What should be considered in the medical history of men with urinary tract infection (UTI)?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In men, the most frequent chief complaint related to urinary tract infection (UTI) is dysuria. In fact, complaints of dysuria, urinary frequency, and urgency are approximately 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream are only approximately 33% predictive for it. Other aspects to inquire about include the following:

  • Previous UTI(s)

  • Nocturia, gross hematuria, any changes in the color and/or consistency of the urine

  • Prostatic enlargement

  • Urinary tract abnormalities - Personally and within their families

  • Comorbid conditions - Eg, diabetes

  • Human immunodeficiency virus (HIV) status

  • Immunosuppressive treatments for other conditions - Eg, prednisone

  • Any previous surgeries or instrumentation involving the urinary tract

In a younger man, the presence of UTI is often associated with anatomic abnormality. In the absence of this history, a detailed sexual history may implicate activities such as sex with a new partner, sex with multiple partners, or other risk-taking behavior associated with sexually transmitted disease (STD)-related urethritis, prostatitis, or epididymitis that may lead to UTI.

Certain patients are at increased risk of urosepsis and complications, such as the very sick and the immunosuppressed, as well as those with a history of genitourinary surgery, a neurogenic bladder, papillary necrosis (sickle cell disease, diabetes, or analgesic abuse), and a history of ureteral stricture or tumor with obstruction.


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