Uncomplicated acute pyelonephritis in young men

Summary: It is widely believed that symptomatic urinary tract infections (UTI) are very uncommon in males, except in infancy and the ‘prostatic’ age group. Most men with a UTI have been considered to have a functional or anatomical abnormality of the urinary tract. Recent reports have suggested that there is an increasing number of otherwise healthy young men presenting with uncomplicated acute pyelonephritis with similar clinical features as those affecting sexually active young women. From 1 January 1988 to 31 July 1995 a total of 42 men were admitted with acute pyelonephritis (fever >37.8°C, loin pain or tenderness and infected urine). of the total of 42 men, 23 (55%) were under the age of 40 years. Five of these 23 young men were known to have a serious underlying urinary tract abnormality and had required frequent admission for a symptomatic UTI. of the other 18 young men with an isolated episode of acute pyelonephritis, 14 were infected with Escherichia coli , 2 with Proteus mirabilis and 1 each with Enterococcus faecadis and Staphylococcus saprophyticus. All 18 had normal imaging of the urinary tract, and all were cured (sterile urine 7–10 days later) with a 5‐day course of treatment. In summary, more than half of the males admitted with acute pyelonephritis were under the age of 40 years. Men with an isolated episode of acute pyelonephritis should be treated in the same way as for women in a similar age group. Not all require extensive urinary tract investigations.