Male Urinary Tract Infections Research Articles

‘Male cystitis does not exist’: A qualitative study of general practitioners’ experiences and management of male urinary tract infections in France

Background Male urinary tract infections (mUTIs) are rare in primary care. The definition of mUTIs varies across countries. The therapeutic management of mUTIs in France is based on a 14-day course of fluoroquinolones despite a high risk of antimicrobial resistance. Objectives The objective of this qualitative study was to explore general practitioners’ (GPs) experiences and behaviours regarding the diagnostic and therapeutic management of mUTIs. Methods GPs were recruited by convenience sampling in Haute Normandie (France) and interviewed individually with semi-structured guides. GPs’ experiences and behaviours were recorded and analysed using an interpretive phenomenological approach. Results From March 2021 to May 2022, 20 GPs were included in the study. Defining a mUTI was perceived as a diagnostic challenge. A diagnosis based on clinical evidence alone was insufficient and complementary tests were required. For GPs: ‘male cystitis does not exist’. A mUTI was considered an unusual disease that could reveal an underlying condition. GPs considered fluoroquinolones to be ‘potent’ antibiotics and treated all patients with the same 14-day course. GPs implemented improvement strategies for antibiotic stewardship and followed the guidelines using a computerised decision support system. Conclusions GPs’ experiences of mUTIs are limited due to low exposure and variable clinical presentations in primary care, representing a diagnostic and therapeutic challenge. In order to modify GPs’ antibiotic prescribing behaviours, a paradigm shift in the guidelines will need to be proposed. KEY MESSAGES Defining a male urinary tract infection represents a diagnostic challenge for GPs. A diagnosis based on clinical evidence alone is insufficient and complementary tests are required. A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition.

Exploring variations in recommended first-choice therapy for complicated urinary tract infections in males: Insights from outpatient settings across age, race, and ethnicity.

There are known disparities in the treatment of infectious diseases. However, disparities in treatment of complicated urinary tract infections (UTIs) are largely uninvestigated. We characterized UTI treatment among males in Veterans Affairs (VA) outpatient settings by age, race, and ethnicity and identified demographic characteristics predictive of recommended first-choice antibiotic therapy. We conducted a national, retrospective cohort study of male VA patients diagnosed with a UTI and dispensed an outpatient antibiotic from January 2010 through December 2020. Recommended first-choice therapy for complicated UTI was defined as use of a recommended first-line antibiotic drug choice regardless of area of involvement (ciprofloxacin, levofloxacin, or sulfamethoxazole/trimethoprim) and a recommended duration of 7 to 10 days of therapy. Multivariable models were used to identify demographic predictors of recommended first-choice therapy (adjusted odds ratio [aOR] > 1). We identified a total of 157,898 males diagnosed and treated for a UTI in the outpatient setting. The average antibiotic duration was 9.4 days (±standard deviation [SD] 4.6), and 47.6% of patients were treated with ciprofloxacin, 25.1% with sulfamethoxazole/trimethoprim, 7.6% with nitrofurantoin, and 6.6% with levofloxacin. Only half of the male patients (50.6%, n = 79,928) were treated with recommended first-choice therapy (first-line drug choice and appropriate duration); 77.6% (n = 122,590) were treated with a recommended antibiotic choice and 65.9% (n = 104,070) with a recommended duration. Age 18-49 years (aOR 1.07, 95% confidence interval [CI] 1.03-1.11) versus age ≥65 years was the only demographic factor predictive of recommended first-choice therapy. Nearly half of the patients included in this study did not receive recommended first-choice therapies; however, racial and ethnic disparities were not identified. Underutilization of recommended first-choice antibiotic therapy in complicated UTIs continues to be an area of focus for antimicrobial stewardship programs.

Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study.

