Can J Urol. 2001;8 Suppl 1:29–38.PubMedGoogle Scholar
  40. 40.
    Bader MS. Management of complicated urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 2010;122(6):7–15.PubMedCrossRefGoogle Scholar
  41. 41.
    Ramakrishnan K. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005;71(5):933–42.PubMedGoogle Scholar
  42. 42.
    Barton DP. Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies. Obstet Gynecol. 1992;80(5):805–11.PubMedGoogle Scholar
  43. 43.
    Plesinac-Karapandzic V. Percutaneous nephrostomy in the management of advanced and terminal-stage gynecologic malignancies: outcome and complications. Eur J Gynaecol Oncol. 2010;31(6):645–50.PubMedGoogle Scholar
  44. 44.
    Benson A. Metal ureteral stent for benign and malignant ureteral obstruction. J Urol. 2011;185(6):2217–22.PubMedCrossRefGoogle Scholar
  45. 45.
    Pichler R. Endoscopic treatment of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer in children: results of postoperative follow-up with real-time 3D sonography. Urol Int. 2011 [Aug 24; Epub ahead of print].Google Scholar
  46. 46.
    Sung J. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2011 [Jun 22; Epub ahead of print].Google Scholar
  47. 47.
    Corcoran AT. Management of benign ureteral strictures in the endoscopic era. J Endourol. 2009;23(11):1909–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Rassweiler JJ. Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques. Eur Urol. 2007;51(2):512–22.PubMedCrossRefGoogle Scholar
  49. 49.
    Salehipour M. Open dismembered tubularized flap pyeloplasty: an effective and simple operation for treatment of ureteropelvic junction obstruction. Urol Int. 2006;76(4):345–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Chang JH. Uretero-enteric fistula. Br J Urol. 1998;81(1):162–3.PubMedCrossRefGoogle Scholar
  51. 51.
    Hyams ES. Malignant extrinsic ureteral obstruction: a survey of urologists and medical oncologists regarding treatment patterns and preferences. Urology. 2008;72(1):51–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Wolf JS. Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007;34(3):421–30.PubMedCrossRefGoogle Scholar
  53. 53.
    Pearle MS. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol. 2001;166(4):1255–60.PubMedCrossRefGoogle Scholar
  54. 54.
    Gault MH. Relationship of frequency, age, sex, stone weight and composition in 15,624 stones: comparison of results for 1980 to 1983 and 1995 to 1998. J Urol. 2000;164(2):302–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Johri N. An update and practical guide to renal stone management. Nephron Clin Pract. 2010;116(3):c159–71.PubMedCrossRefGoogle Scholar
  56. 56.
    McNaughton-Collins M. How common is prostatitis? A national survey of physician visits. J Urol. 1998;159(4):1224–8.CrossRefGoogle Scholar
  57. 57.
    Krieger JN. NIH consensus definition and classification of prostatitis. JAMA. 1999;282(3):236–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Wagenlehner FM. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Urol Rep. 2004;5(4):309–16.PubMedCrossRefGoogle Scholar
  59. 59.
    Schaeffer AJ. Prevalence and significance of prostatic inflammation. J Urol. 1981;125(2):215–9.PubMedGoogle Scholar
  60. 60.
    Weidner W. Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1,461 patients. Infection. 1991;19 Suppl 3:S119–25.PubMedCrossRefGoogle Scholar
  61. 61.
    Van Howe RS. Circumcision and infectious diseases revisited. Pediatr Infect Dis. 1998;17(1):1–6.Google Scholar
  62. 62.
    Berger RE. Etiology and manifestations of epididymitis in young men: correlations with sexual orientation. J Infect Dis. 1987;155(6):1341–3.PubMedCrossRefGoogle Scholar
  63. 63.
    Meares Jr EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968;5(5):492–518.PubMedGoogle Scholar
  64. 64.
