Referral criteria from primary care - UTI in a man

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

• referral for assessment is not routinely indicated
  • however, referral for assessment should be considered 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 (1)
    • 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) SIGN (2006) Management of suspected bacterial urinary tract infection in adults: a national clinical guideline. Scottish Intercollegiate Guidelines Network.
• (2) CKS (2006). UTI (lower) in men