Urinary tract infections (UTIs) in childhood are common and are associated with considerable acute morbidity and long-term complications. The need for updated data to optimize empiric antibiotic therapy is crucial. We aimed to investigate the pathogens causing pediatric community acquired UTIs, their correlation with demographic characteristics, and trends in their antimicrobial resistance. This nationwide cross-sectional study included all 53,203 children (<18 years) diagnosed with UTI in community outpatient clinics in the following selected years: 2007, 2011, 2015, 2019 and 2021. Escherichia coli (E. coli) (82.1%) was the most common uropathogen, followed by Enterobacter, Klebsiella, Proteus, Pseudomonas, and Enterococcus species. The bacterial distribution displayed statistically significant (p < 0.0001) gender- and sector-specific patterns with a higher relative prevalence of non-E. coli UTI in Jewish and males. The rate of extended-spectrum beta-lactamase-positive E. coli increased substantially and significantly (p < 0.001) from only 6.1% in 2007 to 25.4% in 2021. Most non-E. coli uropathogens exhibited resistance to commonly used empiric antibiotics for UTIs in children. These findings are significant in guiding optimal empiric antibiotic treatment for pediatric community acquired UTIs. The resistance of uropathogens to antimicrobials is region- and time-dependent. Therefore, the periodic and local assessment of antibiotic resistance trends is essential to update guidelines and provide the most appropriate antibacterial therapy for children with UTIs.

Androgen exposure impairs neutrophil maturation and function within the infected kidney.

Urinary tract infections (UTIs) in men are uncommon yet carry an increased risk for severe pyelonephritis and other complications. In models of Escherichia coli UTI, C3H/HeN mice develop high-titer pyelonephritis (most with renal abscesses) in a testosterone-dependent manner, but the mechanisms underlying this phenotype are unknown. Here, using female mouse models, we show that androgen exposure impairs neutrophil maturation in the upper and lower urinary tract, compounded by a reduction of neutrophil function within the infected kidney, enabling persistent high-titer infection and promoting abscess formation. Following intravesical inoculation with uropathogenic E. coli (UPEC), kidneys of androgen-exposed C3H mice showed delayed local pro-inflammatory cytokine responses while robustly recruiting neutrophils. These were enriched for an end-organ-specific population of aged but immature neutrophils (CD49d+, CD101-). Compared to their mature counterparts, these aged immature kidney neutrophils exhibited reduced function in vitro, including impaired degranulation and diminished phagocytic activity, while splenic, bone marrow, and bladder neutrophils did not display these alterations. Furthermore, aged immature neutrophils manifested little phagocytic activity within intratubular UPEC communities in vivo. Experiments with B6 conditional androgen receptor (AR)-deficient mice indicated rescue of the maturation defect when AR was deleted in myeloid cells. We conclude that the recognized enhancement of UTI severity by androgens is attributable, at least in part, to local impairment of neutrophil maturation in the urinary tract (largely via cell-intrinsic AR signaling) and a kidney-specific reduction in neutrophil antimicrobial capacity.IMPORTANCEAlthough urinary tract infections (UTIs) predominantly occur in women, male UTIs carry an increased risk of morbidity and mortality. Pyelonephritis in androgen-exposed mice features robust neutrophil recruitment and abscess formation, while bacterial load remains consistently high. Here, we demonstrate that during UTI, neutrophils infiltrating the urinary tract of androgen-exposed mice exhibit reduced maturation, and those that have infiltrated the kidney have reduced phagocytic and degranulation functions, limiting their ability to effectively control infection. This work helps to elucidate mechanisms by which androgens enhance UTI susceptibility and severity, illuminating why male patients may be predisposed to severe outcomes of pyelonephritis.

