<b><i>Background:</i></b> Increasing life expectancy and demographic change result in a rising number of geriatric patients, but knowledge about geriatric treatment options and adapted diagnostic pathways is low. Simultaneously, urinary tract infections (UTIs) are common in older people and often difficult to treat. <b><i>Methods:</i></b> Patients with a UTI at a urological outpatient department between January 01, 2016, and December 31, 2017, were retrospectively identified in the data system. One thousand one hundred fifteen patients with “N30” and “N39” diagnosis were included in this study, 965 of which were under the age of 75 (group 1) and 150 of which 75 years or older (group 2). <b><i>Results:</i></b> Of 150 patients in group 2, 41.6% had nitrite-positive urine (vs. 20.9% in group 1, <i>p</i> &#x3c; 0.05 in χ² testing). Patients in group 2 often had indwelling devices (30.3 vs. 6.0%, <i>p</i> &#x3c; 0.05) and presented a sterile urine culture in only 20.7% (vs. 40.1% in group 1). Regarding calculated antibiotic therapy, there were significant differences concerning prescription of ciprofloxacin (34.9 vs. 25%, <i>p</i> &#x3c; 0.05) and fosfomycin (12.7 vs. 40.7%, <i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> UTI in geriatric patients should be treated differently than in younger patients because antibiotic resistance is high. The group with indwelling devices is complex. Individual strategies for geriatric patients should be considered.