History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include renal tract obstruction (e.g., benign prostatic hyperplasia [BPH], stones, stricture), previous urinary tract infection, age >50 years, and instrumentation of renal tract.

dysuria

Denotes inflammation of the urinary tract epithelium and most commonly results from infection.[2]​[8][64][65]​​

urgency

Presence of this symptom significantly increases the probability of urinary tract infection.[2]​[65]​

frequency

Presence of this symptom significantly increases the probability of urinary tract infection.[2]​[65]​

suprapubic pain

Presence of this symptom significantly increases the probability of urinary tract infection.[2]​[65]​

uncommon

costovertebral angle pain

Suggests extension of urinary tract infection (UTI) to the kidney (pyelonephritis), but UTI without direct renal involvement occurs more often.[2]​[65]​

Other diagnostic factors

common

hesitancy

Occurs with obstruction of urine flow (e.g., BPH).[66][67]

nocturia

Occurs with obstruction of urine flow (e.g., BPH).[68]

uncommon

tender prostate

Suggests the presence of prostatitis.[69]

rectal/perineal pain

May occur in patients with urinary tract infection associated with prostatitis.[70]

fever/rigors

May occur with underlying prostatitis, epididymitis, orchitis, pyelonephritis​.[2][60]​​[71]

urethral discharge

Occasional discharge has been reported.[8][72]

Risk factors

strong

benign prostatic hypertrophy

Benign prostatic hypertrophy (BPH) and other causes of urine-flow obstruction are often identified as risk factors in trials relating to urinary tract infection (UTI) in men.[5][8][30]

Up to 30% of young men with UTI have anatomical or functional abnormalities of the urinary tract, and this is higher in older men.[14][29][31] In one study of UTI in men with an average age of 54, 53% had abnormal findings on urinary tract imaging.[32]

bladder stones

Bladder stones and other causes of urine-flow obstruction are often identified as risk factors in trials relating to urinary tract infection in men.[5][8][30]

urological surgery, instrumentation

Urinary surgery, instrumentation, and other causes of urine-flow obstruction are often identified as risk factors in trials relating to urinary tract infection in men.[5][8][30]

urethral strictures

Urethral strictures and other causes of urine-flow obstruction are often identified as risk factors in trials relating to urinary tract infection in men.[5][8][30]

age >50 years

Up to 30% of young men with urinary tract infection (UTI) have anatomical or functional abnormalities of the urinary tract, and this is higher in older men.[14][29][31]​ In one study of UTI in men with an average age of 54, 53% had abnormal findings on urinary tract imaging.[32]

The majority of UTIs in men occur after 50 years of age.[8][15][32]

Asymptomatic bacteriuria is present in up to 10% of community-dwelling men who are older than 80 years of age.[14]

previous urinary tract infection (UTI)

Epidemiological data suggest that the risk of acquiring another UTI increases with each subsequent infection.[7]

catheterisation

Urinary tract infection is the most common nosocomial infection, and the majority of cases result from indwelling catheters.[33]

Removal of a catheter within 5 days of placement decreases the rate of occurrence.[34]

Changing chronic indwelling catheters before initiating antimicrobial therapy has also been shown to improve microbiological cure.[2]​​​​

weak

anal sex

It is commonly accepted that vaginal sex increases the risk in women, but this seems to be less of a risk factor in men. Anal intercourse has been associated with urinary tract infection in women, and in men who have sex with men.[17][18]​​​​

vaginal sex

It is commonly accepted that vaginal sex increases the risk in women, but this seems to be less of a risk factor in men. If, however, vaginal colonisation with enteric pathogens has occurred, the risk increases.[19][35]

uncircumcised

Circumcision may reduce the risk of future urinary tract infection (UTI) development in boys at higher risk, such as those with recurrent UTI or high-grade vesicoureteric reflux.[36] Proper hygiene and routine retraction of the foreskin in uncircumcised males reduces this risk.[37]

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