Due to anatomical differences between the male and female urinary tract, particularly the urethra, their predisposition and risk factors to urinary tract infections (UTIs) are naturally expected to vary. It had long been established that women are particularly prone to UTIs but in no way are men exempted from getting infected. Understanding the pathologic mechanisms of these infections will help explain these variations.
As mentioned, women are more predisposed to UTI because of the anatomical location of their urethra which is situated at close proximity to the anus and vagina. This renders easier transfer, and subsequent entry, of bacteria into the urinary tract through the urethra, which may happen during sexual activity as the penetrating penis rub or massage this flora into the opening or during cleansing of genitalia when done inappropriately from back to front. On the other hand, the normal male urinary tract has natural defenses to infection including epithelial barrier and long urethra. For this reason, the cause of male UTI is often complicated and may usually involve anatomic abnormalities which require surgical intervention. The incidence also increases with age and is suggested to be secondary to prostatic hypertrophy (enlarged prostate) which occurs more frequently in older male.
The pathophysiology between male and female UTI involves similar route of bacterial inoculation from the gut, both having Escherichia coli as the most common offending pathogen. In female, these organisms usually cause ascending infection into the bladder via the urethra; this is the reason why cystitis, or inflammation of the bladder, is the most common form of UTI affecting women. This migration from the periurethral vaginal introitus into the urinary tract is often promoted by sexual intercourse and infection happens after sexual activity, especially after one’s first or with a new partner. Hence, the term honeymoon cystitis or honeymoonitis are becoming popular references to this infection. In male, instead of ascending bacterial infection, UTI may be caused by an infection in other portion of the genitourinary tract, typically the prostate. As mentioned, it is common with ascending age for the prostate to become enlarged, a condition termed as prostatic hypertrophy. This enlargement hinders the bladder from emptying completely. An incompletely emptied bladder provides an environment for faster bacterial proliferation, thus promoting the development of infection. Since this etiology usually occurs in older men, UTI in younger male should be highly considered as anatomical in origin.
Though varying in the mechanism as to how UTIs are caused, preventive measures which are modifiable through behavioral and lifestyle adjustment are considered to be similar in both male and female. These include the following:
- Have adequate fluid intake,
- If possible, completely empty bladder when voiding,
- Do not put off the urge to void,
- Practice proper hygiene, especially in women whose urethra are particularly prone to bacterial migration,
- Limit bladder irritants such as tobacco, alcohol and caffeine,
- Intake of cranberry juice which is suggested to be helpful in UTI prevention,
- Voiding before and after coitus and
- Not having multiple sexual partners.