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Recurrent lower urinary tract infection in a man — MSRA MCQ

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HardUrologyRecurrent lower urinary tract infection in a manMSRA

A 67-year-old man attends for review after two culture-confirmed lower UTIs in the past 4 months. Each episode caused dysuria and frequency, grew Escherichia coli sensitive to prescribed antibiotics, and resolved completely with treatment. He is currently well, with no dysuria, fever, loin pain or visible haematuria. Urine dipstick is negative for blood, nitrites and leucocytes. He has no catheter, diabetes, known urinary tract abnormality or recent instrumentation. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Refer or seek urology specialist advice for further investigation and management

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

This man has recurrent UTI, defined in adults as at least 2 UTIs within 6 months or 3 within 12 months. Although both episodes were uncomplicated lower UTIs that resolved with culture-directed treatment, NICE recommends referral or specialist advice for recurrent UTI in men aged 16 years and over. This is because recurrent infection in men warrants assessment for an underlying urological cause before a prevention strategy is selected. A and B may be considered as preventive strategies in selected people, but recurrent UTI in men requires specialist advice; neither is the appropriate independent first step in primary care here. E is attractive because he has had clearly recognisable previous episodes, but self-start treatment does not address the need to investigate recurrence in a male patient. D is incorrect because NICE advises considering non-urgent bladder-cancer referral in people aged 60 years or over with recurrent or persistent *unexplained* UTI. In this case, the episodes were microbiologically confirmed, fully responsive to treatment and there is no persistent or recurrent haematuria or other feature requiring a suspected cancer pathway.

Reference: Urinary tract infection (recurrent): antimicrobial prescribing (NG112) — Recommendations (Last updated 12 December 2024) — https://www.nice.org.uk/guidance/ng112/chapter/Recommendations Suspected cancer: recognition and referral (NG12) — Recommendations organised by site of cancer (2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer