Recurrent Urinary Tract Infections in Men

Abstract

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.