Prostatitis Workup

  • Author: Paul J Turek, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jun 27, 2011
 

Approach Considerations

Urinalysis and urine culture can confirm the presence of infection and identify pathogens. Fractional urine studies (urethral and bladder urine) and cytology of expressed prostatic secretions can help differentiate prostatitis from urethritis and cystitis. Further studies may be indicated in patients with possible complications (eg, urinary tract obstruction). There is no criterion-standard diagnostic test for chronic abacterial prostatitis.[15]

Next

Urine Studies

On urinalysis, obtain quantitative values for the white blood count and bacterial count, presence of oval fat bodies, and lipid-laden macrophages. A urine culture can be used to identify the causative organism, if any. Escherichia coli is the pathogen most often identified on positive cultures (see the image below).

Urine culture with greater than 100,000 colony-forUrine culture with greater than 100,000 colony-forming units (CFU) of Escherichia coli, the most common pathogen in acute and chronic prostatitis. Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.

Fractional urine examination

The use of fractional urine specimens may be useful in the diagnosis of prostatitis. Although not practical in most emergency departments, this technique is used by urologists if the diagnosis of prostatitis remains unclear.

The initial 10 mL of voided urine represents urine from the urethra and is termed voided urine 1 (V1). Elevated bacterial counts in V1 suggest urethritis. The next 200 mL of voided urine is discarded, and a midstream urine sample (V2) is collected, which represents bladder urine. Bacterial counts elevated in the midstream sample suggest cystitis without prostatitis.

Next, the physician performs a prostatic massage and the expressed prostatic secretions (EPS) are collected from the urethral meatus (see the image below). Finally, the 10 mL of voided urine following prostatic massage (V3) are collected. The bacterial findings of the EPS and V3 samples represent the microbiologic characteristics of the prostate gland.

Bacterial prostatitis. Expressed prostatic fluid cBacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.

Chronic bacterial prostatitis can be diagnosed if the culture of the EPS and V3 samples produce the same bacteria as the first-voided specimen and the colony count of the 2 cultures is at least 10 times as great as the first-void specimen.

Previous
Next

Blood Studies

A complete blood count (CBC) with differential and blood cultures are indicated in cases of acutely toxic patients or suspected septicemia.

Obtain an electrolyte panel, including blood urea nitrogen (BUN) and creatinine values, in patients presenting with urinary retention or obstruction.

Prostate inflammation can lead to elevation of serum prostate-specific antigen (PSA). PSA is used primarily as a cancer screening tool and should not be routinely used for the diagnosis of prostatitis.[16]

Previous
Next

Ultrasonography and Computed Tomography

Transabdominal ultrasonography or a bladder scan is used to assess for volume of retained urine in cases of prostatitis associated with significant voiding dysfunction.[2]

On transrectal ultrasonography, characteristic features of prostatitis are capsular thickening and prostatic calculi. A hypoechoic halo in the periurethral region, a heterogeneous echo pattern, and enlargement and thickening of the septa of the seminal vesicles may be seen.[17]

Interpretation of transrectal ultrasound is highly subjective and therefore not very reliable for the diagnosis of prostatitis. This study is not routinely indicated in prostatitis patients, except when prostatic abscess is suspected.

Computed tomography (CT) studies of the pelvis may also be useful in the evaluation of prostatic abscess or suspected neoplasm. Cystoscopy is useful in refractory cases with significant voiding dysfunction symptoms to rule out neoplasm of the bladder or interstitial cystitis. Voiding cystourethrography (VCUG) or retrograde urethrography (RUG) may be appropriate for evaluation of the bladder neck anatomy and penile and anterior urethra in cases of suspected bladder neck dyssynergia or urethral stricture.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Paul J Turek, MD  Director, The Turek Clinic; Former Professor in Residence, Academy of Medical Educators Endowed Chair, Department of Urology, Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine

Paul J Turek, MD is a member of the following medical societies: American Association of Clinical Urologists, American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Society for the Study of Male Reproduction

Disclosure: BioQuiddity, Inc Ownership interest Board membership; HealthLoop.com Ownership interest Board membership; MandalMed, Inc Intellectual property rights Management position

Coauthor(s)

Tarlan Hedayati, MD  Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Christine R Stehman, MD  Resident Physician, Department of Emergency Medicine, John H Stroger Hospital of Cook County

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

  1. Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236-7. [Medline].

  2. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009;69(1):71-84. [Medline].

  3. Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006;57:195-206. [Medline].