Male urinary tract infection with Trichosporon asahii fungemia

Male urinary tract infection with Trichosporon asahii fungemia

Survey of urinary tract infection among male students residing in the federal polytechnic, Ado-Ekiti

Urinary tract infections are among the most common bacterial infections in humans both in the community and hospital settings, and they occur in all age groups, and usually required urgent treatment. This study aimed at determining the prevalence of urinary tract infection among male students residing in the Federal Polytechnic, Ado-Ekiti, Ekiti State, Nigeria. Clean-catch midstream urine was collected from fifty (50) male students in the study area into clean sterile specimen bottles. The urine samples were processed and microbial isolates identified. The prevalence of urinary tract infection was significantly high (50%). Five bacterial strains were identified which are; Staphylococcus saphrophyticus, Staphylococcus aureus, Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa. S. aureus was found to be the most prevalent and predominant bacterial causing urinary tract infection in males in the study area. The best choice of active antibacterial agents would be trimethoprim, cephalosporin and Fluoroquinolones in the treatment of urinary tract infections in male.

Isolation of Bacteriophage against Pseudomonas aureginosa from Male Urinary Tract Infection (UTI) Specimen

Bacteriophages were isolated from raw sewage and selected based on the size and clarity of plaque that were formed. The selected phages were further enriched and purified. The isolated bacteriophages were found to be able to lyse Pseudomonas aeruginosa isolate from raw sewage. The virulent bacterial viruses of Pseudomonas aeruginosa were found to be of widespread occurrence in nature Bacterial viruses were applied to control pathogenic bacteria in different fields and successfully. Therefore, this work aimed to study is to isolate bacteriophages capable of lysing Pseudomonas aeruginosa as a potential therapeutic alternative to antibiotics.

A REVIEW ON CHRONIC MALE UTI AND ITS IMPACT ON MENTAL HEALTH

The most common bacterial infections in men are Urinary Tract Infections (UTI). 30-50% of men who get UTI will have a recurrence within 6-12 months despite receiving acute therapy. There are several organisms that can cause these, but Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus are the most prevalent ones. Other conditions include prostatitis, epididymitis, orchitis, cystitis, and urethritis. Men are susceptible to this, and it frequently significantly lowers quality of life. The severity of the discomfort, urinary problems, and quality of life restrictions were some of the outcomes. The personal psychosocial effects of male UTI recurrence are the main topic of this review. This research offers a review of chronic male UTI and its impact on Mental health. This study also looks at the several psychosocial factors such as pain, severity, and urine sensations may influence their quality of life.

Microbiological Profile of Urinary Tract Infections in Males: A Cross-sectional Study

Introduction: Urinary Tract Infections (UTI) are uncommon among men. It is because the male urethra is longer and is away from the anal opening. Moreover, the perianal area is dry, and the prostatic secretion prevents from occurring of any infection. Hence, if men suffer from UTI, it is considered as a complicated infection. Complicated UTIs are difficult to treat and are more prone to treatment failures. Microorganisms causing these infections have a wide spectrum ranging from a variety of both Gram-negative and gram-positive organisms. Early diagnosis and treatment of UTIs, plays a major role in preventing the spread of infection to the upper urinary tract. Aim: To determine the microbiological profile and antibiotic sensitivity pattern from urine samples of male patients. Materials and Methods: The present cross-sectional study was done for a period of two years (1/3/2019-31/4/2021) in the Department of Microbiology, Malla Reddy Institute of Medical Sciences and Research, Jeedimetla, Hyderabad, Telangana, India. Urine samples from male inpatients and outpatients suffering from various clinical conditions received in the microbiology laboratory were processed and analysed. These samples were cultured by conventional semi-quantitative methods and the organisms were identified using standard biochemical reactions. Antibiotic sensitivity testing was done on Mueller Hinton agar by Kirby Bauer’s disk diffusion technique. Clinical history, associated conditions, and comorbidities were noted from the case sheets of all the culture-positive patients to identify the risk factors which made them prone to UTIs. The data was descriptive and percentages were calculated for all the numerical data obtained. Results: Out of 304 urine samples received, 104 (34%) were found to be positive for bacterial and fungal isolates. E.coli (44%) was the predominant organism, followed by Klebsiella spp (15%) among the Gram-negative bacteria isolated. Coagulase-negative Staphylococcus (5%) was the predominant organism among the gram-positive bacteria followed by Staphylococcus aureus (4%) and Enterococcus spp (4%). 84.8% of E.coli and 68% of Klebsiella spp were Extended Spectrum Beta Lactamase (ESBL) enzymes producing organisms. An analysis of the health conditions of the patients who were culture positive showed that 28% of patients had signs and symptoms suggestive of UTI. Diabetes (25%), Hypertension (20%), and Benign Prostatic Hypertrophy (BPH) (5%) were observed commonly in patients above 60 years. Conclusion: UTI in male patients are quite uncommon as in female patients. The microbiological profile and drug sensitivity pattern of these organisms causing the infection is similar to that in female patients suffering from UTI. But, as UTI in males is considered a complicated infection thorough investigation of these patients for various health conditions like diabetes mellitus, hypertension, and BPH has to be done, particularly in elderly males. This helps in initiating prompt treatment to prevent recurrent UTIs and drug resistance.

Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus-a systematic review of the literature.

The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR). An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline. From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever. This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.

Prevalence and Antibiogram of Escherichia Coli Isolated from Urine Sample of Male UTI Patient.

Background: E. coli is found to be the commonest cause of Urinary Tract Infection (UTI). However, E. coli antibiotic resistance has escalated over the past many years. To observe the possible uropathogen from suspected UTI male outdoor patient, different pathogenic bacteria isolated and identified from urine sample by culture and biochemical tests. Out of 200 urine samples, 160 (80.00%) yielded significant bacterial growth. Among them E. coli was the most predominant bacteria 82 (51.25%) followed by Klebsiella 30 (18.75%), Pseudomonas 14 (8.75%), Proteus 10 (6.25%) and different Gram positive bacteria 10 (6.25%). Only antibiotic susceptibility test of E. coli was done. All (100%) E. coli were sensitive to imipenem and colistin sulphate and 100% resistant to ciorofloxacin. In conclusion, it can be said that antibiotic resistance against commonly using antibiotics is an alarming sign for us to treat the outdoor patients.&#x0D; Central Medical College Journal Vol 5 No 1 Jan 2021 PP 47-50

Efficacy and Safety of Oral Fosfomycin-Trometamol in Male Urinary Tract Infections with Multidrug-Resistant Enterobacterales.

Background: Antimicrobial drugs to treat male urinary tract infection (UTI) with multidrug-resistant Enterobacterales are limited. We studied oral fosfomycin-trometamol (FT) in this situation. The objective was to assess the clinical cure rate in patients presenting UTIs treated with oral FT. Methods: We conducted a single-center observational retrospective study from January 2017 to August 2018. The primary endpoint was clinical cure; and the secondary endpoints were incidence of recurrences, oral FT safety, and microbiological cure. Results: Sixteen male patients were included, presenting 21 UTI episodes. Fourteen patients (88%) have at least one underlying urologic disorder. We described 4 episodes of acute UTI and 17 episodes of chronic bacterial prostatitis (CBP). Sixteen out of twenty-one Enterobacterales were extended spectrum beta-lactamase (ESBL)-producers and all the patients presented a resistance to fluoroquinolones and trimethoprim/sulfamethoxazole. In acute UTI, the regimen was a daily dose of oral FT for a mean duration of 2.5 weeks (+/−7.0 days). Clinical and microbiological recovery was achieved in all patients, with no recurrence after 5.3 months follow-up on average (+/−10.4 days). In CBP, the regimen was one oral dose of fosfomycin every 24–48 h, for a mean duration of 5.5 weeks/UTI episodes (+/−15.3 days). Clinical and microbiological recovery was found in 16/17 cases. Seven of the twelve patients with CBP had relapsed and 3/12 had had a new episode of infection after an average follow-up of 5.8 months. Only 6/21 of patients presented minor or moderate adverse effects, such as digestive disorders. Conclusions: FT could be an alternative option to carbapenems in the treatment of multidrug-resistant Enterobacterales infections for male UTIs.

