男性泌尿外科感染：10个需要知道的相关问题
尽管泌尿道感染在女性最为常见，但男性也可以有泌尿道感染。这里有10个为您推荐的男性泌尿道感染相关问题，包括谁有可能感染，和怎么治疗等。
1.什么是泌尿道感染
泌尿道感染就是身体的泌尿系统（包括肾，输尿管，膀胱，尿道等输送尿液的管道系统的感染）。大部分泌尿道感染是由细菌引起，细菌进入尿道，前列腺，膀胱，肾脏引起感染。
2.男性泌尿道感染和女性又什么区别
女性比男性更容易得泌尿道感染。解剖上女性尿道比较短，宽，直。这些特征导致细菌更容易进入泌尿系统。男性尿道比较长，这样细菌不容易进入泌尿系统，从而保护男性少得泌尿道感染。
但单独尿道长度并不能完全保护男性不得泌尿道感染，在男性一生中有12%的机率发生泌尿道感染相关症状。这不取决于尿道或阴茎的长度。在男性，泌尿道感染通常有比较清晰的病理因素，导致泌尿道感染，而不是尿道长度。
3.是什么因素导致男性有较高风险得泌尿道感染？
这里有很多原因导致男性泌尿道感染，所有这些原因都需要我们认真对待，不能忽略。
男性超过50岁以后比年青时易得泌尿道感染。作为一个泌尿外科大夫，我经常见到，当男性因为前列腺增生，不能够完全排空膀胱的尿液时，就容易发生复发泌尿道感染。除了前列腺增生，当男性发生中风后神经损害，外伤时脊髓损伤，及糖尿病控制不佳，也会出现尿液排空障碍
男性也可以因为前列腺及睾丸感染，细菌沿前列腺腺管及附睾管进入膀胱，发生泌尿道感染。也可以因为泌尿道感染，细菌进入前列腺，睾丸而发生前列腺炎，睾丸炎。肾结石也是泌尿道感染的一个原因。（我知道这个原因，是因为我自己也有肾结石）
年青人也可以发生泌尿道感染，因为性传播疾病。男性感染泌尿系统，还可能因为他们最近接受过泌尿系统的手术或检查。
4.泌尿道感染的症状或体征
泌尿道感染症状有尿痛，烧灼样疼痛，尿频，尿急，急迫性尿失禁，尿有臭味，血尿，发热，寒战，膀胱区疼痛。不管相信与否，有些男性泌尿道感染没有症状，因为其他原因做尿培养是发现的。
5.怎样诊断泌尿道感染
泌尿道感染是靠尿培养来诊断。当你的尿液经处理，并评估各种细菌菌落。最常见泌尿道感染的细菌是大肠杆菌。当尿培养结果出来后，可以指导治疗。通常泌尿道感染口服抗生素就可以了。目前我们常用的尿常规很快有结果，可以提示有泌尿道感染。但最好的检查是细菌培养。
临床大夫不必等细菌培养结果出来后，再开始治疗。尿细菌培养通常需要3天时间。如果临床上尿常规提示有泌尿道感染，可以先用抗生素，等尿培养结果出来后，再调整抗生素应用。
6. 治疗泌尿道感染
泌尿道感染通常可以口服或静脉用抗生素，但大部分泌尿道感染，口服抗生素就已经足够了。有些超级细菌，对有些口服抗生素耐药，需要给以静脉点滴强力抗生素。大部分泌尿道感染治疗需要持续7-10天，但有些泌尿道感染可能需要更长时间。
严重的泌尿道感染，细菌进入血液，需立即静脉用更好的抗生素，来控制感染。患者需住院治疗，但不需要住院很长时间。当你的感觉很好，症状消失，没有发热，实验室检查正常，心脏和脉搏无异常，那么就可以回家继续静脉用抗生素了。每一个治疗都根据个人具体情况而定。
7. 泌尿道感染可以在家自己治疗吗？
泌尿系感染不能用家里的办法治疗。你不能按自己的方法治疗泌尿道感染。如果有症状，你需要去医院或急诊科就诊。
8. 预防泌尿道感染
最好的预防措施是，首先排除有没有需要纠正的解剖异常。如前列腺增生，肾结石，肾积水。
正确的卫生习惯可以预防泌尿道感染。如果有包皮过长，要保证包皮能够翻开，彻底清洗包皮及龟头。蔓越莓制剂可以预防泌尿道感染。补充足够的水份或液体；不要憋尿；保持健康的状态；避免和治疗慢性病如糖尿病，心脏病，也可以防止泌尿道感染。
9. 泌尿道感染治疗后，会有远期不良后果吗
目前，未治疗的泌尿道感染会导致尿道狭窄，疤痕挛缩。这会使你尿流变慢，不能排空膀胱。感染还会导致膀胱丧失充盈及排空功能。长远后果，你需要经常用抗生素治疗，这会产生抗生素耐药，严重时没有敏感抗生素可用。
10.当经历首次泌尿道感染，下一次感染怎么办？
首先，要用抗生素清除感染。症状消失后要全面评估检查，详细询问病史，评估慢性疾病，检查外生殖器，有无包茎。影像学检查包括腹部，盆腔CT，评估有无肾结石，积水，梗阻及其他异常。
如果你来泌尿外科就诊，你需要做一个膀胱镜，来排除尿道狭窄，前列腺增生，及膀胱壁改变，一旦感染病因发现，就可以积极针对病因治疗（如药物，手术）。
By Dr. Jamin Brahmbhatt
CNN —
While urinary tract infections are more common in women, men can still get what’s commonly known as a UTI. Here are 10 things I’d like you to know about urinary tract infections, including who’s more at risk and how to get treatment.
