Referral criteria from primary care - UTI in a man

Further investigation/referral depends on various factors (1,2,3,4)

• referral for assessment is not routinely indicated
  • however, refer or seek specialist advice for men who have:
    • symptoms of upper urinary tract infection (pyelonephritis) (1)
    • failure to respond to appropriate antibiotic therapy (1)
    • frequent episodes of urinary tract infection (UTI) - this is stated as two or more episodes in a 3-month period or 3 or more UTIs in the last 12 months
    • features of urinary obstruction (e.g. in older men, enlarged prostate)
    • history of pyelonephritis, calculi, or previous genitourinary tract surgery
      
      
  • urgent referral is indicated for men with suspected cancer
    • any age with painless macroscopic haematuria:
      • if haematuria is associated with symptoms of UTI
        • culture the urine before referring
        • if UTI is not confirmed by urine culture, or if haematuria does not resolve with treatment of the UTI
          • refer urgently
    • recurrent or persistent UTI associated with haematuria, in a male aged 40 years or older
    • unexplained microscopic haematuria, in a male aged 50 years or older
    • with an abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract

Reference:

1. NICE (October 2018). Urinary tract infection (lower): antimicrobial prescribing
2. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
3. Harper M, Fowlis G. Management of urinary tract infections in men. Trends in Urology, Gynaecology & Sexual Health 2007;12(1):30-35
4. Health Protection Agency (2009). Management of infection guidance for primary care: for consultation and local adaptation