Diagnostic Evaluation and Management of Recurrent UTIs in Men

Definition and Diagnosis

Recurrent UTIs are defined as ≥3 UTIs per year or ≥2 UTIs in the last 6 months, according to the European Urology guidelines 1, 2
UTIs in men are always considered complicated UTIs and require more extensive evaluation than in women, as stated by the European Urology guidelines 3
Confirming diagnosis with urine culture for each symptomatic episode before initiating treatment is recommended by the European Urology guidelines 1
Common causative organisms include E. coli, Proteus mirabilis, Klebsiella, Enterococcus faecalis, and Staphylococcus saprophyticus, as reported in the Journal of the American College of Radiology 4

Evaluating for urinary tract obstruction at any site is essential, as recommended by the European Urology guidelines 3
Assessing for presence of foreign bodies, such as catheters or stents, is crucial, according to the European Urology guidelines 3
Checking for incomplete bladder emptying with post-void residual measurement is necessary, as stated by the European Urology guidelines 3, 5
Evaluating for vesicoureteral reflux and reviewing recent history of urinary tract instrumentation are important steps, as recommended by the European Urology guidelines 3
Screening for diabetes mellitus and immunosuppression is also essential, according to the European Urology guidelines 3

Treating acute episodes with appropriate antibiotics based on culture results is recommended by the European Urology guidelines 1, 3
Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days is the recommended first-line treatment for men, as stated by the European Urology guidelines 1
Addressing underlying anatomical or functional abnormalities when identified is crucial, according to the European Urology guidelines 3
Correcting underlying urological abnormalities when possible is essential for prevention, as recommended by the European Urology guidelines 3
Considering continuous or post-coital antimicrobial prophylaxis when non-antimicrobial interventions have failed is an option, as stated by the European Urology guidelines 2

Surgery is recommended for men with recurrent urinary tract infections (UTIs) due to benign prostatic hyperplasia (BPH) when refractory to other therapies, as suggested by the American Urological Association 6
Obtain urinalysis and urine culture with sensitivity for each symptomatic acute cystitis episode, as recommended by the American Urological Association 7
Consider patient-initiated treatment (self-start) for select patients while awaiting urine cultures, as suggested by the American Urological Association 7
Adhere to antimicrobial stewardship principles to reduce inappropriate treatment and decrease broad-spectrum antibiotic use, as recommended by the American Urological Association 7
Tailor treatment to the shortest effective duration to mitigate increasing antibiotic resistance, as suggested by the American Urological Association 7
Consider local antibiogram patterns when selecting antimicrobial agents, as recommended by the American Urological Association 7
For surgical management, consider referral to urology if BPH is causing recurrent UTIs, as suggested by the American Urological Association 6