Prostatitis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

There is no gold standard for the diagnosis and evaluation of patients presenting with prostatitis. The evaluation of a patient with acute and chronic bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively. The evaluation of chronic pelvic pain syndrome includes tests which can be broadly divided into mandatory, recommended and optional.

Diagnostic Study of Choice

Study of choice

• There is no gold standard for the diagnosis and evaluation of patients presenting with prostatitis. In acute prostatitis, palpation of the prostate reveals a tender and enlarged prostate.

In chronic prostatitis, palpation of the prostate reveals a tender and soft (boggy) prostate gland.

• The evaluation of a patient with acute and chronic bacterial prostatitis consists of history and physical examination and urine culture for lower urinary tract localization cultures, respectively.
• The evaluation of chronic pelvic pain syndrome includes tests which can be broadly divided into mandatory, recommended and optional.

Sequence of Diagnostic Studies in Acute Bacterial Prostatitis

A digital rectal exam (DRE) should be performed when:

• The patient presents with fever, local pelvic/perineal pain, irritative and obstructive voiding symptoms, and other generalized symptoms of an acute infection.
• The diagnosis of acute bacterial prostatitis is confirmed by microscopic analysis of a midstream urine specimen and confirmed by culturing uropathogenic bacteriuria in a urine specimen.
• Bladder scan may be done to further rule out urinary tract obstruction.
• Patients who don’t respond to appropriate therapy may require further imaging [transrectal ultrasound (TRUS), pelvic ultrasound or computed tomography (CT) scan] to rule out prostate abscess.

Sequence of Diagnostic Studies in Chronic Bacterial Prostatitis

A digital rectal exam (DRE) with prostatic massage should be performed when:

• The patient presents with history of recurrent urinary tract infections and/or previous response to antibiotics
• The diagnosis of chronic bacterial prostatitis is confirmefd by the traditional Meares–Stamey 4-glass test.
• Meares–Stamey 4-glass test consists of collecting urine samples prior to the prostate massage, an initial stream urine and a midstream urine alongwith an expressed prostatic secretion (EPS) plus a post-prostatic massage urine specimen for microscopy and culture.