title: Value of Provoked or Spontaneous Flank Pain in Men with Febrile Urinary Tract Infections.
abstract: BACKGROUND
  Our objective was to identify the clinical, laboratory and radiological characteristics of febrile urinary tract infections (UTI) in men and to focus on the value of flank pain in these men managed in an ambulatory care system.
  
  
  METHODS
  A network was designed to manage men with febrile UTI without hospitalization according to an algorithm designed with different specialists. The patients' characteristics were prospectively recorded and each patient was followed up until completely cured. We artificially divided patients into two groups. Group 1: men without flank pain diagnosed as prostatitis and a second group (Group 2) of men with flank pain or provoked flank pain more likely to have a pyelonephritis. Groups were compared to find arguments to differentiate prostatitis to pyelonephritis.
  
  
  RESULTS
  350 men were included in the study, half of these men reported urinary symptoms (dysuria, urgency and burning urination). The negative predictive values of the nitrite and leukocytes test were poor alone or in combination. The renal ultrasound was never informative. None of the patients failed to respond to the treatment. No difference was found between groups.
  
  
  CONCLUSIONS
  Laboratory test results and radiological features had a poor predictive value. Men with suspected pyelonephritis did not evolve differently from those with suspected prostatitis. Monitoring and treatment of men with febrile UTI does not seem to depend on the existence of a pyelonephritis suspected after the presence of a lumbar pain. Ambulatory management of febrile UTI is feasible and safe, requiring an efficient network for patient's surveillance.
authors.affiliation: Urology Department, University Hospital of Tours, Loire Valley 37044, France. f.bruyere@chu-tours.fr.|University Francois Rabelais de Tours, PRES Centre Val de Loire Université, Tours 37000, France. f.bruyere@chu-tours.fr.
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
authors.affiliation: General Practitioner, 15 rue Jean Baptiste Berlier, Paris 75013, France. joseph.ruimy@spherescare.fr.
authors.forename: Joseph-Alain
authors.initials: JA
authors.lastname: Ruimy
authors.affiliation: University Francois Rabelais de Tours, PRES Centre Val de Loire Université, Tours 37000, France. Louis.bernard@chu-tours.fr.|Infectious Disease Department, University Hospital of Tours, Loire Valley 37044, France. Louis.bernard@chu-tours.fr.
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.affiliation: General Practitioner, 15 rue Jean Baptiste Berlier, Paris 75013, France. raphael.elfassi@gmail.com.
authors.forename: Raphael
authors.initials: R
authors.lastname: Elfassi
authors.affiliation: General Practitioner, 15 rue Jean Baptiste Berlier, Paris 75013, France. olboy92@gmail.com.
authors.forename: Olivier
authors.initials: O
authors.lastname: Boyer
authors.affiliation: General Practitioner, 15 rue Jean Baptiste Berlier, Paris 75013, France. dr.fabrice.amann@ump.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Amann
authors.affiliation: Urology Department, Saint Louis Hospital, Paris 75010, France. paul.meria@sls-aphp.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Meria
keywords: ambulatory; clinical; general practitioner; network; prostatitis