Imaging for recurrent UTI in male?

Specialties NP

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I have a male in his 50s, negative for STI, who keeps getting recurrent UTIs. I'm referring to urology, but I'm not sure whether there are diagnostics I should do prior to the referral. Any suggestions?

Thanks

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Besides a CT/US for abnormalities? Maybe a chem panel? Urology will most likely do a cytoscopy to see whats going on.

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I am going to do a renal US but wondered if I should do a bladder CT or similar. Maybe not...

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Specializes in Urology.

This just came up yesterday in conversation between myself and a urologist. Order a CT abd/pelvis without contrast to check for an obstructing stone. Urology will want that to determine if a stone is causing his hangup. Not sure if the renal US covers the ureters so you could likely be missing the culprit.

Edit: I'm assuming you have a CBC/Chem panel and a UA already.

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This just came up yesterday in conversation between myself and a urologist. Order a CT abd/pelvis without contrast to check for an obstructing stone. Urology will want that to determine if a stone is causing his hangup. Not sure if the renal US covers the ureters so you could likely be missing the culprit.

Edit: I'm assuming you have a CBC/Chem panel and a UA already.

Yeah CT ABD/Pelvis w/o contrast is almost exclusively used to see anatomy and stones.

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Awesome, thank you. Any other suggestions welcome.

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Specializes in Urology.
Awesome, thank you. Any other suggestions welcome.

Should be good to go after the CT scan. If there isnt a stone, no biggy, it's time to be in Urologys court anyway. You got the ball rolling for them, and for that I'm sure they will be thankful!

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I would look to physical anomalies (obstruction of any kind), infected prostate, history of recent regional surgery, kidney or bladder stones, does he live in a nursing home, is he frequently admitted to hospitals, does he chronically use catheters, or is he a diabetic? Does he have a history of renal disease? How has he been treated for the UTIs in the past? What are you seeing in his workups...hematuria, pyuria?...

It sounds like chronic bacterial cystitis or chronic prostatitis. If he's neg for STIs it's probably E-coli. If he's having fever, pain n/v with it you could also work him up for atypical pyelo. Blood cultures might be helpful. I would also r/o HIV.

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Ct urogram could also be a good step rather than standard ct imaging better look at ureters image reconstruction

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Specializes in LTC.

CT abd w/w/o contrast and a KUB. UA C&S on last UTI. Micro w/reflex if hematuria. Void diary if A&O to do one and possibly bring to appt (depends on doc, some like them some don't care too much). Also, get a PSA, just so urology has a current one.

Urology will probably order a cysto but it's nice to have the other info to see if an invasive procedure is really indicated.

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm in nephrology - get a BMP, UA, Urine Culture

Renal USD is fine. No need to image further and no need to expose them to CT.

Send to Urology.

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I'm in nephrology - get a BMP, UA, Urine Culture

Renal USD is fine. No need to image further and no need to expose them to CT.

Send to Urology.

You need to tell our ED that, they CT everything that hurts lol.

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