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Urinary tract infections in men (UTIs) are infections of the urinary system. Men are much less likely to develop UTI compared to women, due to a longer water pipe (urethra) so much so that men are usually very surprised if they experience symptoms that women recognise immediately. Classically these are burning on passing urine, urgency and frequency. Some may also experience back pain due to kidney involvement and fever with shivering. If the infection is severe, some men may pass blood. The symptoms are often described as similar to flu.
The diagnosis of a UTI can be made quite easily by dipping a sample of urine with a test strip of plastic which can detect blood, protein and nitrites, which are present in infected urine. The sample is sent to a laboratory to be examined for bacteria and to allow identification of suitable antibiotics for treatment. However, this can take 2 or 3 days and as immediate treatment is required, an antibiotic is usually prescribed on a ‘best guess’ basis. There are a number of antibiotics used for UTI on this basis. Most UTI respond quickly to such treatment however the sample may report a bacteria which is not sensitive to the prescribed antibiotic and it is important to make sure the result is reported and an alternative antibiotic prescribed. In addition, simple measures to ease discomfort are helpful ie paracetamol to reduce inflammation and fever, plenty of water to dilute the urine and resting. Usually, UTI settles over 2 or 3 days. If not then this might suggest the antibiotic is not effective and an alternative based on the laboratory report may be necessary. It is important to retest the urine after treatment to check the infection has cleared, usually 10 days or so later.
Once treated it is necessary to consider investigations to find out the cause of the infection. Quite often no obvious cause is found but it is important to check. Dehydration is a common factor especially if combined with hot environments and fatigue. Other causes include urinary stones (is there a family history?), incomplete bladder emptying, reduced immunity (due to other illnesses) and occasionally congenital abnormalities of the urinary system.
These are quite simple. Blood test investigations to examine kidney function, a blood sugar test to test for diabetes and a general blood count for general health. Ultrasound scans are useful to check the kidneys are normal and a scan of the bladder to look at how it empties. A flow test where urine is passed (in private) into a measuring device to assess the speed of the flow is helpful to exclude obstruction to the bladder. In older men, the prostate gland is checked to look for enlargement and cancer changes. Occasionally, a telescope examination of the bladder (cystoscopy) is carried out, particularly if blood has been passed. This can easily be done under local anaesthetic.
The main defence for urinary tract infections in men is to avoid dehydration. This can be achieved by aiming to drink at least 2 litres of water each day and your urine should be light in colour.
Mr John H Davies is the chairman of the PROSTATE project
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