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Recurrent lower urinary tract infection in a man — MSRA MCQ

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ModerateUrinary Tract InfectionsRecurrent lower urinary tract infection in a manMSRA

A 64-year-old man requests advice after three culture-confirmed episodes of Escherichia coli lower UTI in the past 5 months. Each episode caused dysuria and urinary frequency without fever, rigors, loin pain or perineal pain, and resolved with culture-directed oral antibiotics. He is currently asymptomatic. He has no catheter, renal stones, diabetes, visible haematuria, known urinary tract abnormality or symptoms of urinary retention. Renal function is normal. He has already increased his fluid intake and avoids delaying micturition. All three isolates were susceptible to trimethoprim and nitrofurantoin. He wishes to prevent further episodes. What is the most appropriate management now?

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

This man has recurrent UTI, defined in adults as at least 2 episodes in 6 months or 3 episodes in 12 months. Although his episodes have been microbiologically confirmed lower UTIs and he is currently well, NICE recommends referral or specialist advice for men aged 16 years and over with recurrent UTI. This permits assessment for an underlying structural or functional cause and informs prevention strategy. A patient-initiated antibiotic approach may form part of an individualised recurrent-UTI plan, but it should not replace specialist assessment in a man with recurrent infection. Daily trimethoprim prophylaxis may be considered for recurrent UTI in men only with specialist advice, after considering investigations and other preventive measures. Methenamine hippurate likewise requires specialist advice when being considered in men. Renal tract ultrasonography may be included in subsequent investigation, but arranging imaging alone is not the recommended overall next step and should not delay specialist assessment.

Reference: Urinary tract infection (recurrent): antimicrobial prescribing (NG112) — Recommendations (Updated December 2024) — https://www.nice.org.uk/guidance/ng112/chapter/Recommendations Urinary tract infection (recurrent): antimicrobial prescribing (NG112) — Referral and seeking specialist advice for recurrent UTI (Updated December 2024) — https://www.nice.org.uk/guidance/ng112/chapter/Recommendations Urinary tract infection (recurrent): antimicrobial prescribing (NG112) — Daily antibiotic prophylaxis in men (Updated December 2024) — https://www.nice.org.uk/guidance/ng112/chapter/Recommendations