Urinary tract infections are among the most common conditions seen by both urologists and primary care clinicians. According to urologist Dr. Chris Kim, UTIs affect people of all ages and genders for a wide range of reasons.
“UTIs are a fairly common condition that we see as urologists, and frankly, a lot of primary care physicians will see them as well,” he said.
Who gets UTIs?
Dr. Kim noted that UTIs are especially common in women. “About half of women somewhere in their lifetime will experience a UTI, and it increases probability as we age,” he said. Changes in vaginal flora after menopause increase susceptibility due to “vaginal dryness, inflammation, [and] changes in the pH.”
Men also develop UTIs, though less frequently. In males, he said, infections are often tied to the prostate: “The kind of root cause is different.”
Several additional groups face higher risks, including:
- People with diabetes
- Patients with multiple sclerosis
- Those with rheumatoid arthritis or immune-suppressing medications
- Individuals with a family history of kidney stones or urinary disorders
- People who experience frequent sexual intercourse, use certain birth control methods or take repeated rounds of antibiotics
Some risk is also genetic.
“Those receptors can be, in some patients, more sensitive to binding or susceptible to bacteria sticking,” Dr. Kim explained.
How UTIs are evaluated
Diagnosis begins with a history and physical exam. Providers assess symptom patterns, abdominal or flank pain, and, in men, prostate health.
But Dr. Kim emphasized one key step: urine culture.
“You want to make sure that they actually send the urine off for a culture,” he said. “If we need to change the antibiotic without culture data, we’re running blind.”
Treatment principles
Treatment starts with culture-directed antibiotics. While clinicians begin with the most likely medication, they adjust once culture results return. Symptom relief strategies may include:
- Hydration
- Over-the-counter pain relievers
- Phenazopyridine (Pyridium), which “makes your urine turn orange and helps with that burning sensation”
Typical treatment durations vary.
“In an uncomplicated UTI in a female, we treat for about 3 to 5 days,” Dr. Kim said. “For a male … we do tend to do a longer treatment, 7 to 14 days.”
Hormone therapy can also help postmenopausal women.
“Replenishing that vaginal flora with estrogen lining … is absolutely warranted and helps prevent infection,” he said.
Recurrent UTIs: When to see a urologist
Recurrent UTIs — three or more infections in a year — warrant further evaluation. “These have to be culture-proven infections,” Dr. Kim stressed.
Imaging may be needed to detect underlying causes such as kidney or bladder stones, prostate issues or incomplete bladder emptying.
For prevention, clinicians may recommend:
- Vaginal estrogen
- Probiotics
- Cranberry or D-mannose supplements
- Hydration
- As-needed or low-dose daily antibiotics
