Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment.

PURPOSE: To review the epidemiology, pathophysiology, diagnosis, and treatment of urinary tract infections in men, especially insofar as they differ from those in women.

DATA IDENTIFICATION: Studies published between 1954 and 1988 were identified using MEDLINE (1981-1988) and Index Medicus (1981-1988), and through extensive manual searching of textbooks, symposia, monographs, and bibliographies of identified articles.

STUDY SELECTION: More than 200 studies were reviewed; those studies most pertinent to the topics reviewed were cited. Unpublished data from the author's studies were also cited.

DATA EXTRACTION: Study quality and descriptive information about prevalence, evaluations, interventions, and outcomes were assessed. Quantitative synthesis was not done.

RESULTS OF DATA ANALYSIS: Most men with urinary tract infection have a functional or anatomic abnormality of the genitourinary tract. Prostatic hypertrophy and genitourinary instrumentation are the major predispositions to infection in men. Signs and symptoms of bacteriuria in men are similar to those in women. Diagnosis rests on a properly collected specimen yielding 10(3) or more colony-forming units/mL of a single or predominant species. Eschericia coli is the most frequent uropathogen, but other gram-negative and gram-positive species cause up to one half of cases. Treatment of men with single-dose therapy is inadequate; men with recurrent infections require at least 6 weeks of appropriate treatment. Asymptomatic bacteriuria is common in elderly men, but does not usually necessitate treatment. Although genitourinary abnormalities are frequent in bacteriuric male patients, a diagnostic evaluation is probably indicated only in young boys and in men with recurrent or complicated infections.

CONCLUSIONS: Several important aspects of the epidemiology, pathophysiology, diagnosis, and treatment of urinary tract infections differ in male populations from those in the much better studied female populations. Knowledge of recently available data will help clinicians develop a rational approach to caring for bacteriuric men.