  4. Mastroianni A, Coronado O, Manfredi R, Chiodo F, Scarani P. Acute cytomegalovirus prostatitis in AIDS. Genitourin Med. Dec 1996;72(6):447-8. [Medline].

  5. Gebo KA. Prostatic tuberculosis in an HIV infected male. Sex Transm Infect. Apr 2002;78(2):147-8. [Medline].

  6. Feneley M, Kirby RS, Parkinson C. Clinico-pathological findings simulating prostatic malignancy following sclerotherapy: a diagnostic pitfall. Br J Urol. Jan 1996;77(1):157-8. [Medline].

  7. 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].

  8. Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. Mar 2001;165(3):842-5. [Medline].

  9. Schaeffer AJ. Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med. Oct 19 2006;355(16):1690-8. [Medline].

  10. Awadh B, Watson K, Abdou NI. Wegener prostatitis presenting with acute urinary retention. J Clin Rheumatol. Feb 2006;12(1):50-1. [Medline].

  11. Huong DL, Papo T, Piette JC, Wechsler B, Bletry O, Richard F, et al. Urogenital manifestations of Wegener granulomatosis. Medicine (Baltimore). May 1995;74(3):152-61. [Medline].

  12. Middleton G, Karp D, Lee E, Cush J. Wegener's granulomatosis presenting as lower back pain with prostatitis and ureteral obstruction. J Rheumatol. Mar 1994;21(3):566-9. [Medline].

  13. Donovan DA, Nicholas PK. Prostatitis: diagnosis and treatment in primary care. Nurse Pract. Apr 1997;22(4):144-6, 149-56. [Medline].

  14. [Guideline] Grabe M, Bishop MC, Bjerklund-Johansen TE, et al. Prostatitis and chronic pelvic pain syndrome. Guidelines on the management of urinary and male genital tract infections. Arnhem, The Netherlands: European Association of Urology (EAU). Mar 2008;79-88. [Full Text].

  15. McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med. Sep 5 2000;133(5):367-81. [Medline]. [Full Text].

  16. Loeb S, Gashti SN, Catalona WJ. Exclusion of inflammation in the differential diagnosis of an elevated prostate-specific antigen (PSA). Urol Oncol. Jan-Feb 2009;27(1):64-6. [Medline].

  17. de la Rosette JJ, Giesen RJ, Huynen AL, Aarnink RG, van Iersel MP, Debruyne FM, et al. Automated analysis and interpretation of transrectal ultrasonography images in patients with prostatitis. Eur Urol. 1995;27(1):47-53. [Medline].

  18. [Guideline] Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, et al. General treatment of chronic pelvic pain. Guidelines on chronic pelvic pain. Arnhem, The Netherlands: European Association of Urology (EAU). Mar 2008;84-97. [Full Text].

  19. Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  20. [Guideline] Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. Dec 17 2010;59:1-110. [Medline]. [Full Text].

  21. Le BV, Schaeffer AJ. Genitourinary pain syndromes, prostatitis, and lower urinary tract symptoms. Urol Clin North Am. Nov 2009;36(4):527-36, vii. [Medline].

  22. Nickel JC. alpha-Blockers for Treatment of the Prostatitis Syndromes. Rev Urol. 2005;7 Suppl 8:S18-25. [Medline]. [Full Text].

  23. Berghuis JP, Heiman JR, Rothman I, Berger RE. Psychological and physical factors involved in chronic idiopathic prostatitis. J Psychosom Res. Oct 1996;41(4):313-25. [Medline].

  24. Sindhwani P, Wilson CM. Prostatitis and serum prostate-specific antigen. Curr Urol Rep. Jul 2005;6(4):307-12. [Medline].

  25. Mehik A, Hellström P, Sarpola A, Lukkarinen O, Järvelin MR. Fears, sexual disturbances and personality features in men with prostatitis: a population-based cross-sectional study in Finland. BJU Int. Jul 2001;88(1):35-8. [Medline].

  26. Wise GJ, Shteynshlyuger A. How to diagnose and treat fungal infections in chronic prostatitis. Curr Urol Rep. 2006;7(4):320-8. [Medline].

 
Previous
Next
 
Bacterial prostatitis. Expressed prostatic fluid contains more than 10 white blood cells per high-power field, indicating prostatitis.
A nonspecific mixed inflammatory infiltrate that consists of lymphocytes, plasma cells, and histiocytes is typical in chronic bacterial prostatitis.
Urine culture with greater than 100,000 colony-forming units (CFU) of Escherichia coli, the most common pathogen in acute and chronic prostatitis. Chronic bacterial prostatitis must be confirmed and diagnosed using a urine culture.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.