Journal of Advances in Microbiology

Urinary tract infection in adult men has long been treated as a minor variant of a predominantly female disease, and the microbiological literature reflects that assumption. Most large aetiological surveys pool the sexes, report proportions dominated by female specimens, and offer little that clarifies which organisms genuinely cause disease in the male urinary tract and which merely occupy it. This critical narrative review examines the evidence for species-level attribution of bacterial uropathogens in men, covering relative frequency, pathogenic mechanism, syndrome specificity, resistance behaviour and the diagnostic assumptions that determine what is counted as a pathogen. Literature was identified through open scholarly web searching, retrieval of indexed biomedical records, bibliographic verification through a metadata registry, citation tracking from recent reviews, and consultation of professional guidance, with a search period extending to 1 June 2026. Evidence was appraised for design adequacy, representativeness, sex-stratification and the transparency of case definitions rather than scored with a formal instrument. Escherichia coli remains the leading isolate in men, but its reported share varies far more widely than in women, and the residual fraction is occupied by organisms whose pathogenic status is genuinely contested. Enterococcus faecalis is recovered from male urine at frequencies that culture-based attribution cannot easily distinguish from colonisation. Urease-producing and device-associated species dominate the catheterised male tract through mechanisms that are mechanistically well characterised but clinically difficult to separate from asymptomatic carriage. Fastidious Gram-positive organisms are recovered disproportionately from older men, and their apparent rarity partly reflects laboratory method. Prostatic involvement introduces a compartment with no analogue in women, altering persistence, recurrence and antibiotic selection. Confidence is highest for mechanistic descriptions of individual species and lowest for the sex-specific epidemiological claims that clinical guidance depends upon. Progress requires male-stratified, syndrome-anchored studies that pair standardised sampling with methods capable of detecting organisms that routine culture systematically discards.