What is the routine workup of suspected urinary tract infection (UTI) in males?

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

The workup of urinary tract infections (UTIs) is dependent on the suspected diagnosis; however, routine studies include urine studies, such as urinalysis, Gram staining, and urine culture. The threshold for establishing true UTI includes finding 2-5 or more white blood cells (WBCs) or 15 bacteria per high-power field (HPF) in a centrifuged urine sediment.

As with females, a positive nitrite test is poorly sensitive but highly specific for UTI, and false-positives are uncommon.

Proteinuria is commonly observed in UTIs, but the proteinuria is usually low-grade. More than 2g of protein per 24 hours suggests glomerular disease.

The older patient who appears toxic, has diabetes, or is immunocompromised may be at risk for emphysematous pyelonephritis; radiographic studies (eg, kidney, ureters, bladder [KUB]) may be necessary to exclude this possibility.


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