eMedicine Specialties > Emergency Medicine > Genitourinary

Urinary Tract Infection, Male: Follow-up

Author: David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
Coauthor(s): M Tyson Pillow, MD, Emergency Medicine Resident and Flight Physician, University of Chicago Medical Center
Contributor Information and Disclosures

Updated: Apr 27, 2009

Follow-up

Further Inpatient Care

  • As noted in Emergency Department Care, consider admission for urinary tract infection for elderly patients and patients who have diabetes, who are immunocompromised, or who show signs of toxicity such as dehydration, hyperpyrexia, rigors, or inability to tolerate oral fluids or medications. Also admit if the patient is unable to care for himself.
  • Administer IV fluids sufficient to restore adequate circulating volume and treat dehydration or shock.
  • Administer antimicrobial therapy, initially given intravenously, such as a third-generation cephalosporin, a fluoroquinolone, or an aminoglycoside. In patients with risk factors associated with an unfavorable prognosis, such as old age, debility, renal calculi, recent hospitalization or instrumentation, diabetes, sickle cell anemia, underlying carcinoma, or intercurrent cancer chemotherapy, the antimicrobial coverage should be broadened and an antipseudomonal agent should be added.
  • Provide supportive management with antipyretics and pain medications.

Complications

  • Consider the presence of a complicating urinary calculus with obstructing hydronephrosis in the patient with clinically apparent pyelonephritis.
  • The older patient who appears toxic, has diabetes, or is immunocompromised may be at risk for emphysematous pyelonephritis; radiographic studies (eg, KUB) may be necessary to exclude this possibility.
  • If prostatism and a high residual volume are suspected, the volume of postvoid residual urine must be determined. If it is elevated, then a urinary catheter must be placed and urologic consultation obtained.

Prognosis

  • The following conditions or settings increase the rates of mortality and morbidity associated with urinary tract infection (UTI) in men:
    • Older patients who present with signs of dehydration, hypoperfusion, or overt shock
    • Complicating urinary obstruction due to calculi
    • Recent urinary tract instrumentation, hospitalization, or broad-spectrum antibiotic therapy
    • Development of emphysematous pyelonephritis
    • Patients who are older and have diabetes or are immunocompromised

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Young men have a very low incidence of urinary tract infection (UTI). If UTI is diagnosed frequently in a young man, the physician is overlooking the far more likely sexually transmitted disease (STD) – related urethritis/prostatitis.
  • Treatment regimens must assume that infection of the upper urinary tract has occurred.
  • In elderly patients, pyelonephritis carries a 3% mortality rate. Take a conservative management approach with these patients.
  • Failure to consider an obstructing urinary calculus results in delay of inpatient consultation with a urologist in the septic elderly patient.
  • Patients with diabetes and those with recent urinary tract instrumentation, recent hospitalization, or taking broad-spectrum antibiotics have an increased incidence of resistant organisms.
 


More on Urinary Tract Infection, Male

Overview: Urinary Tract Infection, Male
Differential Diagnoses & Workup: Urinary Tract Infection, Male
Treatment & Medication: Urinary Tract Infection, Male
Follow-up: Urinary Tract Infection, Male
References
Further Reading
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References

  1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. Jul 8 2002;113 Suppl 1A:5S-13S. [Medline].

  2. Johnson JR. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis. Sep 15 2004;39(6):873; author reply 873-4. [Medline].

  3. Daunt SW. Accuracy of ultrasonography and plain-film abdominal radiography in the diagnosis of urologic abnormalities in men with urinary tract infection: critically appraised topic. Can Assoc Radiol J. Feb 2004;55(1):16-7. [Medline].

  4. Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother. Jul-Aug 2004;38(7-8):1148-52. [Medline].

  5. Anandkumar H, Kapur I, Dayanand A. Increasing prevalence of antibiotic resistance and multi drug resistance among uropathogens. J Commun Dis. Jun 2003;35(2):102-8. [Medline].

  6. Ginde AA, Rhee SH, Katz ED. Predictors of outcome in geriatric patients with urinary tract infections. J Emerg Med. Aug 2004;27(2):101-8. [Medline].

  7. Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. J Urol. Apr 2005;173(4):1288-94. [Medline].

  8. Guay DR. Contemporary management of uncomplicated urinary tract infections. Drugs. 2008;68(9):1169-205. [Medline].

  9. Hooton TM. The current management strategies for community-acquired urinary tract infection. Infect Dis Clin North Am. Jun 2003;17(2):303-32. [Medline].

  10. Howes DS, Bogner MP. Urinary tract infections. In: Tintinalli JE et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:606-612.

  11. Hummers-Pradier E, Ohse AM, Koch M, et al. Urinary tract infection in men. Int J Clin Pharmacol Ther. Jul 2004;42(7):360-6. [Medline].

  12. Sanford JP. Guide to Antimicrobial Therapy. Dallas, Tex: Antimicrobial Therapy Inc; 2008.

  13. Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. Nov 1 2008;47(9):1150-8. [Medline].

  14. Thompson PDR. Physicians' Desk Reference. 2008.

  15. Weir M, Brien J. Adolescent urinary tract infections. Adolesc Med. Jun 2000;11(2):293-313. [Medline].

  16. Wells WG, Woods GL, Jiang Q, Gesser RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother. Jun 2004;53 Suppl 2:ii67-74. [Medline].

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Further Reading

Clinical guidelines

 Prevention of catheter-associated urinary tract infections. In: Prevention and control of healthcare-associated infections in Massachusetts. Prevention of catheter-associated urinary tract infections. In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Massachusetts. Part 1: final recommendations of the Expert Panel. Boston (MA): Massachusetts Department of Public Health; 2008 Jan 31. p. 83-9.

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Keywords

urinary tract infection men, UTI, cystitis, pyelonephritis, Escherichia coli infection, gonococcal urethritis, nongonococcal urethritis, prostatitis, epididymitis, orchitis, dysuria, urgency, frequency, nocturia, hematuria, prostatic enlargement, urinary dribbling, urinary hesitancy, indwelling catheter, Foley catheter, nephrolithiasis, neurogenic bladder, meatal discharge, scrotal hematoma, hydrocele, costovertebral angle tenderness, CVA tenderness, prostatic tenderness, prostatic hypertrophy

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Contributor Information and Disclosures

Author

David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

M Tyson Pillow, MD, Emergency Medicine Resident and Flight Physician, University of Chicago Medical Center
M Tyson Pillow, MD is a member of the following medical societies: Air Medical Physician Association, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Student National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone, III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine
Joseph A Salomone, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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