Urinary tract infections in men

Urinary tract infection (UTI) in men rarely occurs before 50 years of age.

Often associated with abnormal structure or function of the urinary tract (complicated UTI).

Catheter-associated UTI is the most common cause of nosocomial infection.

Imaging of the urinary tract is recommended for men with persistent hematuria, voiding dysfunction without a clearly identifiable cause such as benign prostatic hyperplasia (BPH), failure of initial therapy, or signs of upper tract infection.

Symptomatic men with a positive urinalysis by dipstick or microscopic exam should receive empiric antibiotic therapy, and all men should have a urine culture to ensure that treatment is warranted and antimicrobial choice is appropriate based on the sensitivities provided. Intravenous therapy and hospitalization are indicated for patients who are severely ill.

Asymptomatic bacteriuria does not require treatment except before urologic procedures.

A UTI is an inflammatory reaction of the urinary tract epithelium in response to pathogenic microorganisms, most commonly bacteria. In men, the definition of a UTI can include cases of cystitis, urethritis, prostatitis, epididymitis, and orchitis. Guidelines often refer to UTIs as being complicated or uncomplicated with UTIs in men often falling into the category of being complicated (cUTI). The classifications are intended to guide treatment, not diagnosis, and recent guidelines have revised these classifications. The 2025 Infectious Diseases Society of America (IDSA) guidelines define uncomplicated UTI as an infection confined to the bladder in an afebrile male or female, while a complicated UTI is defined as an infection beyond the bladder in women or men with systemic symptoms (e.g., pyelonephritis, febrile patient, catheter-associated UTI).[1]Infectious Diseases Society of America. Complicated urinary tract infections (cUTI): clinical guidelines for treatment and management.​ 2025 [internet publication]. https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections Similarly, the 2025 European Association of Urology (EAU) guideline classifies UTIs as localized (i.e., cystitis) or systemic (e.g., prostatitis, pyelonephritis). Both conditions may be accompanied by risk factors that clinicians must be aware of and tailor treatment accordingly.[2]European Association of Urology. Guidelines on urological infections. Mar 2025 [internet publication]. https://uroweb.org/guidelines/urological-infections ​