How should I manage a patient with recurrent UTIs, and when should I consider referral to a urologist?

Manage recurrent urinary tract infections (UTIs) by ensuring appropriate treatment of acute episodes, with urine culture and sensitivities sent before antibiotics are prescribed ¹.

Consider non-antibiotic measures for prevention, such as maintaining adequate hydration (about 1.5 L/day), avoiding douching, wearing breathable underwear, wiping from front to back, and avoiding delay in urination ¹.

Do not routinely prescribe antibiotics for asymptomatic bacteriuria in non-pregnant women with recurrent UTI ¹.

Arrange further investigation and consider referral to a urologist if there is an underlying cause needing specialist assessment, such as renal or ureteric stones, interstitial cystitis, or urogynaecological cancer ¹.

Refer or seek specialist advice for recurrent upper UTI, when the cause is unknown, or if there are features suggestive of underlying pathology ¹.

In women aged 60 years and over with unexplained recurrent or persistent UTI, consider a non-urgent urological referral for bladder cancer assessment ¹.

In men, trans women, and non-binary people with recurrent lower UTI, consider referral if symptoms persist despite initial management, or if investigations reveal underlying pathology ¹.

Referral should also be considered if there are red flags such as haematuria, unexplained persistent symptoms, or suspicion of malignancy, following NICE guidelines on suspected cancer ¹.