Age and gender based study of urine microscopy in children and adolescents: a retrospective study

Background: Urinary tract infection (UTI) is a common reason for accessing health care services in all age groups. Women are more susceptible to UTI across age groups. Among males, the prevalence decreases in adolescence. Socio-economic and behavioural factors may play a significant role in the higher prevalence of UTI among adolescent girls. A study on UTI among children and adolescents will give a better insight in to the gravity of the problem and suggest appropriate interventions. Aim of the current study was to investigate the prevalence of urinary tract infection in males and females in the age group 0 to 20 based on the urine routine examination.Methods: This retrospective study included patients who had urine routine examination (URE) done based on clinical symptoms, during the period from January to December 2018 in a tertiary care teaching hospital. Data was obtained from the laboratory records and medical records department.Results: 1574 (3.43%) out of 45896 patients had a URE. This included 716 males (46%) and 858 females (54%). Among those with positive URE results, females were more affected than their male counterparts and this was statistically significant (male 21.8%, female 78.2%, p&lt; 0.0001). As age advances, the prevalence decreases in males.Conclusions: Urinary tract infection is more prevalent in females across the pre- adolescent and adolescent age group. It decreases with age in males. Understanding the factors responsible for the persistent higher prevalence in females may decrease the prevalence of urinary infection in adolescent females.

Computerized decision support system (CDSS) use for surveillance of antimicrobial resistance in urinary tract infections in primary care.

Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care. To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs. We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections. We collected 43 591 Q-UTI, of which 10 192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%-42.2%) for amoxicillin, 16.6% (95% CI, 15.9%-17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%-7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%-6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P value = 0.004), and in EARS-NET (55.2%, P value < 0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P value < 0.001) and EARS-NET (15.8%, P value = 0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at ∼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P value < 0.001), but lower than in EARS-NET (9.5%, P value < 0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P value < 0.001). CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.

Leclercia adecarboxylata as Emerging Pathogen in Human Infections: Clinical Features and Antimicrobial Susceptibility Testing

(1) Background: Leclercia adecarboxylata (L. adecarboxylata) is a gram-negative bacillus of the Enterobacteriaceae family, which is uncommonly isolated from clinical specimens. L. adecarboxylata is considered as an aquatic opportunistic pathogen and most of the human infections are polymicrobial and usually occur in immunocompromised hosts. (2) Methods: In this retrospective study, we included all L. adecarboxylata strains since the introduction of MALDI-TOF MS in the Microbiology Department of Nord Franche-Comté Hospital, France (from 1 March 2015 to 31 July 2019). We studied demographic characteristics, comorbidities, characteristics of the current infection and outcome as well as antimicrobial susceptibility testing in all isolates. (3) Results: A total of 8 samples were identified (in 6 patients (4M/2F), with a recurrent L. adecarboxylata infection in 2 patients). The patients’ mean age was 66.2 years (range: 19–84). All patients were considered as immunocompetent, except a peritoneal dialysis patient with kidney transplantation. An exposition to an aquatic environment was identified in one patient. The most prevalent clinical feature was catheter-associated male urinary tract infection (in 3 cases) followed by ventilator-associated pneumonia (in 2 cases). One of 6 patients presented L. adecarboxylata bacteremia. L. adecarboxylata was part of a polymicrobial infection in 4 patients. The isolates showed a high susceptibility to all tested antibiotics, except one strain, which was resistant to fosfomycin. All patients with L. adecarboxylata infection were treated with antibiotics with a favorable outcome. (4) Conclusion: This study confirms the pathogenicity of L. adecarboxylata, even in immunocompetent patients, with a high susceptibility to antibiotics.

