Primary prevention

Trials involving boys suggest that circumcision may be preventative, especially for those at increased risk (e.g., high-grade vesicoureteric reflux).[36] However, other studies have suggested that the evidence for circumcision preventing urinary tract infections (UTIs) in anatomically normal boys is weak, that there are pros and cons to circumcision, and the decision to do so should be made on an individual basis.[38][39]​​​ No clear recommendations exist for adult males. In uncircumcised males, routine retraction of the foreskin during urination with proper hygiene reduces the risk of UTI.[37][40]​​​

A catheter-associated UTI (CAUTI) is a UTI that has occurred when a hospitalised patient has had an indwelling catheter for more than two consecutive days.[41]

In patients with neurogenic bladder requiring catheterisation, clean intermittent catheterisation (CIC) is believed to cause fewer urinary tract complications compared with urethral indwelling catheterisations.[42]​ Hydrophilic-coated catheters have also been found to be beneficial for reducing CAUTI rates.[2]​ One meta-analysis of seven studies investigating randomised controlled trials comparing hydrophilic coated to peripheral venous catheter (standard) for IC, found a statistically lower risk ratio (0.84) for the frequency of UTI in the hydrophilic catheter group.[43]​ Silver- or antibiotic-coated catheters also decrease catheter-associated bacteriuria but have not conclusively been shown to prevent UTI; therefore, removal or avoidance of the catheter offers the best prevention.[34]​​[44]​​​​[45][46]​​​​​​​​​​​

The quality and applicability of evidence regarding prophylaxis for use of several pharmacological and non-pharmaceutical treatment strategies (e.g., encouraging cranberry intake) in clinical practice for different patient groups is debatable, as there are significant gaps in understanding for particular subgroups of men with UTI. Trial of these therapies should never preclude investigation for structural abnormality in the male urinary tract.[47]​​[48]​​[49][50]

Secondary prevention

Secondary prevention of UTI in men is possible when a correctable or treatable cause of the UTI exists. For example, treatment of benign prostatic hyperplasia (BPH) and restoration of appropriate urine flow may decrease the risk of future UTI development. For uncircumcised patients, it is important to teach proper hygiene and daily retraction of the foreskin during urination.[40]

Underlying conditions contributing to UTI should be sought using imaging of the urinary tract in men with:

  • Voiding dysfunction without a clearly identifiable cause such as BPH

  • Treatment failure

  • Signs of upper tract infection.

Urological consultation may be necessary to correct an underlying structural or functional abnormality.

Methenamine hippurate, an oral antiseptic agent, is proving to be effective as a possible non-antibiotic option for prophylaxis in recurrent UTIs. One systematic review demonstrated it to be effective in various populations, including older adults and kidney transplant recipients.[2]​[124]

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