eMedicine Specialties > Urology > Infections and Related Inflammatory Conditions

Acute Bacterial Prostatitis and Prostatic Abscess: Workup

Author: Jonathan J Rhee, MD, Staff Physician, Department of Urology, University of Virginia
Coauthor(s): Michael Piesman, MD, Staff Physician, Department of Internal Medicine, Madigan Army Medical Center; Raymond A Costabile, MD, Jay Y Gillenwater Professor of Urology, University of Virginia Health System
Contributor Information and Disclosures

Updated: Dec 21, 2009

Workup

Laboratory Studies

  • In patients with acute bacterial prostatitis (ABP), prostatic secretions contain large numbers of leukocytes and fat-laden macrophages.
  • Urinalysis, which shows leukocytes, and a positive result on urine culture are essential for diagnosis. The urine specimen should include midstream premassage and postmassage of the prostate. This test is known as the 2-glass test.9 If the patient is febrile or exhibits signs of acute bacterial prostatitis, only the midstream urine is collected for urine culture. The prostatic massage is contraindicated.
  • Urethral swab culture and postmassage urine culture and microscopic examination may be an alternative standard protocol to simplify the evaluation of prostatitislike syndrome in the clinical practice.10 The evaluation for chronic prostatitis may include first voided urine, midstream urine, urine after prostatic massage, and expressed prostatic secretions to localize the nidus of infection, as described by Meares and Stamey.11
  • Occasionally, blood culture results are positive.
  • Serum prostate-specific antigen (PSA) levels are also increased but should not be used as a screening test for prostatitis. In the setting of acute bacterial prostatitis, PSA has little to no clinical value. If the PSA level is obtained and is found to be elevated, the study should be repeated 30-60 days after adequate treatment. Recent studies showed that a 2- to 4-week treatment with antibiotics decreased the PSA levels in approximately half of patients with PSA levels in the gray zone who did not have prostatitis symptoms.12
  • Urodynamics: Because prostatitis may cause irritative and obstructive voiding symptoms that mimic other primary causes of those symptoms, the use of urodynamics helps to avoid misdiagnosis of prostatitis.

Imaging Studies

Imaging studies, including CT scanning of the pelvis or transrectal ultrasonography, should be reserved for cases in which laboratory analysis findings are equivocal or when no improvement is observed following medical therapy. Ruling out complications of prostatitis (eg, prostatic abscess) is a strong indication to proceed to imaging studies. Transrectal ultrasonography and CT scanning of the pelvis can be very useful in diagnosing and draining prostatic abscesses.13 However, transrectal ultrasonography should be performed as gently as possible to prevent bacteremia.

Diagnostic Procedures

Prostate biopsy is contraindicated in cases of suspected acute bacterial prostatitis because of the potential complication of seeding the bacterial infection in adjacent organs. Biopsy in the face of acute bacterial prostatitis may result in gram-negative sepsis.

Histologic Findings

A stromal leukocytic infiltrate may be accompanied by increased prostatic secretion or leukocytic infiltration within gland spaces (see image below). When complicated by abscess formation, focal or larger areas of the prostate become necrotic.

Leukocytic infiltration of stroma and glandular l...

Leukocytic infiltration of stroma and glandular lumina during acute bacterial prostatitis (ABP).

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Leukocytic infiltration of stroma and glandular l...

Leukocytic infiltration of stroma and glandular lumina during acute bacterial prostatitis (ABP).


More on Acute Bacterial Prostatitis and Prostatic Abscess

Overview: Acute Bacterial Prostatitis and Prostatic Abscess
Workup: Acute Bacterial Prostatitis and Prostatic Abscess
Treatment: Acute Bacterial Prostatitis and Prostatic Abscess
Follow-up: Acute Bacterial Prostatitis and Prostatic Abscess
Multimedia: Acute Bacterial Prostatitis and Prostatic Abscess
References
Further Reading
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References

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  2. Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. Apr 1998;159(4):1224-8. [Medline].

  3. Nickel, JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. In: Wein, Kavoussi, Novick, Partin, Peters, eds. Campbell-Walsh Urology. Vol 1. 9th ed. 2005:Ch 9.

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  6. Lomberg H, Cedergren B, Leffler H, et al. Influence of blood group on the availability of receptors for attachment of uropathogenic Escherichia coli. Infect Immun. Mar 1986;51(3):919-26. [Medline].

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  10. Magri V, Cariani L, Bonamore R, et al. Microscopic and microbiological findings for evaluation of chronic prostatitis. Arch Ital Urol Androl. Jun 2005;77(2):135-8. [Medline].

  11. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. Mar 1968;5(5):492-518. [Medline].

  12. Terrone C, Poggio M, Bollito E, et al. [Asymptomatic prostatitis: a frequent cause of raising PSA]. Recenti Prog Med. Jul-Aug 2005;96(7-8):365-9. [Medline].

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Keywords

acute bacterial prostatitis, prostatic abscess, ABP, acute prostatitis, prostatitis, prostate disease, bladder outlet obstruction, benign prostatic hyperplasia, chronic bacterial prostatitis, nonbacterial prostatitis, abacterial prostatitis, prostatodynia, male urinary tract infection, Escherichia coli, Proteus mirabilis, Klebsiella species, Enterobacter species, Pseudomonas aeruginosa, Serratia species, acute infection of the prostate, recurrent urinary tract infection, chronic infection of the prostate, chronic abacterial prostatitis, chronic pelvic pain syndrome, inflammatory chronic pelvic pain syndrome, noninflammatory chronic pelvic pain syndrome, asymptomatic inflammatory prostatitis, intraprostatic urinary reflux

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Contributor Information and Disclosures

Author

Jonathan J Rhee, MD, Staff Physician, Department of Urology, University of Virginia
Jonathan J Rhee, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Piesman, MD, Staff Physician, Department of Internal Medicine, Madigan Army Medical Center
Michael Piesman, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Raymond A Costabile, MD, Jay Y Gillenwater Professor of Urology, University of Virginia Health System
Raymond A Costabile, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Andrology, American Urological Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Edmund S Sabanegh Jr, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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