Urinary Tract Infection in Male

Urinary Tract Infection in Male

Urinary Tract Infections in Adults

A urinary tract infection (UTI) is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. The incidence of UTIs in adult males aged under 50 years is low, with adult women being 30 times more likely than men to develop a UTI.

Diagnosis and management of male urinary tract infections: a need for new guidelines. Study from a French general practice electronic database.

The definition and the treatment of male urinary tract infections (UTIs) are imprecise. This study aims to determine the frequency of male UTIs in consultations of general practice, the diagnostic approach and the prescribed treatments. We extracted the consultations of male patients, aged 18 years or more, during the period 2012-17 with the International Classification of Primary Care, version 2 codes for UTIs or associated symptoms from PRIMEGE/MEDISEPT databases of primary care. For eligible consultations in which all symptoms or codes were consistent with male UTIs, we identified patient history, prescribed treatments, antibiotic duration, clinical conditions, additional examinations and bacteriological results of urine culture. Our study included 610 consultations with 396 male patients (mean age 62.5 years). Male UTIs accounted for 0.097% of visits and 1.44 visits per physician per year. The UTIs most commonly identified were: undifferentiated (52%), prostatitis (36%), cystitis (8.5%) and pyelonephritis (3.5%). Fever was recorded in 14% of consultations. Urine dipstick test was done in 1.8% of consultations. Urine culture was positive for Escherichia coli in 50.4% of bacteriological tests. Fluoroquinolones were the most prescribed antibiotics (64.9%), followed by beta-lactams (17.4%), trimethoprim-sulfamethoxazole (11.9%) and nitrofurantoin (2.6%). Male UTIs are rare in general practice and have different presentations. The definition of male UTIs needs to be specified by prospective studies. Diagnostic evidence of male cystitis may reduce the duration of antibiotic therapy and spare critical antibiotics.

Recommandations courtes du CIAFU : intérêt de l’ECBU avant biopsie de la prostate réalisée par voie endo-rectale

A literature search was performed on Pubmed and Medline. We selected randomized studies or meta-analyzes using the keywords "prostate biopsy" and "infection" or "infectious complications". All abstracts and articles have been analyzed. The summary of the analysis was reviewed by all the members of the committee proposing the most consensual recommendation possible. The literature on the subject remains poor, but no evidence of a link between prebiopsy bacteriuria and post-biopsy infection has been demonstrated. Apart from a clinical situation which could evoke a male urinary tract infection, and moreover having to prefer the postponement of biopsies, it is not recommended to perform a routine urine culture before endo-rectal prostate biopsies (expert opinion).

Vesicoureteral reflux increases the risk of urinary tract infection prior to corrective surgery in newborn males with anorectal malformation.

The ideal colostomy type indicated for patients with anorectal malformation (ARM) is disputed. The aim of this study was to analyze the clinical factors associated with urinary tract infection (UTI) prior to corrective surgery in male ARM without perineal fistula having undergone diverting enterostomy. A retrospective review of patients diagnosed with ARM and surgically managed at our center from January 2011 to December 2019 was performed. Logistic regression was used to analyze the association between clinical factors and UTI. Eighty boys with ARM without perineal fistula underwent diverting enterostomy and subsequent corrective surgery via laparoscopic-assisted anorectal pull-through. A sigmoid loop colostomy was most often performed (70 patients, 87.5%). Twenty-nine patients (36.3%) were diagnosed with vesicoureteral reflux (VUR), including 14 (48.3%) with febrile UTIs. Six patients had other concomitant genitourinary anomalies excluding VUR. Multivariate logistic regression analysis revealed the presence of VUR as the only independent factor associated with the occurrence of febrile UTI (OR 17.3, 95% CI 3.51-85.26, p < 0.001). The development of UTI in newborn males with ARM is associated with the presence of VUR, regardless of stoma type. Voiding cystourethrography should be considered in patients with ARM for early diagnosis of VUR and subsequent antibiotic prophylaxis.