UTI is short for urinary tract infection. It’s an infection of the organs in your body – I call them pipes – that are meant to funnel your urine out of your system and into the urinal. Most UTIs are caused by bacteria that work their way into the urethra, prostate, bladder or kidneys.
Way more women than men are diagnosed with UTIs. Anatomically, we feel this happens because women have a shorter urethra – the tube that connects the bladder to the outside world. The shorter length makes it easier for bacteria to travel to the urinary system. Men have longer urethras and therefore can be protected against urinary infections.
But the length of the urethra alone cannot protect men against UTIs – over their lifetimes, 12% of men will get urinary symptoms linked to a UTI. This by no means implies a urethra or penis are short or small. In men, there is usually a more clear pathologic cause to the infection beyond just the length of the urethra.
There are many reasons why a guy may get a UTI – all of them we take seriously and should not be ignored.
Men older than 50 tend to get more infections than younger men. As a urologist, I see men get recurrent infections when they do not properly empty their bladder because of an enlarged prostate. Beyond the prostate, men may not empty their bladder if they have nerve damage from stroke, uncontrolled diabetes or injury to the spine.
Men can also get infections that start from the prostate or testicles that seed up into the bladder, or the opposite can happen where the infection goes from the bladder to the other organs. Kidney stones can also be a cause of infection. (I know this from personal experience – I’ve had a kidney stone myself!)
Younger men may also present with urinary infections because of sexually transmitted diseases. Men can also get an infection if they have a recent procedure done in the
Burning with urination (dysuria), increased urinary frequency, urgency, incontinence, foul smell, blood in the urine, fevers, chills, pain in the abdomen near the bladder. Believe it or not, some men may have zero symptoms and still get diagnosed with a UTI based on urine cultures done for other purposes.
UTI is diagnosed by sending your urine off for a culture. This is when a sample of your urine is processed and evaluated for various strains of bacteria. The most common bacteria identified in urinary tract infections is E.coli. Once the culture is done, the results can guide treatment, which is usually oral antibiotics. There is a test called a urine analysis which can be done quickly in our office which can suggest an infection. However, the best test is an actual culture.
Doctors do not wait for the culture results – which can take one to three days – to start treatment. If an infection is suspected, an antibiotic will be started immediately and then adjusted based on the culture results.
UTIs generally are treated with oral or IV antibiotics. Most infections can be treated with oral antibiotics. However there are superbugs that may be resistant to what we can give you by mouth that may require the use of stronger antibiotics through an IV. Most treatments last seven to 10 days, but can be longer.
As a doctor, my answer is: No. Men should not try to treat infections on their own. If you have symptoms, get yourself to a doctor or emergency room.
The best prevention is making sure first there is nothing anatomical that needs to be corrected, such as an enlarged prostate, kidney stone or blockage.
Proper hygiene can help prevent infections. Men with uncircumcised penises should make sure they can retract the foreskin and clean under the foreskin and the glans properly. Cranberry supplements have been shown to help prevent infections. Staying hydrated by drinking enough fluids/water during the day can also help. Making sure you don’t hold your urine can help, too. Staying in good health to avoid chronic medical conditions such as diabetes and heart disease will also protect against infections.
Recurrent, untreated infections could cause strictures, or tight scars, in your urethra that would slow your stream and make it difficult to empty your bladder. Infections could also cause the bladder to lose its ability to fill and empty properly. In the long run, if you are getting constantly treated with antibiotics, we may run out of antibiotics to give you due to resistance.
The first priority is to clear the infection with antibiotics.
From there, we do a full workup with a detailed history, evaluation of chronic medical problems and exam of the genitals to look for anatomic issues such as a foreskin that won’t retract back. Imaging may include a CT scan of the abdomen and pelvis to look for kidney stones, blocked tubes and other abnormalities.