    McNaughton Collins M. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? Urology. 2000;55(3):403–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Nickel JC. How does the pre-massage and post-massage 2-glass test compare to the Meares–Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome? J Urol. 2006;176(1):119–24.PubMedCrossRefGoogle Scholar
  66. 66.
    Magri V. Microscopic and microbiological findings for evaluation of chronic prostatitis. Arch Ital Urol Androl. 2005;77(2):135–8.PubMedGoogle Scholar
  67. 67.
    Doble A. Ultrasonographic findings in prostatitis. Urol Clin North Am. 1989;16:763–72.PubMedGoogle Scholar
  68. 68.
    Berger RE. Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J Urol. 1997;157(3):863–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Nickel JC. Bacterial localization in antibiotic-refractory chronic bacterial prostatitis. Prostate. 1993;23(2):107–14.PubMedCrossRefGoogle Scholar
  70. 70.
    Schaeffer AJ. Overview summary statement. Diagnosis and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Urology. 2002;60 Suppl 6:1–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Bergman B. On the relevance of gram-positive bacteria in prostatitis. Infection. 1994;22 Suppl 1:S22.PubMedCrossRefGoogle Scholar
  72. 72.
    De la Rosette JJ. Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology. 1993;41(4):301–7.PubMedCrossRefGoogle Scholar
  73. 73.
    Nickel JC. Prostatitis: myths and realities. Urology. 1998;51(3):362–6.PubMedCrossRefGoogle Scholar
  74. 74.
    Becopoulos T. Acute prostatitis: which antibiotic to use first. J Chemother. 1990;2(4):244–6.PubMedGoogle Scholar
  75. 75.
    Stamey TA. Pathogenesis and treatment of urinary tract infections. Baltimore: Williams & Wilkins; 1980. p. 343–429.Google Scholar
  76. 76.
    Meares Jr EM. Acute and chronic prostatitis: diagnosis and treatment. Infect Dis Clin North Am. 1987;1(4):855–73.PubMedGoogle Scholar
  77. 77.
    Neal DE Jr. In: Nickel JC, editor. Textbook of prostatitis. Oxford: ISIS Medical Media; 1999. p. 279–284.Google Scholar
  78. 78.
    Nickel JC. Prostatitis: evolving management strategies. Urol Clin North Am. 1999;26(4):743–51.CrossRefGoogle Scholar
  79. 79.
    Schaeffer AJ. The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin. J Urol. 1990;144(3):690–3.PubMedGoogle Scholar
  80. 80.
    Bundrick W. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology. 2003;62(3):537–41.PubMedCrossRefGoogle Scholar
  81. 81.
    Koff W. Clinical trial comparing lomefloxacin and ofloxacin in the treatment of chronic bacterial prostatis. Rev Bras Med. 1996;53:88–91.Google Scholar
  82. 82.
    Granados EA. Prostatic abscess: diagnosis and treatment. J Urol. 1992;148(1):80–2.PubMedGoogle Scholar
  83. 83.
    Koumans EH. Laboratory testing for Neisseria gonorrhoeae by recently introduced nonculture tests: a performance review with clinical and public health considerations. Clin Infect Dis. 1998;27(5):1171–80.PubMedCrossRefGoogle Scholar
  84. 84.
    Van Dyck E. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by enzyme immunoassay, culture, and three nucleic acid amplification tests. J Clin Microbiol. 2001;39(5):1751–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Deguchi T. Mycoplasma genitalium: another important pathogen of nongonococcal urethritis. J Urol. 2002;167(3):1210–7.PubMedCrossRefGoogle Scholar
  86. 86.
    Centers for Disease Control and Prevention. Updated recommended treatment regimens for gonococcal infections and associated conditions—United States 2007.Google Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Stacey C. Carter
    • 1
  • Mya E. Levy
    • 1
  • Scott I. Zeitlin
    • 2
    Email author
  1. 1.Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of Urology and OB/GYNDavid Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare SystemLos AngelesUSA

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