Last reviewed: 27 Oct 2020
Last updated: 02 Nov 2020

Summary

Definition

History and exam

Key diagnostic factors

  • dysuria
  • new nocturia
  • cloudy-looking urine
  • risk factors
  • fever

Other diagnostic factors

  • urgency
  • visible haematuria
  • frequency
  • suprapubic pain or tenderness
  • flank pain
  • costo-vertebral angle tenderness
  • new incontinence
  • new or worsening delirium/debility
  • loss of diabetic control
  • malaise
  • rigors

Risk factors

  • sexual activity
  • spermicide use
  • post-menopause
  • positive family history of UTIs
  • history of recurrent UTI
  • presence of a foreign body
  • insulin-treated diabetes
  • high lifetime number of UTIs
  • recent antibiotics
  • poor bladder emptying
  • increasing age

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine culture and sensitivity
Full details

Investigations to consider

  • urine microscopy
  • post-void residual
  • renal ultrasound
  • abdominal/pelvic CT
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Disclosures

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Una J. Lee, MD

Female Pelvic Medicine and Reconstructive Surgery Section of Urology and Renal Transplantation

Virginia Mason Medical Center

Seattle

WA

Disclosures

UJL declares that she has no competing interests.

Peer reviewersVIEW ALL

Consultant Urological Surgeon

Princess Royal Spinal Injuries Unit

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield 

UK

Disclosures

SR is lead for the spinal injuries urology course; in the past this course has received funding from Coloplast, AMS, and Hollister. SR is chair of the FNUU section of the British Association of Urological Surgeons.

Section Editor, BMJ Best Practice

Consultant in Paediatric Emergency Medicine

Royal London Hospital

London

UK

Disclosures

TD declares that she has no competing interests.

Section Editor, BMJ Best Practice

Disclosures

EQ declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Use of this content is subject to our disclaimer